title: Disease severity in ankylosing spondylitis: variation by region and local area deprivation.
abstract: OBJECTIVE
  To investigate whether patient disease severity in ankylosing spondylitis (AS) varies among regions or by local area social deprivation.
  
  
  METHODS
  Eight hundred patients with AS from 8 specialist rheumatology centers across England were invited to participate in a cross-sectional survey. Sociodemographic and disease-related variables were collected [pain (numerical rating scale), disease activity (Bath AS Disease Activity Index), and physical function (Bath AS Functional Index)]. Deprivation was measured using the Index of Multiple Deprivation 2004.
  
  
  RESULTS
  Of the 800 patients invited, 468 responded (adjusted response rate 62.8%). Most were male (72.9%), with a mean age of 50.2 years (SD 12.1), and a mean diagnosed disease duration of 17 years (SD 11.4). Across all centers, those living in more deprived areas demonstrated significantly greater disease severity and poorer psychological health. After controlling for age, gender, disease duration, and region, greater deprivation was significantly associated with greater disease activity (OR 3.39; 95% CI 1.65, 6.98) and poorer function (OR 4.46; 95% CI 2.11, 9.44). There was a nonsignificant trend toward more pain (OR 1.98; 95% CI 0.97, 4.07). There was also a significant independent association between region and disease severity.
  
  
  CONCLUSIONS
  The need for healthcare is greatest for patients with AS who are living in more socially deprived areas. With the growing use of interventional therapies, these findings have important implications if health service resources are to be allocated equitably; particularly as deprived patients are known to access healthcare less frequently.
authors.affiliation: Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. e.healey@cphc.keele.ac.uk
authors.forename: Emma L
authors.initials: EL
authors.lastname: Healey
authors.forename: Kirstie L
authors.initials: KL
authors.lastname: Haywood
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Garratt
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Packham
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011584:Psychology; D011610:Psychosocial Deprivation; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013167:Spondylitis, Ankylosing / Q000453:epidemiology / Q000523:psychology / Q000628:therapy