Kim Joseph, Zhang Song, Gao Ang, Xie Donglu, Kazi Salahuddin, Karp David R, Bartels Christie M, Solow E Blair
University of Texas Southwestern Medical Center, Dallas.
University of Wisconsin School of Medicine and Public Health, Madison.
ACR Open Rheumatol. 2025 Jan;7(1):e11754. doi: 10.1002/acr2.11754. Epub 2024 Oct 18.
The objective of this study was to analyze the impact of the Area Deprivation Index (ADI) on disease activity and cardiovascular comorbidity in rheumatoid arthritis (RA).
A retrospective analysis of adult patients with RA was conducted to highlight differences in academic and safety net hospital clinics. Demographics, RA medication history, patient portal engagement, primary care presence, emergency or inpatient visits, RA disease activity and functional scores, Charlson Comorbidity Index (CCI), and cardiovascular disease (CVD) presence were captured. The ADI rank was assigned using nine-digit zip codes. Patients were stratified by the upper versus lower ADI decile group and matched by age, sex, race, ethnicity, insurance, and CCI using propensity score analysis.
Patients with RA from the academic practice (n = 542) and the safety net hospital (n = 496) were assessed. In the academic cohort, those with high ADI scores (>8, more deprivation) had higher RA disease activity scores (Routine Assessment of Patient Index Data 3 mean ± SD: high 13.83 ± 6.94 vs low 11.17 ± 7.37, P < 0.0001; Clinical Disease Activity Index mean ± SD: high 11.97 ± 11.74 vs low 9.40 ± 7.97, P < 0.05), more functional impairment (Multidimensional Health Assessment Questionnaire mean ± SD: high 2.99 ± 2.29 vs low 2.34 ± 2.23, P < 0.01), lower MyChart use (P < 0.001), and different smoking history (P < 0.01) compared to those with low ADI scores (<3, less deprivation). In the safety net cohort, there was a statistically significant difference only in smoking status (P < 0.05). CVD was not significantly different in either cohort.
The absence of differences in RA disease activity and functional impairment in patients suggests that the ADI may not be as effective at predicting RA disease activity specifically in a safety net health care context. Identifying the discrepancies between the two systems may elucidate areas of improvement for patient care.
本研究的目的是分析地区贫困指数（ADI）对类风湿关节炎（RA）疾病活动度和心血管合并症的影响。
对成年RA患者进行回顾性分析，以突出学术医院诊所和安全网医院诊所之间的差异。记录人口统计学资料、RA用药史、患者门户网站参与情况、初级保健情况、急诊或住院就诊情况、RA疾病活动度和功能评分、查尔森合并症指数（CCI）以及心血管疾病（CVD）情况。使用九位邮政编码确定ADI排名。采用倾向得分分析，根据ADI十分位数的高低将患者分层，并按年龄、性别、种族、民族、保险和CCI进行匹配。
对来自学术机构（n = 542）和安全网医院（n = 496）的RA患者进行了评估。在学术队列中，与ADI得分低（<3，贫困程度较低）的患者相比，ADI得分高（>8，贫困程度较高）的患者RA疾病活动度评分更高（患者指数数据3常规评估平均值±标准差：高13.83±6.94 vs低11.17±7.37，P < 0.0001；临床疾病活动指数平均值±标准差：高11.97±11.74 vs低9.40±7.97，P < 0.05），功能障碍更严重（多维健康评估问卷平均值±标准差：高2.99±2.29 vs低2.34±2.23，P < 0.01），MyChart使用频率更低（P < 0.001），吸烟史也不同（P < 0.01）。在安全网队列中，仅吸烟状况存在统计学显著差异（P < 0.05）。两个队列中的CVD无显著差异。
患者的RA疾病活动度和功能障碍无差异，这表明ADI在预测RA疾病活动度方面可能并不有效，尤其是在安全网医疗环境中。识别这两个系统之间的差异可能有助于阐明改善患者护理的领域。
