Socioeconomic status in Behçet's syndrome

To compare socioeconomic status (SES) of patients with Behçet's syndrome (BS) with other chronic inflammatory diseases and healthy controls (HC), and to identify associated clinical factors.

The InCharge Financial Distress/Financial Well-being (IFDFW) and Socioeconomic Status Composite (SES-C) scales were translated, validated in Turkish, and administered face-to-face to 506 BS, 144 ankylosing spondylitis (AS), 113 psoriatic arthritis (PsA), 140 inflammatory bowel disease (IBD), and 94 multiple sclerosis (MS) patients, and 402 HC. SES-C served as the primary outcome measure. Ordinal logistic regression identified independent SES predictors across all participants and within the BS subgroup.

Both instruments demonstrated excellent psychometric properties in Turkish (ICC=0.979 for IFDFW; ICC=0.962 for SES-C). BS patients had the lowest mean SES-C score (17.76±2.98); 33.9% were classified in the very low or low SES categories, exceeding IBD (25.7%), PsA (20.4%), AS (16.0%), HC (15.7%), and MS (11.7%). In multivariate analysis, BS (OR 2.135, p<0.001) and IBD (OR 1.709, p=0.015) were independently associated with lower SES, whereas MS was associated with higher SES [OR 0.516, p=0.009]. Within the BS subgroup, employment status (OR 4.480, p<0.001) and BDCAF score (OR 1.154, p=0.022) were independent predictors of lower SES. Lower SES persisted in BS patients without major organ involvement.

BS patients had the lowest SES among all groups. The opposing SES associations of BS and MS within the same healthcare setting support disease-specific environmental contributions to pathogenesis. The independent association of disease activity with lower SES in BS suggests a bidirectional relationship, in which low SES may amplify disease through environmental exposures while active disease drives socioeconomic decline through work disability.