Polina Putrik1, Sofia Ramiro2, Elisabeth Lie3, Andras P Keszei4, Tore K Kvien3, Désirée van der Heijde5, Robert Landewé6, Till Uhlig7, Annelies Boonen8. 1. Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Health Promotion and Education, Maastricht University, Maastricht polina.putrik@gmail.com. 2. Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. 3. Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. 4. Medical Informatics, Uniklinik RWTH Aachen University, Aachen, Germany. 5. Rheumatology, Leiden University Medical Center, Leiden, the Netherlands Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. 6. Amsterdam Rheumatology & Immunology Center, Amsterdam, Amsterdam Rheumatology, Atrium Medical Center, Heerlen, the Netherlands and. 7. Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Rheumatology, Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway. 8. Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University.
Abstract
OBJECTIVE: To explore whether age, gender or education influence the time until initiation of the first bDMARD in patients with RA. METHODS: Data from the Norwegian Register of DMARDs collected between 2000 and 2012 were used. Only DMARD-naïve patients with RA starting their first conventional synthetic DMARD were included in the analyses. The start of the first bDMARD was the main outcome of interest. Cox regression analyses were used to explore the impact of education, age and gender on the start of a first bDMARD, adjusting for confounders, either at baseline or varying over time (time-varying model). RESULTS: Of 1946 eligible patients [mean (s.d.) age: 55 (14) years, 68% females], 368 (19%) received a bDMARD during follow-up (mean 2.6 years). In the baseline prediction model, older age [Hazard Ratio (HR) 0.97, 95% CI: 0.96, 0.98], lower education [HR = 0.76 and 0.68 for low and intermediate education levels vs college/university education, respectively (P = 0.01)] and female gender [only in the period 2000-03, HR = 0.61 (95% CI: 0.41, 0.91)] were associated with a lower hazard ratio to start a bDMARD. The time-varying model provided overall consistent results, but the effect of education was only relevant for older patients (>57 years) and became more pronounced by the end of the decade. CONCLUSIONS: Less educated and older patients have disadvantages with regard to access to costly treatments, even in a country with highly developed welfare like Norway. Females had lower access in the beginning of the 2000s, but access had improved by the end of the decade.
OBJECTIVE: To explore whether age, gender or education influence the time until initiation of the first bDMARD in patients with RA. METHODS: Data from the Norwegian Register of DMARDs collected between 2000 and 2012 were used. Only DMARD-naïve patients with RA starting their first conventional synthetic DMARD were included in the analyses. The start of the first bDMARD was the main outcome of interest. Cox regression analyses were used to explore the impact of education, age and gender on the start of a first bDMARD, adjusting for confounders, either at baseline or varying over time (time-varying model). RESULTS: Of 1946 eligible patients [mean (s.d.) age: 55 (14) years, 68% females], 368 (19%) received a bDMARD during follow-up (mean 2.6 years). In the baseline prediction model, older age [Hazard Ratio (HR) 0.97, 95% CI: 0.96, 0.98], lower education [HR = 0.76 and 0.68 for low and intermediate education levels vs college/university education, respectively (P = 0.01)] and female gender [only in the period 2000-03, HR = 0.61 (95% CI: 0.41, 0.91)] were associated with a lower hazard ratio to start a bDMARD. The time-varying model provided overall consistent results, but the effect of education was only relevant for older patients (>57 years) and became more pronounced by the end of the decade. CONCLUSIONS: Less educated and older patients have disadvantages with regard to access to costly treatments, even in a country with highly developed welfare like Norway. Females had lower access in the beginning of the 2000s, but access had improved by the end of the decade.
Authors: Peter C Taylor; Rieke Alten; Juan J Gomez-Reino; Roberto Caporali; Philippe Bertin; Emma Sullivan; Robert Wood; James Piercy; Radu Vasilescu; Dean Spurden; Jose Alvir; Miriam Tarallo Journal: RMD Open Date: 2018-03-17
Authors: John Waller; Emma Sullivan; James Piercy; Christopher M Black; Sumesh Kachroo Journal: Patient Prefer Adherence Date: 2017-03-13 Impact factor: 2.711
Authors: Mark Tatangelo; George Tomlinson; J Michael Paterson; Vandana Ahluwalia; Alex Kopp; Tara Gomes; Nick Bansback; Claire Bombardier Journal: JAMA Netw Open Date: 2019-12-02