Relationship of education level to treatment received for rheumatoid arthritis

To determine whether treatment received for rheumatoid arthritis (RA) is systematically different among individuals with different levels of formal education.

Using 4,455 patient-years of observational data from the University of California, San Francisco (UCSF) RA panel, we estimated the relationship between patients' education level and treatment received for RA. We define RA treatment broadly in terms of both the use of specific medications and use of health services. Independent variables include spouse's education level, as well as demographic, clinical, and socioeconomic characteristics, which are potential cofounders of this relationship due to associations with education level or RA treatment.

Patients with RA with higher levels of formal education are more likely to be hospitalized or to undergo surgery for RA, even after differences in demographic, clinical, and socioeconomic characteristics are taken into account. In contrast, the use of specific medications was not systematically different among individuals with different education levels.

The association of education level with use of health services may partially explain the association of education with RA outcomes. Further studies are needed to test this hypothesis formally.