Association of Socioeconomic Status and Health Lifestyles with Incident Early-onset and Late-onset Rheumatoid Arthritis: A Prospective Cohort Study in the UK
Chenye Jin, Siying Liu, Bingxin You, Zhifeng Wen, Yongze LiAbstract
Introduction:
Socioeconomic status (SES) and lifestyle behaviors are recognized determinants of chronic disease risk, but their relative contributions to early-onset and late-onset rheumatoid arthritis (RA) remain uncertain.
Methods:
This cohort study comprised 35,360 participants from the UK Biobank. SES was derived from education, income, and employment using latent class analysis, and lifestyle was assessed through a four-component score (smoking, alcohol, physical activity, and diet). Incident RA was identified through hospital and mortality records. Cox models estimated hazard ratios (HRs) for early-onset (<65 years) and late-onset (≥65 years) RA, with subgroup and sensitivity analyses performed to test robustness.
Results:
During follow-up, 997 incident RA cases were identified (318 early-onset, 679 late-onset). Lower SES was strongly associated with a higher risk of RA in both groups, with a greater relative effect in early-onset disease (low vs. high SES, HR: 2.31, 95% confidence interval [CI]: 1.66–3.22) than in late-onset disease (HR: 1.99, 95% CI: 1.63–2.43). A healthy lifestyle was associated with reduced RA risk, particularly in late-onset RA (HR: 0.62, 95% CI: 0.50–0.75 for lifestyle score 3–4 vs. 0–1), while the effect was more modest in early-onset RA (HR: 0.74, 95% CI: 0.55–0.98). Joint analyses showed the highest risks among individuals with both low SES and poor lifestyle, with HRs of 3.42 (95% CI: 1.93–6.07) for early-onset and 3.24 (95% CI: 2.29–4.60) for late-onset RA.
Conclusion:
Socioeconomic disadvantage is a predominant driver of early-onset RA, whereas lifestyle factors are more influential for late-onset disease. Healthy lifestyles can attenuate but not fully offset the risk associated with low SES.