Lower socioeconomic status is associated with a higher likelihood of Sjögren disease compared with non-Sjögren sicca and higher immunoglobulin levels, suggesting its potential influence on disease phenotype.

A cross-sectional study published in the journal RMD Open examined whether socioeconomic status influenced the risk and clinical features of Sjögren disease, using a UK Optimising Assessment in Sjögren’s Syndrome single-centre cohort of 256 Sjögren disease patients, 175 controls with non-Sjögren sicca and 972 population controls.

Socioeconomic status was defined using the Index of Multiple Deprivation (IMD) and educational attainment. Primary outcomes were associations between socioeconomic status and the risk of Sjögren disease, compared with sicca and population controls, as well as disease-related clinical and biological markers.

Sjögren disease risk and immunoglobulin levels

Participants with Sjögren disease had lower socioeconomic status than those with sicca on both the IMD and education measures. The highest odds of Sjögren disease (versus sicca) were observed in IMD quintile 1, which represents the most deprived 20% of areas in England.

Compared with this group, odds were reduced by 74% in IMD quintile 2 after adjustment (odds ratio 0.26; 95% CI 0.12–0.58; P<0.001).

Compared with population controls, however, IMD was not a risk factor for Sjögren disease (P=0.257), whereas sicca was associated with lower deprivation (P=0.003). Higher educational attainment was associated with increased odds of diagnosis (359% for individuals with a degree).

There was an inverse association between immunoglobulin (Ig) levels and IMD. Each increase in IMD quintile (signifying less deprivation) was associated with a 6.03% reduction in IgG (95% CI −9.84% to −2.05%; P=0.003) and a 6.46% reduction in IgA (95% CI −10.87% to −1.60%; P=0.010).

Median IgG levels were highest in the most deprived group (17.4 g/L) and lowest in the less deprived groups, supporting a gradient effect.

Despite these associations, socioeconomic status was not associated with key clinical indices, including the EULAR Sjögren's Syndrome Disease Activity Index and the EULAR Sjögren’s Syndrome Patient Reported Index. Associations with salivary flow and depression scores were not significant after adjustment.

Implications for future research

Overall, these findings suggests that socioeconomic deprivation may influence biological disease activity rather than overt clinical presentation.

While the authors suggested that environmental exposures linked to deprivation may affect immune responses, they emphasised that the findings should be interpreted with caution.

The cross-sectional design limited causal inference, and there was potential for selection bias, particularly in analyses involving education due to missing data, they said. The single-centre nature of the cohort may also limit generalisability, and differences in socioeconomic status between Sjögren disease and sicca groups further complicated interpretation.

The authors also pointed out that healthcare-seeking behaviour and access may influence diagnosis patterns – particularly for sicca – and acknowledged that socioeconomic status may both influence and be influenced by disease.

Clinically, the findings underscore the importance of considering socioeconomic context in patients with suspected or established Sjögren disease, particularly given its potential association with disease activity markers.

Looking ahead, the authors concluded that future research should explore longitudinal relationships between socioeconomic status and disease progression. The underlying mechanisms linking deprivation to immunological activity should also be considered alongside routine reporting of socioeconomic data and careful selection of control populations, they added.

Reference
Baranskaya A et al. Impact of socioeconomic deprivation on risk and disease activity of Sjögren’s disease. RMD Open 2026;12:e006348.