{
  "abstract": "Objective Although socioeconomic status has been linked to various rheumatoid arthritis (RA)-related outcomes, evidence on the association of sustained income status with mortality among patients with RA remains limited.Methods We followed a nationally representative cohort of 50 600 Korean adults aged ≥40 years newly diagnosed with RA between 2010 and 2017 through 31 December 2020. Income status, based on monthly health insurance premiums, was tracked over the 5-year period preceding diagnosis. Primary exposure included the cumulative years in a low- or high-income status. The outcome was all-cause mortality. Cox proportional hazards models were used to estimate HRs after adjusting for sociodemographic, behavioural and clinical covariates. We conducted a comprehensive stratified analysis using a range of relevant factors.Results Sustained low-income status was significantly associated with increased mortality in a dose–response manner among patients aged <65 years, even after adjusting for income status at diagnosis (p for trend=0.011 vs 0.374 in older patients). Sustained high-income status was associated with reduced mortality in both age groups, with a stronger association observed in younger patients (adjusted HR (95% CI) for 5-year high-income exposure: 0.50 (0.38–0.64) in patients aged <65 years versus 0.74 (0.62–0.88) in patients ≥65 years). Rural residence further amplified the adverse effects of prolonged low-income exposure.Conclusions Persistent low-income status increases mortality risk among younger patients with RA, a group often overlooked by policy interventions. Policies that address the sustained economic disadvantages beyond short-term assistance are required.",
  "authors": [
    {
      "affiliations": [
        "Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea",
        "Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea"
      ],
      "name": "Hwa-Young Lee"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Internal Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea"
      ],
      "name": "Seonyoung Kang"
    },
    {
      "affiliations": [
        "Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea",
        "Department of Family Medicine and Supportive Care Centre, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea"
      ],
      "name": "Dong Wook Shin"
    },
    {
      "affiliations": [
        "Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea"
      ],
      "name": "Kyung-Do Han"
    }
  ],
  "title": "Sustained exposure to low- and high-income status and risk of all-cause mortality in individuals with rheumatoid arthritis: a population-based retrospective cohort study from 2010 to 2020",
  "uid": "ea6f51d5-ec23-585e-b6ae-ed47e3d876a6"
}