Association between socioeconomic status and patient delay in rheumatoid arthritis: linking self-reported and national registry data.

Abstract

Early treatment is critical for improving outcomes in rheumatoid arthritis (RA), with patient-initiated delays being a key barrier. Socioeconomic status (SES) influences health behaviour, but its role in the timing of first general practitioner (GP) contact after RA symptom onset remains unclear. This study examined the association between SES and time to help-seeking in people newly diagnosed with RA. Data on incident RA were collected from the Danish Rheumatology Database. Patients' self-reported time from symptom onset to first GP contact was collected via questionnaire data. Responses were linked to national registries for SES information, including education, wealth, cohabitation status, and occupation. Median delays and IQRs were calculated overall, and by SES strata. Multiple logistic regression provided adjusted odds ratios (aOR) and 95% CIs. Selection bias was investigated by comparing the SES between responders and nonresponders. Median patient delay was 59 days (IQR 15-182). Medium education level was associated with longer delay compared to high level (aOR 1.96 [CI: 1.01-3.79]); low occupational status showed a tendency towards longer delay (aOR 1.58 [CI: 0.47-5.33]). No consistent associations were found for wealth or cohabitation. Delays were longer among younger patients, those without comorbidities, and those with lower disease activity. Significantly lower SES was seen among nonresponders. Educational level showed the strongest socioeconomic association with patient delay. The nonresponse analysis highlighted a possible overrepresentation of socially vulnerable patients among nonresponders, reinforcing the need to address equity in early RA care pathways.