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Background <p>Social determinants of health (SDH), including housing instability, income, and education, play a vital role in shaping health outcomes in rheumatoid arthritis (RA). Nonetheless, there is a paucity of research examining these relationships within Iraqi populations. Objectives: The study aimed to examine the relationships between social determinants of health (SDH) factors specifically housing insecurity, social support, income, and education, and clinical outcomes, including disease activity, medication adherence, and patient satisfaction, in RA patients.</p> Methods <p>A cross-sectional study involved a convenient sample of RA patients from the Rheumatology Clinics at Baghdad Teaching Hospital in Medical City, Baghdad, Iraq with data collection from April 2025 to June 2025. The study evaluated SDH through validated questionnaires which include Housing Stability Assessment questionnaire and Social Support Networks Assessment questionnaire, in addition to patient education and income. Disease activity was assessed utilizing Disease Activity Score-28 (DAS28) and erythrocyte sedimentation rate (ESR). Medication adherence was assessed by asking patients to indicate the frequency of taking prescribed RA medications. Patient satisfaction was measured by having patients rate their overall satisfaction with their RA care. Statistical analyses evaluated the association between social determinants of health and clinical outcomes utilizing Pearson correlation, Spearman’s rank-order correlation and multivariate regression analysis.</p> Results <p>The study involved 203 patients, with a mean age of 51.6 years (± 14.8), of which 62.6% were female. The mean values for DAS28 and ESR were 3.8 (± 1.23) and 140 (± 56.2) ml/hr respectively. About half of the patients had low income (52.2%) with only 28.1% under or post graduates. A majority of patients demonstrated high medication adherence (62.1%), with 54.2% experiencing low housing insecurity and 11.3% facing high insecurity. Most patients had moderate and high social support status (60.6% and 29.5% respectively), meanwhile only 9.9% of patients had low social support status. Housing insecurity shows a weak correlation with elevated DAS28 scores (correlation coefficient = 0.149, <i>p</i> = 0.033). Lower income and education levels were associated with significantly decreased adherence (correlation coefficient = 0.221 and 0.157, <i>p</i> = 0.002 and 0.026, respectively), however, no social determinants of health significantly impacted satisfaction.</p> Conclusions <p>Socioeconomic barriers, specifically low income and education levels, may impede medication adherence, whereas housing insecurity may intensify disease activity in Iraqi RA patients. The findings underscore the necessity for targeted interventions that address SDH to enhance RA management.</p>

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Association between different social determinants of health and clinical outcome of rheumatoid arthritis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月16日

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  • Samer Imad Mohammed,
  • Fadia Thamir Ahmed,
  • Mohammed Yawuz Jamal,
  • Alyaa Hussein Hammadi

摘要

Background

Social determinants of health (SDH), including housing instability, income, and education, play a vital role in shaping health outcomes in rheumatoid arthritis (RA). Nonetheless, there is a paucity of research examining these relationships within Iraqi populations. Objectives: The study aimed to examine the relationships between social determinants of health (SDH) factors specifically housing insecurity, social support, income, and education, and clinical outcomes, including disease activity, medication adherence, and patient satisfaction, in RA patients.

Methods

A cross-sectional study involved a convenient sample of RA patients from the Rheumatology Clinics at Baghdad Teaching Hospital in Medical City, Baghdad, Iraq with data collection from April 2025 to June 2025. The study evaluated SDH through validated questionnaires which include Housing Stability Assessment questionnaire and Social Support Networks Assessment questionnaire, in addition to patient education and income. Disease activity was assessed utilizing Disease Activity Score-28 (DAS28) and erythrocyte sedimentation rate (ESR). Medication adherence was assessed by asking patients to indicate the frequency of taking prescribed RA medications. Patient satisfaction was measured by having patients rate their overall satisfaction with their RA care. Statistical analyses evaluated the association between social determinants of health and clinical outcomes utilizing Pearson correlation, Spearman’s rank-order correlation and multivariate regression analysis.

Results

The study involved 203 patients, with a mean age of 51.6 years (± 14.8), of which 62.6% were female. The mean values for DAS28 and ESR were 3.8 (± 1.23) and 140 (± 56.2) ml/hr respectively. About half of the patients had low income (52.2%) with only 28.1% under or post graduates. A majority of patients demonstrated high medication adherence (62.1%), with 54.2% experiencing low housing insecurity and 11.3% facing high insecurity. Most patients had moderate and high social support status (60.6% and 29.5% respectively), meanwhile only 9.9% of patients had low social support status. Housing insecurity shows a weak correlation with elevated DAS28 scores (correlation coefficient = 0.149, p = 0.033). Lower income and education levels were associated with significantly decreased adherence (correlation coefficient = 0.221 and 0.157, p = 0.002 and 0.026, respectively), however, no social determinants of health significantly impacted satisfaction.

Conclusions

Socioeconomic barriers, specifically low income and education levels, may impede medication adherence, whereas housing insecurity may intensify disease activity in Iraqi RA patients. The findings underscore the necessity for targeted interventions that address SDH to enhance RA management.