{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:17:35Z","timestamp":1787026655181,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    Use of biologics or targeted synthetic disease-modifying anti-rheumatic drugs (b\/tsDMARDs) is associated with infection in patients with rheumatoid arthritis (RA). Socioeconomic status is substantial in infectious diseases; however, the impact of socioeconomic status on risk for infection in patients with RA receiving b\/tsDMARD remains unclear.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We used the 2003\u20132017 Taiwanese National Health Insurance Research Database to identify patients with RA receiving b\/tsDMARDs. A Cox regression analysis was used to estimate the associations of covariates with the risk of hospitalised infection shown as hazard ratios (HRs) with 95% confidence interval (CIs).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    We identified 7,647 RA patients who started their first bDMARD\/tsDMARD treatment. Log-rank analyses demonstrated the association between age (\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001), urbanisation (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.001), the insured amount (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.021), and the hospitalisation. Cox proportional regression analyses showed that age was independently associated with hospitalised infection in a dose\u2013response manner, whereas a high-income category had an inverse association (HR 0.48, 95% CI 0.23\u20130.96). Hospitalisation for infection within 5 years was a strong risk factor (HR 5.63, 95% CI 1.91\u201316.62), and living in a rural area tended to be a risk factor (HR 1.76, 95% CI 0.98\u20133.14) for incident hospitalised infection.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    This study showed the crucial impacts of age, socioeconomic status, and history of infection on hospitalised infection in patients with RA receiving b\/tsDMARDs. These findings highlight the largely ignored role of socioeconomic status in risk stratification among patients receiving b\/tsDMARDs for RA.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2021.696167","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T02:24:13Z","timestamp":1626056653000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of Hospitalised Infection With Socioeconomic Status in Patients With Rheumatoid Arthritis Receiving Biologics or Tofacitinib: A Population-Based Cohort Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Hsin-Hua","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Heng","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Yu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Cheng","family":"Chao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1016\/S0140-6736(10)60826-4","article-title":"Rheumatoid arthritis","volume":"376","author":"Scott","year":"2010","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1136\/annrheumdis-2013-204627","article-title":"The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study","volume":"73","author":"Cross","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"98","DOI":"10.2174\/1871530317666171114122417","article-title":"A clinical update and global economic burden of rheumatoid arthritis","volume":"18","author":"Fazal","year":"2018","journal-title":"Endocr Metab Immune Disord Drug Targets"},{"key":"B4","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1136\/annrheumdis-2013-204311","article-title":"Evolution of cost structures in rheumatoid arthritis over the past decade","volume":"74","author":"Huscher","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"i17","DOI":"10.1093\/rheumatology\/key225","article-title":"Clinical efficacy of launched JAK inhibitors in rheumatoid arthritis","volume":"58","author":"Taylor","year":"2019","journal-title":"Rheumatology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1136\/annrheumdis-2017-212825","article-title":"Serious infection across biologic-treated patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis","volume":"77","author":"Rutherford","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13075-018-1539-6","article-title":"Effectiveness and safety of tofacitinib in rheumatoid arthritis: a cohort study","volume":"20","author":"Machado","year":"2018","journal-title":"Arthritis Res Ther"},{"key":"B8","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1186\/s13075-019-1992-x","article-title":"Comparative risk of malignancies and infections in patients with rheumatoid arthritis initiating abatacept versus other biologics: a multi-database real-world study","volume":"21","author":"Simon","year":"2019","journal-title":"Arthritis Res Ther"},{"key":"B9","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1002\/acr2.11064","article-title":"Risk of serious infection in patients with rheumatoid arthritis treated with biologic versus nonbiologic disease-modifying antirheumatic drugs","volume":"1","author":"Ozen","year":"2019","journal-title":"ACR Open Rheumatol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1759720X20929208","DOI":"10.1177\/1759720X20929208","article-title":"Factors associated with sepsis risk in immune-mediated inflammatory diseases receiving tumor necrosis factor inhibitors: a nationwide study","volume":"12","author":"Chao","year":"2020","journal-title":"Ther Adv Musculoskelet Dis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1136\/annrheumdis-2018-214326","article-title":"Risk of serious infections in patients with rheumatoid arthritis treated in routine care with abatacept, rituximab and tocilizumab in Denmark and Sweden","volume":"78","author":"Gron","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1016\/S0140-6736(11)61780-7","article-title":"Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study","volume":"379","author":"Baker","year":"2012","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1177\/0885066617703338","article-title":"Association of household income level and in-hospital mortality in patients with sepsis: a nationwide retrospective cohort analysis","volume":"33","author":"Rush","year":"2018","journal-title":"J Intensive Care Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2287","DOI":"10.1002\/art.10524","article-title":"Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study","volume":"46","author":"Doran","year":"2002","journal-title":"Arthritis Rheum"},{"key":"B15","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1377\/hlthaff.22.3.61","article-title":"Taiwan's new national health insurance program: genesis and experience so far","volume":"22","author":"Cheng","year":"2003","journal-title":"Health Affairs"},{"key":"B16","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13223-019-0365-y","article-title":"Shared prenatal impacts among childhood asthma, allergic rhinitis and atopic dermatitis: a population-based study","volume":"15","author":"Lin","year":"2019","journal-title":"Allergy Asthma Clin Immunol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1093\/cid\/cix1109","article-title":"Association of neighborhood socioeconomic status with risk of infection and sepsis","volume":"66","author":"Donnelly","year":"2018","journal-title":"Clin Infect Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1002\/acr.22542","article-title":"Association of socioeconomic status with treatment delays, disease activity, joint damage, and disability in rheumatoid arthritis","volume":"67","author":"Molina","year":"2015","journal-title":"Arthritis Care Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1136\/annrheumdis-2017-212395","article-title":"Patient characteristics influence the choice of biological drug in RA, and will make non-TNFi biologics appear more harmful than TNFi biologics","volume":"77","author":"Frisell","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2612","DOI":"10.1080\/21645515.2018.1522470","article-title":"Treatment of active rheumatoid arthritis: comparison of patients younger vs older than 75 years (CORPUS cohort)","volume":"14","author":"Oishi","year":"2018","journal-title":"Hum Vaccin Immunother"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1917053","DOI":"10.1001\/jamanetworkopen.2019.17053","article-title":"Association of patient, prescriber, and region with the initiation of first prescription of biologic disease-modifying antirheumatic drug among older patients with rheumatoid arthritis and identical health insurance coverage","volume":"2","author":"Tatangelo","year":"2019","journal-title":"JAMA Netw Open"},{"key":"B22","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1186\/s13075-015-0895-8","article-title":"Half of U.K. patients with rheumatoid arthritis are prescribed oral glucocorticoid therapy in primary care: a retrospective drug utilisation study","volume":"17","author":"Black","year":"2015","journal-title":"Arthritis Res Ther"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1093\/rheumatology\/kep291","article-title":"Response of elderly patients with rheumatoid arthritis to methotrexate or TNF inhibitors compared with younger patients","volume":"48","author":"Koller","year":"2009","journal-title":"Rheumatology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1002\/acr.21812","article-title":"Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis","volume":"65","author":"Widdifield","year":"2013","journal-title":"Arthritis Care Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1001\/jama.2015.1410","article-title":"Readmission diagnoses after hospitalisation for severe sepsis and other acute medical conditions","volume":"313","author":"Prescott","year":"2015","journal-title":"JAMA"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.1097\/CCM.0000000000001824","article-title":"Risk of recurrence after surviving severe sepsis: a matched cohort study","volume":"44","author":"Shen","year":"2016","journal-title":"Crit Care Med"},{"key":"B27","unstructured":"Health Promotion Administration, Ministry of Health and Welfare, Taiwan2018"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.696167\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T02:24:17Z","timestamp":1626056657000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.696167\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,12]]},"references-count":27,"alternative-id":["10.3389\/fmed.2021.696167"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.696167","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,12]]},"article-number":"696167"}}