Educational inequalities in mortality associated with rheumatoid arthritis and other musculoskeletal disorders in Sweden

Abstract

Background Musculoskeletal (MSK) disorders are less likely to be reported as an underlying cause of death (UCD) and since cause of death studies are generally limited to the UCD, little is known about socioeconomic inequalities in MSK disorders as cause of death in the general population. Using multiple-cause-of-death data, we aimed to quantify and compare educational inequalities in musculoskeletal (MSK) disorders- with non-MSK disorders-related mortality. Methods All residents aged 30–99 years in the Skåne region, Sweden, during 1998–2013 ( n = 999,148) were followed until their 100th birthday, death, relocation outside Skåne, or end of 2014. We identified any mention of rheumatoid arthritis (RA) or other MSK disorders on death certificates using multiple-cause-of-death data. We retrieved and linked individual-level data from Statistics Sweden on highest level of education. We used Cox regression and additive hazards models with age as time-scale adjusted for sex, marital status, and country of birth to calculate slope and relative indices of inequality (SII/RII). Results During a mean follow-up of 12.2 years, there were 1407 (0.8% of all deaths) and 3725 (2.1% of all deaths) death certificates with mention of RA and other MSK disorders, respectively, and 171,798 death certificates without any mention of a MSK disorder. Age-standardized RA mortality rate was 2.2 (95% confidence interval [CI]: 2.0–2.8) times greater in people with 0–9 years of education compared with those with > 12 years of education. Corresponding figure for other MSK disorders was 1.5 (95% CI: 1.4–1.6). Both RIIs and SIIs revealed statistically significant educational inequalities in RA/other MSK disorders mortality favouring high-educated people. The RIIs of MSK disorders-related deaths were generally greater than non-MSK disorders-related deaths. Conclusion We found substantial educational inequality in mortality from MSK disorders. Further research is needed to investigate underlying pathways driving these inequalities. Electronic supplementary material The online version of this article (10.1186/s12891-019-2465-8) contains supplementary material, which is available to authorized users.

Intersectional Inequalities and Individual Heterogeneity in Chronic Rheumatic Diseases: An Intersectional Multilevel Analysis

“…The lack of inequalities in SpA is in line with a previous study in the Skåne region that reported no socioeconomic differences in the risk of being diagnosed with SpA (24). While not directly comparable, our findings on associations between SSDs and the risk of chronic rheumatic diseases were generally consistent with previous studies (4,25–30). However, we revealed substantial heterogeneities in sociodemographic inequalities in chronic rheumatic diseases that have been overlooked in previous research.…”

“…Chronic rheumatic diseases are among the leading causes of disability globally, entailing a huge health and economic burden on individuals and societies (1,2). The burden of chronic rheumatic diseases, however, is unequally distributed along social status dimensions (SSDs) such as sex, ethnicity, and socioeconomic status (3)(4)(5). The common approach in health inequalities literature (including studies on chronic rheumatic diseases) is to investigate different SSDs in isolation from one another or to treat them as additive distinct processes (6).…”

Associations of musculoskeletal disorders with occupational stress and mental health among coal miners in Xinjiang, China: a cross-sectional study

“…The prevalence of MSDs was highest in miners with junior middle school education and below, and the prevalence decreased with the increase of education level. Kiadaliri et al [ 52 ] drew similar conclusions. Miners with lower education levels are generally engaged in heavy physical labor underground, and their labor intensity is higher than that of other workers working underground, so they are more prone to muscle fatigue and injury, leading to a higher prevalence of MSDs.…”

Perfil del estilo de vida y actividad inflamatoria en personas con artritis reumatoide

“…La importancia de la educación en pacientes con AR es considerada una herramienta complementaria en el tratamiento donde bajo las guías del ACR/EULAR 45 . De igual forma, se encuentra relación inversa entre el nivel de educación y la mortalidad por AR, las tasas de mortalidad por AR fueron 2 a 3 veces más altas en personas con nivel educativo bajo 46 .…”