ORIGINAL RESEARCH article
Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
This article is part of the Research TopicExploring Healthcare Access in Low- and Middle Income Countries: Achievements, Synergies, Opportunities and ChallengesView all 3 articles
When Poverty Gets into Your Joints: Exploring Socioeconomic, Environmental, and Gendered Determinants of Rheumatoid Arthritis in District Dir Lower, Pakistan
Provisionally accepted
- 1School of Business, East China University of Science and Technology Shanghai China, Shanghai, China
- 2University of Malakand, Chakdara, Pakistan
- 3Department of Sociology, Faculty of Arts, The University of Jordan Amman, Amman, Jordan
- 4Department of Social Work, Faculty of Arts, The university of Jordan, Amman, Jordan, Amman, Jordan
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This epidemiological study investigates the socio-structural determinants of patient-reported experiences of Rheumatoid Arthritis (RA) among 300 women in rural Pakistan, where <5% have consistent rheumatology access. Through structured interviews analyzed via ordinal logistic regression and structural equation modeling (SEM), we identified key factors influencing self-reported pain, perceived mobility limitation, psychological stress, and treatment adherence: (1) climate-linked disease burden: Winter temperatures significantly exacerbated self-reported pain (Z=12.24, p <0.001, r=0.52). (2) Gendered care barriers: Spousal unemployment doubled the risk of treatment dropout risk (U=5690.5, p < .001); (3) Structural marginalization: Patients residing >50km from specialists reported 3.2× higher perceived mobility limitations (χ² = 28.49, p < 0.001). SEM confirmed interconnected pathways between income loss, psychological stress, and adverse patient-reported outcomes (CFI=0.94, RMSEA=0.042). As one of the first studies to quantify seasonal and gender disparities in South Asian RA, we propose three evidence-based interventions for undeserved regions: mobile rheumatology units, climate-adaptive pain management protocols, and community-led psychosocial support programs. Our study directly informs WHO Global RA Action Plan priorities for LMICs.
Keywords: Health Disparities, Treatment Adherence, Global rheumatology, Bio- psycho-social model, SDG 3
Received: 06 Oct 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Khan, Daraz, Alsawalqa, Alrawashdeh and Alnajdawi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Younas Khan
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