Is the relationship between deprivation and outcomes in rheumatoid arthritis mediated by body mass index? A longitudinal cohort study
Author:
Witkam Rozemarijn1ORCID, Gwinnutt James M1ORCID, Humphreys Jennifer12ORCID, Verstappen Suzanne M M12, Adebajo Ade, Ahmed Khalid, Al-Ansari Atheer, Amarasena Roshan, Bukhari Marwan, Callan Margaret, Chelliah Easwaradhas G, Chinoy Hector, Cooper Annie, Dasgupta Bhaskar, Davis Martin, Galloway James, Gough Andrew, Green Michael, Gullick Nicola, Hamilton Jennifer, Hassan Waji, Hider Samantha, Hyrich Kimme, Kamath Sanjeet, Knight Susan, Lane Suzanne, Lee Martin, Levy Sarah, Macphie Lizzy, Marguerie Christopher, Marshall Tarnya, Mathews Catherine, McKenna Frank, Naz Sophia, Perry Mark, Pollard Louise, Quilty Brian, Robertson Lindsay, Roy Dipak, Sanders Paul, Saravanan Vadivelu, Scott David, Smith Gillian, Smith Richard, Symmons Deborah, Teh Lee-Suan, Viner Nick,
Affiliation:
1. Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester , Manchester, UK 2. NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester, UK
Abstract
Abstract
Objectives
To understand the relationships between deprivation and obesity with self-reported disability and disease activity in people with RA, and to determine whether BMI mediates the relationship between area-level deprivation and these outcomes.
Methods
Data came from the Rheumatoid Arthritis Medication Study (RAMS), a 1-year multicentre prospective observational cohort of people with RA recruited from rheumatology centres across England commencing MTX for the first time. A total of 1529 and 1626 people were included who had a baseline and at least one follow-up measurement at 6 or 12 months of HAQ—Disability Index (HAQ-DI) and DAS in 28 joints (DAS28), respectively. Linear mixed models estimated the associations of deprivation and obesity with repeated measures HAQ-DI and DAS28. Causal mediation analyses estimated the mediating effect of BMI on the relationship between deprivation and RA outcomes.
Results
Higher deprivation and obesity were associated with higher disability [adjusted regression coefficients highest vs lowest deprivation fifths 0.32 (95% CI 0.19, 0.45); obesity vs no obesity 0.13 (95% CI 0.06, 0.20)] and higher disease activity [adjusted regression coefficients highest vs lowest deprivation fifths 0.34 (95% CI 0.11, 0.58); obesity vs no obesity 0.17 (95% CI 0.04, 0.31)]. BMI mediated part of the association between higher deprivation and self-reported disability (14.24%) and DAS (17.26%).
Conclusions
People with RA living in deprived areas have a higher burden of disease, which is partly mediated through obesity. Weight-loss strategies in RA could be better targeted towards those living in deprived areas.
Funder
Economic and Social Research Council
Publisher
Oxford University Press (OUP)
Subject
Pharmacology (medical),Rheumatology
Cited by
4 articles.
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