Body size changes and social determinants: Effects on rheumatoid arthritis, complications, and life expectancy in middle-aged and older adults

Yang Yang; Liangkai Chen; Jing Cheng; Guangming Zhang; Qianqian Song; Wei Chen; Yan Liu

doi:10.59717/j.xinn-med.2025.100134

The Innovation Medicine > 2025 Vol. 3 > No. 2 > 100134

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Body size changes and social determinants: Effects on rheumatoid arthritis, complications, and life expectancy in middle-aged and older adults

1.
School of Public Health, Imperial College London, London W12 0BZ, UK
2.
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
3.
Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
4.
Division of Oral Epidemiology & Dental Public Health, University of California San Francisco, San Francisco, CA 94143-1361, USA
5.
School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
6.
Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida 32611, USA
7.
Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
8.
Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

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Corresponding authors: shyneeliu@163.com (Y.L.); txchenwei@sina.com (W.C.)
Received Date: February 21, 2025

Accepted Date: May 07, 2025

Published Online: May 09, 2025

The Innovation Medicine 3(2), https://doi.org/10.59717/j.xinn-med.2025.100134 | Cite this article

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GRAPHICAL ABSTRACT

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PUBLIC SUMMARY

PUBLIC SUMMARY
1. Adverse body size changes, especially leading to adult obesity, increase rheumatoid arthritis (RA) risk.
  
  This increased RA risk was compounded by unfavorable social determinants of health (SDOHs).
  
  These interactive effects were consistently associated with an increased risk of post-RA complications.
  
  Individuals with unfavorable SDOHs had shorter life expectancies across all body size change groups.
  
  Public health strategies are needed to address adverse body size changes and socioeconomic disparities.

ABSTRACT

ABSTRACT

Little is known about the combined effects of body size changes and social determinants of health (SDOHs) on rheumatoid arthritis (RA). In this study, we assessed these effects on (1) the incidence and age at onset of RA; (2) complications after RA diagnosis; and (3) life expectancy in 302,239 middle-aged and older adults from the UK Biobank. Childhood body size data at age 10 were collected through a questionnaire. Adulthood body size was assessed using body mass index (BMI), the waist‒to‒hip ratio (WHR), and the waist‒to‒height ratio (WHtR). The SDOHs were constructed with 20 items, with each item dichotomized into advantaged and disadvantaged levels. Cox proportional hazard models and life tables were applied to calculate adjusted hazard ratios (HRs) and predict life expectancy. During a median follow-up period of 12.5 years, 3,649 participants developed RA. Adverse body size changes, particularly those leading to obesity in adulthood BMI or high WHR/WHtR in adulthood, were associated with an increased risk of RA. These risks were further amplified by unfavorable SDOHs, with hazard ratios ranging from 2.18–2.92. These interactive effects were consistently associated with an elevated risk of RA onset across age groups and post-RA complications. Notably, individuals with unfavorable SDOHs experienced the shortest life expectancies compared with those with favorable SDOHs across all body size change groups. In conclusion, adverse body size changes and unfavorable SDOHs are significantly associated with an increased risk of new-onset and age at onset of RA, post-RA complications, and reduced life expectancy.

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REFERENCES

[1]	Smolen J. S., Aletaha D., Barton A., et al. (2018). Rheumatoid arthritis. Nat. Rev. Dis. Primers 4:18001. DOI:10.1038/nrdp.2018.1 View in Article CrossRef Google Scholar Scopus
[2]	Zhang J., Fang X. Y., Wu J., et al. (2023). Association of combined exposure to ambient air pollutants, genetic risk, and incident rheumatoid arthritis: A prospective cohort study in the UK Biobank. Environ. Health Perspect. 131:37008. DOI:10.1289/ehp10710 View in Article CrossRef Google Scholar
[3]	GBD 2021 Rheumatoid Arthritis Collaborators (2023). Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 5:e594-e610. DOI:10.1016/s2665-9913(23)00211-4 View in Article Google Scholar
[4]	Finckh A., Gilbert B., Hodkinson B., et al. (2022). Global epidemiology of rheumatoid arthritis. Nat. Rev. Rheumatol. 18:591−602. DOI:10.1038/s41584-022-00827-y View in Article CrossRef Google Scholar Scopus
[5]	Tang B., Shi H., Alfredsson L., et al. (2021). Obesity-related traits and the development of rheumatoid arthritis: Evidence from genetic data. Arthritis Rheumatol. 73:203−211. DOI:10.1002/art.41517 View in Article CrossRef Google Scholar
[6]	Feng X., Xu X., Shi Y., et al. (2019). Body mass index and the risk of rheumatoid arthritis: An updated dose-response meta-analysis. BioMed. Res. Int. 2019:3579081. DOI:10.1155/2019/3579081 View in Article CrossRef Google Scholar
[7]	Qin B., Yang M., Fu H., et al. (2015). Body mass index and the risk of rheumatoid arthritis: A systematic review and dose-response meta-analysis. Arthritis Res. Ther. 17:86. DOI:10.1186/s13075-015-0601-x View in Article CrossRef Google Scholar Scopus
[8]	Xu F., Zhou H. and Chen W. (2025). Obesity epigenetic memory: A new mechanism for weight cycling. Innov. Med. 3:100113. DOI:10.59717/j.xinn-med.2025.100113 View in Article CrossRef Google Scholar Scopus
[9]	Ljung L. and Rantapää-Dahlqvist S. (2016). Abdominal obesity, gender and the risk of rheumatoid arthritis - a nested case-control study. Arthritis Res. Ther. 18:277. DOI:10.1186/s13075-016-1171-2 View in Article CrossRef Google Scholar Scopus
[10]	Carrasquilla G. D., Ängquist L., Sørensen T. I. A., et al. (2024). Child-to-adult body size change and risk of type 2 diabetes and cardiovascular disease. Diabetologia 67:864−873. DOI:10.1007/s00125-023-06058-4 View in Article CrossRef Google Scholar Scopus
[11]	Thomas P. E., Aarestrup J., Jacobsen S., et al. (2022). Birthweight, body size, and growth during childhood and risks of rheumatoid arthritis: A large Danish cohort study. Scand. J. Rheumatol. 51:461−469. DOI:10.1080/03009742.2021.1954772 View in Article CrossRef Google Scholar
[12]	World Health Organization (2024). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 View in Article Google Scholar
[13]	Chen Z., Yang J., Gao B., et al. (2025). Multi-scale social-economic-environmental inequities lead to heterogeneity of Developmental Coordination Disorder risk across China. Innov. Med. 3:100109. DOI:10.59717/j.xinn-med.2025.100109 View in Article CrossRef Google Scholar Scopus
[14]	Marmot M. (2005). Social determinants of health inequalities. Lancet 365:1099−1104. DOI:10.1016/s0140-6736(05)71146-6 View in Article CrossRef Google Scholar Scopus
[15]	US Department of Health and Human Services (2024). Healthy people 2030. Social Determinants of Health. https://health.gov/healthypeople/priority-areas/social-determinants-health View in Article Google Scholar
[16]	Margaretten M., Barton J., Julian L., et al. (2011). Socioeconomic determinants of disability and depression in patients with rheumatoid arthritis. Arthritis Care Res. 63:240−246. DOI:10.1002/acr.20345 View in Article CrossRef Google Scholar Scopus
[17]	Greenberg J. D., Spruill T. M., Shan Y., et al. (2013). Racial and ethnic disparities in disease activity in patients with rheumatoid arthritis. Am. J. Med. 126:1089−1098. DOI:10.1016/j.amjmed.2013.09.002 View in Article CrossRef Google Scholar Scopus
[18]	Webb J., Emmert R., Reddy A., et al. (2024). Social determinants of health in patients with arthritis: A cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System. J. Osteopath. Med. 124:69−75. DOI:10.1515/jom-2022-0162 View in Article CrossRef Google Scholar Scopus
[19]	Izadi Z., Li J., Evans M., et al. (2021). Socioeconomic disparities in functional status in a national sample of patients with rheumatoid arthritis. JAMA Netw. Open 4:e2119400. DOI:10.1001/jamanetworkopen.2021.19400 View in Article CrossRef Google Scholar
[20]	Wu D., Luo Y., Li T., et al. (2022). Systemic complications of rheumatoid arthritis: Focus on pathogenesis and treatment. Front. Immunol. 13:1051082. DOI:10.3389/fimmu.2022.1051082 View in Article CrossRef Google Scholar Scopus
[21]	Sudlow C., Gallacher J., Allen N., et al. (2015). UK biobank: An open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 12:e1001779. DOI:10.1371/journal.pmed.1001779 View in Article CrossRef Google Scholar
[22]	Richardson T. G., Sanderson E., Elsworth B., et al. (2020). Use of genetic variation to separate the effects of early and later life adiposity on disease risk: Mendelian randomisation study. BMJ 369:m1203. DOI:10.1136/bmj.m1203 View in Article CrossRef Google Scholar Scopus
[23]	Brandkvist M., Bjørngaard J. H., Ødegård R. A., et al. (2021). Separating the genetics of childhood and adult obesity: A validation study of genetic scores for body mass index in adolescence and adulthood in the HUNT Study. Hum. Mol. Genet. 29:3966−3973. DOI:10.1093/hmg/ddaa256 View in Article CrossRef Google Scholar Scopus
[24]	Collins R. (2007). UK biobank: Protocol for a large-scale prospective epidemiological resource. https://coilink.org/20.500.12592/b91h3n View in Article Google Scholar
[25]	Zeng M., Chen S., Fan T., et al. (2023). Associations of childhood-to-adulthood body size trajectories and genetic susceptibility with the risks of osteoarthritis: A population-based cohort study of UK Biobank data. Lancet Glob. Health 11 Suppl 1:S2. DOI:10.1016/s2214-109x(23)00087-6 View in Article Google Scholar
[26]	Bowman K., Atkins J. L., Delgado J., et al. (2017). Central adiposity and the overweight risk paradox in aging: Follow-up of 130,473 UK Biobank participants. Am. J. Clin. Nutr. 106:130−135. DOI:10.3945/ajcn.116.147157 View in Article CrossRef Google Scholar Scopus
[27]	Ashwell M. and Gibson S. (2016). Waist-to-height ratio as an indicator of 'early health risk': Simpler and more predictive than using a 'matrix' based on BMI and waist circumference. BMJ Open 6:e010159. DOI:10.1136/bmjopen-2015-010159 View in Article CrossRef Google Scholar
[28]	Zhong J., Zhang Y., Zhu K., et al. (2024). Associations of social determinants of health with life expectancy and future health risks among individuals with type 2 diabetes: Two nationwide cohort studies in the UK and USA. Lancet Healthy Longev. 5:e542−e551. DOI:10.1016/s2666-7568(24)00116-8 View in Article CrossRef Google Scholar
[29]	Bycroft C., Freeman C., Petkova D., et al. (2018). The UK Biobank resource with deep phenotyping and genomic data. Nature 562:203−209. DOI:10.1038/s41586-018-0579-z View in Article CrossRef Google Scholar Scopus
[30]	Said M. A., Verweij N. and van der Harst P. (2018). Associations of combined genetic and lifestyle risks with incident cardiovascular disease and diabetes in the UK Biobank study. JAMA Cardiol. 3:693−702. DOI:10.1001/jamacardio.2018.1717 View in Article CrossRef Google Scholar
[31]	Ma H., Xue Q., Wang X., et al. (2022). Adding salt to foods and hazard of premature mortality. Eur. Heart J. 43:2878−2888. DOI:10.1093/eurheartj/ehac208 View in Article CrossRef Google Scholar Scopus
[32]	Office for National Statistics (2021). Single-year life tables, UK: 1980 to 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/datasets/singleyearlifetablesuk1980to2018/singleyearlifetablesuk View in Article Google Scholar
[33]	Dugani S. B., Moorthy M. V., Li C., et al. (2021). Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident coronary heart disease in women. JAMA Cardiol. 6:437−447. DOI:10.1001/jamacardio.2020.7073 View in Article CrossRef Google Scholar
[34]	Bisquera A., Turner E. B., Ledwaba-Chapman L., et al. (2022). Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom. Lancet Reg. Health Eur. 12:100247. DOI:10.1016/j.lanepe.2021.100247 View in Article CrossRef Google Scholar Scopus
[35]	Wu Y., Zhang S., Qian S. E., et al. (2022). Ambient air pollution associated with incidence and dynamic progression of type 2 diabetes: A trajectory analysis of a population-based cohort. BMC Med. 20:375. DOI:10.1186/s12916-022-02573-0 View in Article CrossRef Google Scholar
[36]	Meira-Machado L., de Uña-Alvarez J., Cadarso-Suárez C., et al. (2009). Multi-state models for the analysis of time-to-event data. Stat. Methods Med. Res. 18:195−222. DOI:10.1177/0962280208092301 View in Article CrossRef Google Scholar Scopus
[37]	Wang X., Chen L., Cai M., et al. (2023). Air pollution associated with incidence and progression trajectory of chronic lung diseases: A population-based cohort study. Thorax 78:698−705. DOI:10.1136/thorax-2022-219489 View in Article CrossRef Google Scholar Scopus
[38]	Luo H., Zhang Q., Yu K., et al. (2022). Long-term exposure to ambient air pollution is a risk factor for trajectory of cardiometabolic multimorbidity: A prospective study in the UK Biobank. EBioMedicine 84:104282. DOI:10.1016/j.ebiom.2022.104282 View in Article CrossRef Google Scholar Scopus
[39]	Zhao S. S., Bowes J., Barton A., et al. (2022). Separating the effects of childhood and adult body size on inflammatory arthritis: A Mendelian randomisation study. RMD Open 8:e002321. DOI:10.1136/rmdopen-2022-002321 View in Article Google Scholar
[40]	Lam B. C., Koh G. C., Chen C., et al. (2015). Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as predictors of cardiovascular disease risk factors in an adult population in Singapore. PloS One 10:e0122985. DOI:10.1371/journal.pone.0122985 View in Article CrossRef Google Scholar Scopus
[41]	Sweatt K., Garvey W. T. and Martins C. (2024). Strengths and limitations of BMI in the diagnosis of obesity: What is the path forward. Curr. Obes. Rep. 13:584−595. DOI:10.1007/s13679-024-00580-1 View in Article CrossRef Google Scholar
[42]	Varra F. N., Varras M., Varra V. K., et al. (2024). Molecular and pathophysiological relationship between obesity and chronic inflammation in the manifestation of metabolic dysfunctions and their inflammation-mediating treatment options (Review). Mol. Med. Rep. 29:95. DOI:10.3892/mmr.2024.13219 View in Article Google Scholar
[43]	Kirichenko T. V., Markina Y. V., Bogatyreva A. I., et al. (2022). The role of adipokines in inflammatory mechanisms of obesity. Int. J. Mol. Sci. 23:14982. DOI:10.3390/ijms232314982 View in Article CrossRef Google Scholar
[44]	England B. R., Thiele G. M., Anderson D. R., et al. (2018). Increased cardiovascular risk in rheumatoid arthritis: Mechanisms and implications. BMJ 361:k1036. DOI:10.1136/bmj.k1036 View in Article CrossRef Google Scholar Scopus
[45]	Wang D., Zhang J., Lau J., et al. (2019). Mechanisms of lung disease development in rheumatoid arthritis. Nat. Rev. Rheumatol. 15:581−596. DOI:10.1038/s41584-019-0275-x View in Article CrossRef Google Scholar Scopus
[46]	Fukui S., Winkelmayer W. C., Tedeschi S. K., et al. (2024). Disease activity of rheumatoid arthritis and kidney function decline: A large prospective registry study. Ann. Rheum. Dis. 84:201−209. DOI:10.1136/ard-2024-226156 View in Article CrossRef Google Scholar
[47]	Wilson A., Yu H. T., Goodnough L. T., et al. (2004). Prevalence and outcomes of anemia in rheumatoid arthritis: A systematic review of the literature. Am.J. Med. 116 Suppl 7A:50s-57s. DOI:10.1016/j.amjmed.2003.12.012 View in Article Google Scholar
[48]	Palmer R., Smith B. J., Kite J., et al. (2024). The socio-ecological determinants of help-seeking practices and healthcare access among young men: A systematic review. Health Promot. Int. 39:daae024. DOI:10.1093/heapro/daae024 View in Article CrossRef Google Scholar
[49]	Galdas P. M., Cheater F. and Marshall P. (2005). Men and health help-seeking behaviour: literature review. J. Adv. Nurs. 49:616−623. DOI:10.1111/j.1365-2648.2004.03331.x View in Article CrossRef Google Scholar
[50]	Parks C. G., Pettinger M., de Roos A. J., et al. (2023). Life events, caregiving, and risk of autoimmune rheumatic diseases in the women's health initiative observational study. Arthritis Care Res. 75:2519−2528. DOI:10.1002/acr.25164 View in Article CrossRef Google Scholar
[51]	Feki A., Sellami I., Mnif I., et al. (2024). Quality of life assessment in female rheumatoid arthritis patients. Eur. Psychiatry 67:S809−S810. DOI:10.1192/j.eurpsy.2024.1687 View in Article CrossRef Google Scholar
[52]	Xiao N., Ding Y., Cui B., et al. (2024). Navigating obesity: A comprehensive review of epidemiology, pathophysiology, complications and management strategies. Innov. Med. 2:100090. DOI:10.59717/j.xinn-med.2024.100090 View in Article CrossRef Google Scholar Scopus
[53]	Rios-Leyvraz M., Ortega N. and Chiolero A. (2022). Reliability of self-reported height and weight in children: A school-based cross-sectional study and a review. Nutrients 15:75. DOI:10.3390/nu15010075 View in Article CrossRef Google Scholar
[54]	Mandic M., Safizadeh F., Schöttker B., et al. (2024). Childhood-to-adulthood body size trajectory and cancer risk: A prospective cohort study. Eur. J. Public Health 34:ckae144.979. DOI:10.1093/eurpub/ckae144.979 View in Article CrossRef Google Scholar
[55]	Bann D., Johnson W., Li L., et al. (2017). Socioeconomic inequalities in body mass index across adulthood: Coordinated analyses of individual participant data from three british birth cohort studies initiated in 1946, 1958 and 1970. PLoS Med. 14:e1002214. DOI:10.1371/journal.pmed.1002214 View in Article CrossRef Google Scholar
[56]	Fry A., Littlejohns T. J., Sudlow C., et al. (2017). Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population. Am. J. Epidemiol. 186:1026−1034. DOI:10.1093/aje/kwx246 View in Article CrossRef Google Scholar

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Yang Y., Chen L., Cheng J., et al. (2025). Body size changes and social determinants: Effects on rheumatoid arthritis, complications, and life expectancy in middle-aged and older adults. The Innovation Medicine 3:100134. https://doi.org/10.59717/j.xinn-med.2025.100134

Yang Y., Chen L., Cheng J., et al. (2025). Body size changes and social determinants: Effects on rheumatoid arthritis, complications, and life expectancy in middle-aged and older adults. The Innovation Medicine 3:100134. https://doi.org/10.59717/j.xinn-med.2025.100134

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Body size changes and social determinants: Effects on rheumatoid arthritis, complications, and life expectancy in middle-aged and older adults

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Body size changes and social determinants: Effects on rheumatoid arthritis, complications, and life expectancy in middle-aged and older adults

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