# Impact of socioeconomic deprivation on risk and disease activity of Sjögren’s disease

## TL;DR

Lower socioeconomic status is linked to a higher risk of Sjögren’s disease compared to similar conditions and is associated with higher immunoglobulin levels.

## Contribution

This study is the first to show a strong association between socioeconomic deprivation and Sjögren’s disease risk and disease activity.

## Key findings

- Sjögren’s disease patients had lower socioeconomic status compared to Sicca patients.
- Higher deprivation was linked to increased immunoglobulin G and A levels in Sjögren’s disease.
- Sicca patients were less deprived than the general population.

## Abstract

We aimed to assess the impact of socioeconomic status (SES) on risk of Sjögren’s disease (SjD) compared with non-Sjögren’s Sicca and population controls, and on the clinical features of SjD.

A single-centre UK cohort provided participants with SjD (European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) 2016, n=256) and non-Sjögren’s Sicca (anti-Sjögren’s syndrome type A (SSA)/Ro negative, n=175). Health Survey for England 2019 provided local population controls (n=972). English Indices of Multiple Deprivation (IMD) 2019 quintiles at recruitment and highest educational attainment defined SES.

Adjusted logistic regression models evaluated associations between SES and diagnosis. Linear models assessed the impact of IMD on disease variables. Population controls were matched with age, sex and ethnicity to compare SES distributions.

Across IMD and educational attainment, participants with SjD had lower SES status compared to Sicca (p=0.008 and p=0.018). Odds of SjD (vs Sicca) were highest in most deprived IMD quintile 1 and reduced by 74% in quintile 2 (OR 0.26 (0.12, 0.58), p<0.001).

Immunoglobulin G and A levels were inversely associated with IMD. In SjD, each unit increase in IMD reduced IgG by 6.03% (−9.84%, −2.05%; p=0.003) and IgA by 6.46% (−10.87%, −1.60%; p=0.010).

When compared with population controls, IMD was not a risk factor for SjD (p=0.257) whereas Sicca was associated with lower deprivation (p=0.003). Those with a degree level qualification had the highest odds of diagnosis (SjD or Sicca).

Low SES is associated with increased risk of SjD compared to Sicca and with higher immunoglobulin levels. The Sicca cohort may be less deprived than the general population. The role of environmental factors in modulating salivary gland pathology requires further exploration.