Published in the Annals of the Rheumatic Diseases, the study analyzed real-world data from the European Spondyloarthritis Research Collaboration Network, known as EuroSpA. Researchers examined 38,911 patients across 13 European countries, including 17,296 people with PsA and 21,615 with axSpA. All participants began treatment with a biologic or targeted synthetic disease-modifying antirheumatic drug, collectively referred to as b/tsDMARDs, between 2015 and 2021.

These medicines are generally used when conventional treatments do not adequately control inflammation or when disease severity warrants a more advanced approach. Biologic drugs target specific immune pathways, such as tumor necrosis factor or interleukin signaling, while targeted synthetic drugs interfere with intracellular molecules involved in inflammatory signaling. Treatment retention—the length of time a patient continues a therapy before stopping or switching—is commonly used as a real-world measure of effectiveness, tolerability, adherence, and clinical satisfaction.

The investigators compared treatment outcomes with country-level socioeconomic indicators, including gross domestic product per capita, gross national income per capita, current health expenditure per capita, out-of-pocket healthcare spending, and the Human Development Index. Rather than measuring only a patient’s personal income or education, this approach evaluated the broader healthcare and economic environment in which treatment decisions were made.

A consistent pattern emerged. Patients living in wealthier European countries were more likely to begin b/tsDMARD treatment sooner in the course of their disease and at lower levels of disease activity than patients in middle- and lower-income countries. The difference was particularly apparent among people with PsA. Patients in wealthier countries also had shorter disease duration when advanced treatment was initiated, suggesting that diagnosis, referral, treatment eligibility, and access to specialists may occur earlier in better-resourced health systems.

However, greater economic resources were also associated with shorter treatment retention. Both men and women with PsA or axSpA from countries with higher socioeconomic indicators were more likely to discontinue or change their b/tsDMARD at six, 12, and 24 months. The result may appear paradoxical: patients in wealthier countries started treatment earlier and with less active disease, yet they were more likely to stop or switch therapy during the two-year observation period.

Several explanations are possible. Earlier access may allow clinicians to intervene before disease activity becomes severe, reducing the tolerance for residual symptoms or modest treatment limitations. In systems with a broad range of available therapies, physicians and patients may also have more opportunities to switch when the initial response is incomplete, side effects arise, or a different mechanism of action is considered preferable. By contrast, patients in countries with fewer resources may remain on a therapy longer because alternative treatments are less accessible, even when disease control is inadequate.

The study also identified differences in the composition of the patient populations. People starting advanced treatment in wealthier countries were more likely to be women and current smokers. These characteristics can influence symptoms, disease perception, treatment response, and clinical decision-making, although the country-level associations remained an important feature of the analysis. The researchers emphasized that the findings describe relationships between national socioeconomic conditions and treatment outcomes; they do not prove that national wealth directly causes treatment discontinuation or switching.

The results highlight a central challenge in interpreting international treatment data. A high rate of treatment retention is not automatically evidence of better care, just as frequent switching does not necessarily indicate poor clinical management. Retention can reflect efficacy and tolerability, but it can also be shaped by reimbursement rules, prescribing restrictions, monitoring systems, patient preferences, physician practice patterns, and the availability of alternative medicines. Similarly, higher disease activity at treatment initiation may reflect delayed diagnosis or restricted access rather than differences in the underlying biology of the disease.

According to lead investigator Brigitte Michelsen of the Copenhagen Center for Arthritis Research and collaborating hospitals in Denmark and Norway, the study was designed to understand why disease activity and treatment outcomes vary between countries. The findings point to different priorities across healthcare systems. Lower-resource countries may need to strengthen early recognition of PsA and axSpA, accelerate specialist referral, and improve access to effective therapies before inflammation becomes prolonged or disabling. Wealthier countries, meanwhile, may need to assess whether repeated treatment changes are clinically justified and whether they produce meaningful benefits for patients.

The researchers argue that country-level inequality should be considered when clinicians, policymakers, and researchers compare treatment outcomes. Differences in health expenditure and access can influence the point at which treatment begins, the severity of disease at that time, and the options available when a therapy does not work as expected. Recognizing these influences could help prevent misleading comparisons between nations and support more equitable standards of care.

The study was financially supported by Novartis, while the authors reported that sponsors had no influence on data collection, statistical analyses, manuscript preparation, or the decision to submit the work. The article, published in the Annals of the Rheumatic Diseases, adds evidence that effective rheumatology care depends not only on the development of advanced drugs, but also on whether health systems can deliver them at the right time and sustain clinically appropriate treatment for the people who need them.

Subject of Research: People with psoriatic arthritis and axial spondyloarthritis

Article Title: Influence of national socioeconomic status on treatment retention and disease activity in psoriatic arthritis and axial spondyloarthritis: evidence over 2 years in 13 European countries

News Publication Date: August 11, 2026

Web References: https://doi.org/10.1016/j.ard.2026.06.021; https://ard.eular.org/

References: Michelsen B et al., “Influence of national socioeconomic status on treatment retention and disease activity in psoriatic arthritis and axial spondyloarthritis: evidence over 2 years in 13 European countries,” Annals of the Rheumatic Diseases, published July 13, 2026. DOI: 10.1016/j.ard.2026.06.021

Keywords: psoriatic arthritis, axial spondyloarthritis, biologic therapy, targeted synthetic DMARDs, treatment retention, disease activity, socioeconomic status, healthcare inequality, EuroSpA, rheumatology

The COVID-19 pandemic has undeniably exacerbated pre-existing inequities globally, with mental health repercussions surfacing prominently across demographics. Children with pre-existing psychopathologies form a particularly susceptible group, with their conditions potentially amplified due to disruptions in routine, schooling, socialization, and healthcare access. The study highlights the critical intricacies of how varying SES levels modulate perceived well-being and access to, or perception of, mental health support during these challenging times.

Conducted over three consecutive years, the research adopts a multifaceted methodological framework combining quantitative psychometric assessments with nuanced qualitative interviews. This hybrid approach allows for a robust interrogation of both objective mental health outcomes and subjective experiences reported by parents and their children. The longitudinal design uniquely captures evolution over time rather than static snapshots, providing temporal depth to the understanding of pandemic-related stress and support dynamics.

Central to the findings is the revelation that lower socioeconomic status significantly correlates with diminished perceptions of well-being and greater difficulties in obtaining or benefitting from mental health interventions. Families in economically disadvantaged strata reported heightened stress, anxiety, and depressive symptoms in their children, alongside escalating parental concerns related to their capacity to facilitate effective mental health support. This distress appears compounded by material shortages, limited digital access for telehealth, and fragmented social support structures.

Conversely, participants from higher SES brackets depicted relatively better psychological resilience throughout the pandemic. Although not immune to distress, these families generally experienced more stable access to professional mental health resources, supportive educational environments, and technological tools essential for remote therapeutic interventions. The data underscore that socioeconomic disparities deeply influence not only mental health outcomes but also the subjective interpretation and utilization of available mental health services.

Mechanistically, the study postulates several psychosocial pathways underpinning these SES-driven divergences. Chronic financial insecurity tends to amplify stress hormones and maladaptive coping mechanisms, which are especially detrimental during childhood neurodevelopment. Simultaneously, parental mental health serves as a key intermediary variable; parents under financial and emotional strain may inadvertently diminish the quality of emotional support they provide to their children, further exacerbating psychopathological symptoms.

Notably, the perception of mental health support, a crucial moderator variable, was found to be shaped by both systemic and individual factors. Systemically, under-resourced communities often experienced delays, understaffing, and reduced availability of specialized child mental health services, creating bottlenecks for early intervention. Individually, stigmatization around mental health issues—often more pronounced in lower SES groups—served as an additional barrier against seeking or accepting care, thereby perpetuating adverse outcomes.

The research also highlights the evolving role of digital mental health platforms during the pandemic, which offered a double-edged sword. While telepsychiatry and online counseling expanded service reach, families lacking reliable internet access or digital literacy experienced exclusion, potentially intensifying existing inequities. This digital divide, closely aligned with SES, emerged as a significant hurdle, challenging healthcare providers to innovate more inclusive technological approaches.

From a neurodevelopmental perspective, the article discusses the implications of prolonged psychological stress during sensitive periods in childhood, emphasizing the heightened risk for exacerbated symptomatology and developmental delays among lower SES cohorts. The interactions between environmental deprivation, stress exposure, and psychopathology set the stage for chronic mental health conditions that may persist well beyond the pandemic epoch.

Policy implications of this research are profound. The authors advocate for multi-layered strategies targeting socioeconomic determinants—ranging from enhanced funding for community mental health centers, expanded social safety nets, to culturally sensitive outreach programs. Emphasizing early identification and intervention, these measures aim to alleviate both the psychological and material hardships that disproportionately afflict underprivileged families, thus promoting equitable mental health recovery trajectories.

Furthermore, the study underscores the pivotal role of schools as frontline mental health facilitators that bridge healthcare gaps, especially in financially disadvantaged communities. Recommendations include integrating comprehensive mental health curricula, training educators in psychological first aid, and fostering partnerships with mental health professionals to create supportive, stigma-free environments conducive to child well-being.

Another critical takeaway is the necessity to support parental mental health as an integral component of child psychopathology management. Strengthening parental coping skills, providing targeted parental counseling, and alleviating socioeconomic stressors through policy reform can amplify positive mental health outcomes for children reliant on parental networks for emotional stability.

In conclusion, this seminal research illuminates the complex web interlinking socioeconomic status, mental health support perception, and psychological outcomes among children with psychopathology during COVID-19. It galvanizes attention towards persistent structural inequities that demand concerted action from healthcare systems, policymakers, educators, and communities alike to foster resilient futures for vulnerable populations amidst prolonged global disruption.

The ripple effects of these insights resonate far beyond pandemic contexts, highlighting enduring social determinants of health that shape mental wellness across the lifespan. Future research building on these findings promises to inform more personalized, equity-focused mental health frameworks capable of mitigating disparities and optimizing care delivery across diverse socioeconomic landscapes worldwide.

Subject of Research: Socioeconomic status and its impact on the perception of well-being and mental health support among children with psychopathology and their parents during the COVID-19 pandemic.

Article Title: Socioeconomic status and perception of well-being and mental health support: a three-year COVID-19 study in children with psychopathology and their parents.

Article References:
Donno, F., Prandini, M., Abbracciavento, G. et al. Socioeconomic status and perception of well-being and mental health support: a three-year COVID-19 study in children with psychopathology and their parents. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04978-6

Image Credits: AI Generated

DOI: 28 May 2026

At its core, the study seeks to understand how various factors contribute to the unequal utilization of hypertension care across different socioeconomic strata in Bangladesh. This examination is crucial not only for Bangladesh but for countries worldwide grappling with similar public health challenges. The findings underscore that socioeconomic status plays a vital role in determining an individual’s access to healthcare services, with implications that can exacerbate existing health disparities.

The methodology employed in the study is noteworthy. Utilizing a decomposition analysis, Ishaq and Kakoly evaluate individual and contextual factors that influence healthcare utilization. This analytical approach allows researchers to dissect the elements that significantly contribute to observed inequalities, thus providing a nuanced understanding of the intersection between social determinants of health and healthcare access. The decomposition model offers insights into how various economic and social variables correlate with the likelihood of receiving adequate hypertension care.

Bangladesh, like many low- and middle-income countries, faces a myriad of challenges in its healthcare system. The study highlights that a substantial portion of the population remains unaware of their hypertension status, leading to inadequate treatment. Furthermore, even among those who know their condition, many do not receive proper care due to financial barriers, lack of transportation, and limited access to healthcare facilities. By examining these barriers, the study emphasizes the need for targeted interventions that address both financial and logistical challenges.

One of the critical findings of the analysis is the stark contrast in treatment rates between different socioeconomic groups. Individuals from lower income brackets experience significant obstacles in accessing hypertension care compared to their wealthier counterparts. This disparity is alarming, given the high burden of hypertension in populations that are already vulnerable. The results raise essential questions about the effectiveness of current healthcare policies and whether they adequately cater to the needs of marginalized communities.

Moreover, the research draws attention to the role of education in hypertension care utilization. Those with higher educational attainment tend to seek care more frequently, suggesting that health literacy is a significant determinant in understanding and managing hypertension. The implications are vast: enhancing educational initiatives around hypertension could empower individuals to seek care proactively, thus improving overall health outcomes.

Cultural perceptions and societal attitudes also play a significant role in healthcare utilization. The study details how stigma surrounding chronic diseases like hypertension can hinder individuals from seeking help. This sociocultural dynamic often leads to a silent epidemic, where many sufferers remain untreated due to fear of social ostracism or misunderstanding of the disease. Therefore, addressing these cultural barriers is essential for improving access to hypertension care in Bangladesh and similar contexts.

In terms of public health initiatives, the research calls for an integrated approach that combines awareness campaigns with financial support for lower-income groups. Policymakers must prioritize creating a healthcare environment that is accessible and affordable for all, particularly for the underprivileged. This could include subsidies for hypertension medication and the establishment of community health programs aimed at educating individuals about the importance of regular check-ups and treatment adherence.

Furthermore, the research advocates for enhancing healthcare infrastructure in rural areas, where the majority of Bangladesh’s population resides. A significant barrier identified is the geographical distance from healthcare facilities, particularly for those living in remote regions. Improving transportation systems and establishing more localized care centers could play a pivotal role in mitigating the existing inequalities in healthcare access.

Additionally, the study discusses the importance of collaboration between various stakeholders, including government agencies, non-profits, and community leaders, to create a comprehensive strategy for addressing these inequalities. Collaborative efforts could foster innovative solutions that target root causes and provide sustainable results for hypertension treatment availability and education.

The findings also stress the need for more robust data collection on hypertension prevalence and care utilization across different demographics. Comprehensive data can inform future research and policy-making, enabling a better understanding of how socioeconomic factors influence health behavior and outcomes. With granular data, interventions can be more precisely tailored to meet the needs of specific populations.

Moreover, the research dovetails with global health priorities, emphasizing the need for sustainable development goals that target health inequality. As countries strive to meet these goals, the study serves as a critical reminder of the work that remains in ensuring that healthcare systems are equitable and inclusive.

In conclusion, the research conducted by Ishaq and Kakoly provides a vital perspective on the socioeconomic inequalities affecting hypertension care utilization in Bangladesh. Through its detailed analysis and strategic recommendations, the study calls for concerted efforts to address the multifaceted barriers faced by lower-income populations. By focusing on education, cultural perceptions, infrastructure, and collaborative strategies, there is potential for significant improvements in health outcomes for those affected by hypertension. This research not only adds to the growing body of literature on healthcare disparities but also serves as a catalyst for change in public health policy.

Moreover, the findings can resonate with global audiences, as the challenges of healthcare access transcend borders. Countries worldwide can glean insights from Bangladesh’s experience, reinforcing the universal message that health equity is essential for a thriving society.

Subject of Research: Socioeconomic inequalities in hypertension care utilization in Bangladesh.

Article Title: Decomposition of socioeconomic inequalities of hypertension care utilization: Bangladesh experience.

Article References:

Ishaq, F., Kakoly, I.J. Decomposition of socioeconomic inequalities of hypertension care utilization: Bangladesh experience.
BMC Health Serv Res 25, 1486 (2025). https://doi.org/10.1186/s12913-025-13235-1

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12913-025-13235-1

Keywords: Socioeconomic status, hypertension, healthcare inequality, Bangladesh, health literacy, public health policy.