Abstract
The aim of this study was to estimate the contributions of ethnic group and socioeconomic status as social determinants related to disability and disease activity in Chilean Mapuche and non-Mapuche patients with rheumatoid arthritis (RA). Descriptive cross-sectional study with a stratified hospital-based sample of 189 patients in treatment with disease-modifying anti-rheumatic drugs. We assessed disability as categorical variable with the Health Assessment Questionnaire, disease activity with the Disease Activity Score instrument, and socioeconomic status with a standard questionnaire used by the Chilean government. Measures of association, stratified analyses and a multiple logistic regression model were used to analyze the data using the Stata 12.1 software package. Low socioeconomic status (annual income below US$ 7,200) is associated with disability (OR 3.87 CI 1.68–9.20) and Mapuche ethnic identity also contributes to disability (OR 2.48, CI 1.09–5.89). Relevant but not statistically significant in multivariable models were variables such as age, gender and place of residence. RA patients with a low socioeconomic status have almost three times the odds of having a moderate to high disability, independent of their ethnic group, gender or place of residence. Therefore, healthcare efforts should be aimed at promoting early diagnosis and prompt treatment among populations with high levels of poverty, which in the region of the Araucanía means primarily indigenous rural areas.
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References
Hootman J, Helmick C (2006) Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum 54:226–229
Cheng Y, Hootman J, Murphy L, Langmaid G, Helmeck C (2010) Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation in the United States 2007–2009. Mortal Morb Wkly Rep 59:1261–1265
Riedemann P, Maluje V (1993) Epidemiología de las Enfermedades Reumatológicas en Chile. Informe Proyecto Fondecyt N°1930390
Bolen J, Schieb L, Hootman J, Helmick C, Theis K, Murphy L, Langmai G (2010) Differences in the prevalence and impact of arthritis among racial-ethnic groups in the United States (2003–2006). Prev Chronic Dis 3:1–5
Carmona L (2002) Epidemiología de la artritis reumatoide. Rev Esp Reuma 29:86–89
Obregón A, Iraheta I, García H, Mejia B, García A (2012) Prevalence of musculoskeletal diseases in Guatemala, Central America The COPCORD study of two populations. J Clin Rheumatol Musculoskelet Dis 18:170–174
Sokka T, Kautiainen H, Pincus T, Verstappen SM, Aggarwal A, Alten R, Andersone D, Badsha H et al (2010) Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA. Arthritis Res Ther 12(2):R42
American College of Rheumatology Subcommittee of Rheumatoid Arthritis Guidelines (2002) Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum 46:328–346
Ministerio de Salud de Chile (2007) Guía Clínica Artritis Reumatoide 4:4–39
Ministerio de Salud (2011) Encuesta Nacional de Salud 2009–2010. http://web.minsal.cl/portal/url/item/bcb03d7bc28b64dfe040010165012d23.pdf. Acceded 30 Sept 2013
Ponce L, Larenas G, Riedeman P (2002) Alta prevalencia de osteoporosis en mujeres Mapuche postmenopáusicas asintomáticas. Rev Med Chil 130:1365–1372
Kaliski S, Bustos L, Artigas C, Alarcón C, Vega M, Cárdenas C (2001) Artritis reumatoide en población mapuche, una experiencia de 16 años en la IX región de Chile. Rev Med Chil 129(3):253–258
Citarella L, Conejeros A, Espinosa B, Jelves I, Oyarce A, Vidal A (2000) Medicinas y Culturas en La Araucanía. Sudamericana Chile
Muntaner C, Benach J (2005) Aprender a mirar la salud. Game Vial Venezuela
Alarcón A (2009) Estructura y significado de los Apellidos Mapuche en Chile. In: Amigo H (ed) Apellidos Mapuche historia y significado. Maigret, Chile, pp 51–124
ADIMARK (2009) Investigaciones de Mercado y Opinión Pública Mapa Socioeconómico de Chile. Nivel socioeconómico de los hogares chilenos
Esteve J, Batlle E, Reig A (1993) Spanish version of the Health Assessment Questionnaire (HAQ): reliability, validity and transcultural equivalency. J Rheumatol 20:2116–2122
Belmonte MA (2008) ¿Es la puntuación DAS28 el método más adecuado para estimar la actividad de la artritis reumatoide? Consideraciones clinimétricas y escenarios de simulación. Reumatol Clin 4:183–190
Marmot M (2012) Health equity: the challenge. Aust N Z J Public Health 36:513–514
Aliaga F, Serra J (2002) Salud del Adulto y Desarrollo Regional. Universidad de la Frontera, Chile
Abello B (2000) Epidemiología e impacto de la artritis reumatoide. Rev Colomb Reumatol 7:82–88
Calahan LF (1998) The burden of rheumatoid arthritis: facts and figures. J Rheumatol 25(53):8–12
Guzmán L, Donaire L (2012) Visión General de la Reumatología en Chile. Unidad de Reumatología, Departamento de Medicina Interna. Clínica Las Condes 23:365–368
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Funds for Science and Technology Research of the Chilean Government. Grant No. 1100021.
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Alarcón, A.M., Muñoz, S., Kaufman, J.S. et al. Contribution of ethnic group and socioeconomic status to degree of disability in rheumatoid arthritis in Chilean patients. Rheumatol Int 35, 685–689 (2015). https://doi.org/10.1007/s00296-014-3123-y
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DOI: https://doi.org/10.1007/s00296-014-3123-y