Postgraduate Researchers in Science Medicine Conference 2005: Abstracts
Social deprivation: an important predictor of response to treatment in a clinical trial situation.
Mark Harrison, Karen Tricker, Linda Davies, Peter Dawes, David Scott, Diarmuid Mulherin, Martin Davis & Deborah Symmons
Patients may behave differently in clinical trials than in routine clinical practice. In interpreting and extrapolating results to clinical settings, it is useful to know which patient characteristics predict response to treatment. Rheumatoid arthritis (RA) patients with lower socio-economic status ( SES) have more severe disease, co-morbidity and higher mortality and consequently enter clinical trials with more severe disease. It is unknown whether SES influences treatment response in RA.
The British Rheumatoid Outcome Study Group (BROSG) randomised controlled trial of aggressive vs. symptomatic treatment of long-standing, stable RA recruited 466 patients in 5 centres. Patients were assigned a Townsend score of social deprivation. Outcome measures included Disease Activity Score (DAS28), and Health Assessment Questionnaire (HAQ). 3 year change was examined by Townsend quintile.
At baseline, patients from the most deprived areas had higher DAS28 and HAQ scores. Over 3 years, patients from the most deprived areas showed statistically greater improvement on the DAS28 (p=0.008). No significant difference in change between quintiles was seen for the HAQ.
Social deprivation is an important predictor of response in RA. Possible mechanisms include better treatment compliance, tighter control of RA, improvements in co-morbidity. Social deprivation should be recorded in clinical trials and longitudinal observational studies.
Mark Harrison, arc Epidemiology, Divion of Epidemiology and Health Sciences, Stopford Building, The University of Manchester M13 9PT
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