Independent and combined influence of homeownership, occupation, education, income, and community poverty on physical health in persons with arthritis

Callahan, Leigh F.; Martin, Kathryn; Shreffler, Jack; Kumar, Deepak; Schoster, Britta; Kaufman, Jay S.; Schwartz, Todd A.

doi:10.1002/acr.20428

Cited by 23 publications

(25 citation statements)

References 38 publications

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“…These results suggest that education and community poverty are more important SES predictors of hip OA measures than occupation. This finding is supported by a previous study which showed that only income and education remained significant predictors of physical health in persons with self-reported arthritis (37). It has been suggested that community-level SES measures may provide further information that is not captured by individual-level measures alone (29).…”

Section: Discussionsupporting

confidence: 86%

Associations of Educational Attainment, Occupation, and Community Poverty With Hip Osteoarthritis

Cleveland

Schwartz

Prizer

et al. 2013

Arthritis Care & Research

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Objective To examine cross-sectional baseline data from the Johnston County Osteoarthritis Project for the association between individual and community socioeconomic status (SES) measures with hip osteoarthritis (OA) outcomes. Methods We analyzed data on 3,087 individuals (68% Caucasian and 32% African American). Educational attainment and occupation were used as individual measures of SES. Census block group household poverty rate was used as a measure of community SES. Hip OA outcomes included radiographic OA (rOA) and symptomatic OA (sxOA) in one or both hip joints. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of each hip OA outcome with each SES variable separately, then with all SES measures simultaneously. Associations between hip OA outcomes and SES variables were evaluated for effect modification by race and gender. Results Living in a community of high household poverty rate showed independent associations with hip rOA in one or both hips (OR=1.50; 95% CI=1.18–1.92) and bilateral (both hips) rOA (OR=1.87; 95% CI=1.32–2.66). Similar independent associations were found between low educational attainment among those with sxOA in one or both hips (OR=1.44; 95% CI=1.09, 1.91) or bilateral sxOA (OR=1.91; 95% CI=1.08–3.39), after adjusting for all SES measures simultaneously. No significant associations were observed between occupation and hip OA outcomes, nor did race or gender modify the associations. Conclusion Our data provide evidence that hip OA outcomes are associated with both education and community SES measures, associations which remained after adjustment for covariates and all SES measures.

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Section: Discussionsupporting

confidence: 86%

Associations of Educational Attainment, Occupation, and Community Poverty With Hip Osteoarthritis

Cleveland

Schwartz

Prizer

et al. 2013

Arthritis Care & Research

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“…This study confirmed previous findings in rheumatology research that neighborhoods have an independent effect on outcomes in arthritis [30,31,46]; independent associations were noted between neighborhoods with higher rates of household poverty and outcomes of knee radiographic OA, bilateral knee radiographic OA and symptomatic knee OA in the Johnston County Osteoarthritis Project (Table 2) [40]. A recent multilevel Australian study using self-report measures of arthritis also found independent associations of neighborhood disadvantage with prevalence of arthritis such that residents of the most disadvantaged neighborhoods were 42% more likely than those in the least disadvantaged neighborhoods to self-report arthritis [38].…”

Section: Studies Of Social Determinants and Oa Outcomessupporting

confidence: 92%

“…Evidence exists linking lower levels of individual socioeconomic status (SES) and poorer health outcomes in many diseases [23–27], including arthritis [28–31]. Recent data suggest that the social context (i.e., factors in society that cannot be directly measured at the individual level), or socioeconomic environment of an individual’s neighborhood may be relevant to arthritis prevalence and health outcomes as well.…”

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confidence: 99%

“…Recognizing that social context has not been extensively researched in OA, our proposed schematic is based on previous models for other chronic diseases and what current research findings in other rheumatologic diseases have demonstrated [22,30,31,38,40,46–49]. We summarize the current literature on research about OA and social determinants including discussion of current measures of social context, social position, and potential mediators and moderators between social determinants and OA outcomes.…”

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confidence: 99%

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Social Determinants and Osteoarthritis Outcomes

et al. 2012

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Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual’s socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one’s neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.

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“…Expert opinion varies widely on what constitutes a meaningful difference and its assessment. Our group has previously calculated quasi-effect size for health status [64] to better interpret results. We similarly calculated quasi-effect size for physical functioning, disability, helplessness, and mental health by standardizing the parameter estimates by corresponding standard deviations in this study.…”

Section: Discussionmentioning

confidence: 99%

Coping with Prescription Medication Costs: a Cross-sectional Look at Strategies Used and Associations with the Physical and Psychosocial Health of Individuals with Arthritis

et al. 2012

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Background Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ. Purpose The purposes of this study are (1) to identify characteristics of individuals with arthritis who self-report prescription medication cost-coping strategies and (2) to examine the association between medication cost-coping strategies and health status. Methods Seven hundred twenty-nine people self-reporting arthritis and prescription medication use completed a telephone survey. Adjusted regression models examined medication cost-coping strategies and five health status outcomes. Results Participants reported engaging in cost-coping strategies due to medication costs. Those borrowing money had worse psychosocial health and greater disability; those with increasing credit card debt reported worse physical functioning, self-rated health, and greater helplessness. Medication underuse was associated with worse psychosocial health, greater disability, and depressive symptoms. Conclusion Individuals with arthritis use multiple strategies to cope with medication costs, and these strategies are associated with adverse physical and psychosocial health status.

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Independent and combined influence of homeownership, occupation, education, income, and community poverty on physical health in persons with arthritis

Abstract: Objective. To examine the independent and combined influence of individual-and community-level socioeconomic status (SES) measures on physical health status outcomes in people with self-reported arthritis.

Cited by 23 publications

References 38 publications

Associations of Educational Attainment, Occupation, and Community Poverty With Hip Osteoarthritis

Associations of Educational Attainment, Occupation, and Community Poverty With Hip Osteoarthritis

Social Determinants and Osteoarthritis Outcomes

Coping with Prescription Medication Costs: a Cross-sectional Look at Strategies Used and Associations with the Physical and Psychosocial Health of Individuals with Arthritis

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