Pathways to Pain and Disability: the Impact of Early Social Deprivation and Educational Attainment in Newly Diagnosed Osteoarthritis Patients

Abstract

BackgroundLinks between pain and cognitive function on one hand and pain and anxiety on the other have already been shown in other studies and there is biological evidence linking osteoarthritis to educational attainment. However, the inter-play of these factors and the role of key social (social deprivation) factors at the early disease stages are not understood. Therefore, we tested how social deprivation, education and anxiety, before diagnosis, affects the cognition, pain and independence (activities of daily living) relationship longitudinally after diagnosis of osteoarthritis. MethodsUsing data from waves 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 1,240), we examined the impact of social deprivation, education and anxiety on the dynamic relationship between cognitive function, pain and instrumental activities of daily living (IADL) in a subsample of respondents reporting a diagnosis of osteoarthritis at wave 6, with cross-lagged panel models.ResultsSocial deprivation before diagnosis predicted poorer cognitive function and higher pain levels after diagnosis, and further predicted impairments in IALD at wave 7 through its negative effect on cognitive function at wave 6. Education before diagnosis was protective against impairments in daily living after diagnosis via better cognitive function and lower anxiety at wave 5.ConclusionWe show for the first time that social deprivation, before osteoarthritis diagnosis, predicts functional impairment in daily living, after diagnosis with this effect partly mediated by impaired cognitive function. We also show for the first time that, education before diagnosis was protective against impairments in daily living after diagnosis via better cognitive function and lower anxiety before diagnosis. Therefore, improving cognitive function and managing anxiety may dampen the impact of social deprivation and low educational attainment on poor health and help to promote independence in patients with osteoarthritis.