Uncovering the gap: individual and country level socio-economic inequities in rheumatic and musculoskeletal diseases

Polina Putrik

Research output: ThesisDoctoral ThesisInternal


The thesis presents the evidence on the magnitude and potential reasons of socio-economic inequities – at individual and country level - in disease outcomes in rheumatic and musculoskeletal diseases (RMDs). We have found that all RMDs occur more frequently, and are associated with worse health in persons who are socio-economically disadvantaged. On a country level, patients with rheumatoid arthritis (RA) residing in poorer countries had worse disease outcomes. After having explored the access to innovative biologic medication for patients with RA, we concluded that access differed substantially across European countries and disfavored the lower income countries. We were able to demonstrate that lower access to innovative drugs explains part of the relation between country’s low economic welfare and worse disease activity in RA. Last but not lease, even within wealthy countries, access to drugs is (s)lower in persons who are socio-economically deprived. We concluded that health inequities are deeply rooted in the societies and require coordinated actions on different levels.
Original languageEnglish
Awarding Institution
  • Maastricht University
  • Boonen, Annelies, Supervisor
  • Ramiro, Sofia, Co-Supervisor, External person
Award date7 Jul 2017
Publication statusPublished - 2017


  • socio-economic inequities
  • rheumatic and musculoskeletal diseases

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