Sociodemographic and economic barriers to initial specialist care for patients with rheumatoid arthritis: a scoping review

Abstract

Rheumatoid arthritis is an autoimmune disease that can cause joint destruction, pain, loss of function, and reduced quality of life. Recent advancements in treatment have made it possible to control the impacts of this once-debilitating disease through early intervention. While numerous studies have examined barriers to rheumatoid arthritis care, no review has synthesized sociodemographic and economic factors across high-, upper middle-, and lower middle-income countries. This gap in the literature highlights the need for a comprehensive review that informs global health interventions. This review explores sociodemographic and economic barriers to initial specialist care for patients with rheumatoid arthritis. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A search of CINAHL, MEDLINE, Scopus and Emcare was completed in May 2024. Of the 5165 studies identified through the literature search, 121 full-text articles were reviewed, and 25 studies examining sociodemographic and economic barriers to specialist care were selected for analysis. A total of 17 high-income, one upper middle-income and seven lower middle-income countries were represented. Low socioeconomic status, low income and rurality were consistently reported as barriers to initial rheumatologist appointments across all countries in this review. These findings underscore the importance of addressing common barriers such as low socioeconomic status and rurality in global health interventions. Future large prospective studies are essential to better understand the relationship between sociodemographic factors and timely access to care.