Association of regional racial/cultural context and socioeconomic status with arthritis in the population: a multilevel analysis

Associations of current and childhood socioeconomic status and health outcomes amongst patients with knee or hip osteoarthritis in a Mexico City family-practice setting

OBJECTIVES

To examine the association of current and childhood socioeconomic status (SES) with patient-reported functional status, quality of life and disability in patients with knee or hip osteoarthritis (OA).

METHODS

Cross-sectional study amongst individuals seeking care for any medical reason in a primary care family-practice clinic in Mexico City. We included individuals with self-reported doctor-diagnosed arthritis, recruited through waiting-room posters and invitations by treating family physicians. We administered a survey using validated Spanish language versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Osteoarthritis of Lower Limbs and Quality of Life (AMICAL), and the Stanford Health Assessment Questionnaire-Disability Index (HAQ-DI). To estimate current and childhood SES, we collected data on education level and occupation type for both the patient and their parents, as well as using a validated tool to estimate income quintile.

RESULTS

We recruited 154 patients and excluded 8 patients. There was a high correlation between outcome scores. Estimated income and education levels were correlated with WOMAC, AMICAL and HAQ-DI scores, and significant differences were found in all scores by occupation type. The associations for current SES variables and outcome scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension, and were largely explained by current income in mutually adjusted models. Childhood SES - in particular as measured through maternal education - was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES.

CONCLUSIONS

Current Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. The WOMAC, AMICAL and HAQ-DI scores correlate with each other and are all potentially useful markers of disease severity. More research is needed to elucidate the relationships between childhood SES and OA outcomes. Awareness of life-course SES may be useful in identifying patients at risk for worse outcomes.

Cognitive activity at work and the risk of dementia

Dementia prevalence is projected to rise steeply in coming decades, producing tremendous burdens on families, and health and social services. Motivated by the need for further robust evidence on modifiable risk factors, we investigate the relationship between cognitive activity at work and later-life dementia. Using data from the US Health and Retirement Study matched to the O*NET occupational database, we find that a one standard deviation increase in the cognitive activity associated with one's longest held occupation is associated with a 0.9 percentage point reduction in (predicted) dementia, or a 24% reduction relative to the mean. This relationship is consistently found across model specifications and robustness tests. When controlling for individual fixed-effects we find that the association between dementia and work cognitive activity increases with age. Overall, our results provide some evidence in support of the inclusion of cognitive activity at work as a recognized modifiable risk factor for dementia.

Potential pathways of association from green space to smartphone addiction

Green space is increasingly known to improve physical and mental health. Based on these benefits, green space might also be expected to help mitigate related harmful behavioral patterns, such as obsessive Internet use and relevant addictions. In response, we conducted a study on smartphone addiction, a new form of Internet addiction. We carried out a cross-sectional investigation in August 2022. We recruited 1011 smartphone users across China, measured the Normalized Difference Vegetation Index (NDVI) in their residential neighborhoods (in 1, 2, and 3 km buffers), and captured data on smartphone addiction via the Smartphone Addiction Scale - Short version (SAS-SV). Potential mediators between green space and smartphone addiction, including physical activity, stress, and loneliness, were also reported by participants using the Physical Activity Rating Scale-3 (PRS-3), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and 8-items UCLA Loneliness Scale scales (ULS-8). Multiple linear regression was employed to examine the relationships between green space and smartphone addiction. Structural equation modeling was performed to examine the potential pathways between these variables. Unexpectedly, NDVI in 1 km buffers was positively associated with smartphone addiction. By contrast, population density, an indicator of urbanization, was associated with lower levels of smartphone addiction levels in all NDVI buffer sizes. Meanwhile, we found NDVI was strongly associated with population density as well as other indicators of urbanization. Generally, our findings are unexpected and suggest that greenness may serve as an indicator of urbanization at national levels and that urbanization may buffer against smartphone addiction. During the hot summer, green space and indoor facilities may have competitive land uses, so future research should examine whether this association exists in other seasons and scenarios. We also recommend alternative models to systematically evaluate the effects of different components of residential environments.

Rural-Urban Differences in Non-Local Primary Care Utilization among People with Osteoarthritis: The Role of Area-Level Factors

The utilization of non-local primary care physicians (PCP) is a key primary care indicator identified by Alberta Health to support evidence-based healthcare planning. This study aims to identify area-level factors that are significantly associated with non-local PCP utilization and to examine if these associations vary between rural and urban areas. We examined rural-urban differences in the associations between non-local PCP utilization and area-level factors using multivariate linear regression and geographically weighted regression (GWR) models. Global Moran's I and Gi* hot spot analyses were applied to identify spatial autocorrelation and hot spots/cold spots of non-local PCP utilization. We observed significant rural-urban differences in the non-local PCP utilization. Both GWR and multivariate linear regression model identified two significant factors (median travel time and percentage of low-income families) with non-local PCP utilization in both rural and urban areas. Discontinuity of care was significantly associated with non-local PCP in the southwest, while the percentage of people having university degree was significant in the north of Alberta. This research will help identify gaps in the utilization of local primary care and provide evidence for health care planning by targeting policies at associated factors to reduce gaps in OA primary care provision.

The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old

BACKGROUND

Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis.

OBJECTIVE

This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old.

METHODS

Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance).

RESULTS

A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = -0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group.

CONCLUSION

Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.

Additive Interaction of Work-Related Stress and Sleep Duration on Arthritis Among Middle-Aged Civil Servants

Aim

Occupational strain is recognized as a risk for arthritis, yet little is known about how psychological stress affects arthritis moderated by sleep duration. The objective of this study is to assess work-related stress using the effort-reward imbalance (ERI) model and the job-demand-support (JDS) model on arthritis moderated by sleep duration.

Methods

A nationwide cross-sectional study randomly collected a total of 11,875 middle-aged, employed civil servants from 647 registered governmental institutions. Each participant anonymously and voluntarily filled out a web-based questionnaire and informed consent at the time of the study. Psychosocial work stress was assessed by ERI and JDS measured by a Chinese version of the job content questionnaire.

Results

There were significant odds ratios (ORs) of arthritis positively associated with high ERI (OR = 1.58), high overcommitment (OC) (OR = 1.57), and job demand (OR = 1.31) and negatively associated with job support (OR = 0.69) using multivariate analysis after being adjusted for covariates. For the short sleep duration group, there was an interaction effect of both high ERI and OC on arthritis, with a synergy index of 18.91 and 1.52, respectively. Similarly, there are high ORs of arthritis in both the high job demand and low job support groups.

Conclusion

Work-related stress related to arthritis moderated by sleep duration for civil servants. Civil servants with high job demand and low job support should use caution to reduce the risk of arthritis.

Association of childhood physical and sexual abuse with arthritis in adulthood: Findings from a population-based study

The objective of this cross-sectional study was to investigate childhood physical and sexual abuse as factors associated with arthritis among adults from selected states in the United States. Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,717 adults 18-75 years old (49.7% female) was analyzed using log-binomial regression. The outcome variable investigated in this study was arthritis, and the main explanatory variables were childhood physical and sexual abuse. Of the 75,717 respondents examined, 20,938 (representing 27.6%) had arthritis. A little over one in four respondents (25.5%) experienced childhood physical abuse and 5.6% experienced childhood sexual abuse by age 18. In the multivariable regression, respondents who experienced childhood physical abuse had 1.36 times the risk of having arthritis when compared to respondents who did not experience childhood physical abuse (ARR = 1.36, p < .001, 95% CI = 1.28-1.46). Respondents who experienced childhood sexual abuse had 1.60 times the risk of having arthritis when compared to respondents who did not experience childhood sexual abuse (ARR = 1.74, p < .001, 95% CI = 1.54-1.97). The findings of this study demonstrate that childhood physical and sexual abuse are associated with arthritis later in adulthood. The associations persisted even after adjusting for demographic, socioeconomic status, body mass index (BMI), current smoking status, and self-perceived physical health. The findings of this study add to the burgeoning number of studies demonstrating the adverse impact of childhood physical and sexual abuse on chronic health outcomes among adults.

Experts prioritize osteoarthritis non-surgical interventions from Cochrane systematic reviews for translation into "Evidence4Equity" summaries

OBJECTIVE

Osteoarthritis generates substantial health and socioeconomic burden, which is particularly marked in marginalized groups. It is imperative that practitioners have ready access to summaries of evidence-based interventions for osteoarthritis that incorporate equity considerations. Summaries of systematic reviews can provide this. The present study surveyed experts to prioritize a selection ofinterventions, from which equity focused summaries will be generated. Specifically, the prioritized interventions will be developed into Cochrane Evidence4Equity (E4E) summaries.

METHODS

Twenty-seven systematic reviews of OA interventions were found. From these, twenty-nine non-surgical treatments for osteoarthritis were identified, based on statistically significant findings for desired outcome variables or adverse events. Key findings from these studies were summarised and provided to 9 experts in the field of osteoarthritis.. Expert participants were asked to rate interventions based on feasibility, health system effects, universality, impact on inequities, and priority for translation into equity based E4E summaries. Expert participants were also encouraged to make comments to provide context for each rating. Free text responses were coded inductively and grouped into subthemes and themes.

RESULTS

Expert participants rated the intervention home land-based exercise for knee OA highest for priority for translation into an E4E summaries, followed by the interventions individual land-based exercise for knee OA, class land-based exercise for knee OA, exercise for hand OA and land-based exercise for hip OA. Upon qualitative analysis of the expert participants' comments, fifteen subthemes were identified and grouped into three overall themes: (1) this intervention or an aspect of this intervention is unnecessary or unsafe; (2) this intervention or an aspect of this intervention may increase health inequities; and (3) experts noted difficulties completing rating exercise.

CONCLUSION

The list of priority interventions and corresponding expert commentary generated information that will be used to direct and support knowledge translation efforts.

How Are Neighborhood Characteristics Associated With Mental and Physical Functioning Among Older Adults With Radiographic Knee Osteoarthritis?

OBJECTIVE

To examine how neighborhood characteristics are associated with health outcomes among older adults with osteoarthritis.

METHODS

In multilevel, cross-sectional, and longitudinal analyses we examined whether 4 neighborhood characteristics were associated with depressive symptoms and reported knee impact scores, and whether the neighborhood characteristics interacted with race/ethnicity among older adults with radiographic knee osteoarthritis (n = 656 for cross-sectional analyses and n = 434 for longitudinal analyses). The data came from the Johnston County Osteoarthritis Project, a prospective cohort study in North Carolina designed to examine risk factors for osteoarthritis.

RESULTS

Although few longitudinal associations were found, cross-sectional results suggested that greater perceived neighborhood social cohesion (B = -0.04, P < 0.001) and perceived neighborhood resources for physical activity and walking (B = -0.03, P < 0.001) were associated with fewer depressive symptoms, and that greater perceived neighborhood resources for physical activity and walking were associated with higher (better) knee impact scores (B = 0.48, P = 0.008). We also observed 2 significant interactions among neighborhood characteristics and race/ethnicity related to depressive symptoms (P < 0.01); for African American adults, greater perceived neighborhood resources for physical activity and walking were associated with fewer depressive symptoms (B = -0.03, P < 0.001), but for White adults, greater perceived neighborhood safety was associated with fewer depressive symptoms (B = -0.04, P = 0.003).

CONCLUSION

In a sample of older adults with radiographic knee osteoarthritis, neighborhood context mattered, but in nuanced ways. Interventions aiming to improve mental and physical functioning of older adults with knee osteoarthritis can look to this study as evidence for the importance of neighborhood characteristics.

Educational needs of patients with rheumatic and musculoskeletal diseases attending a large health facility in Austria

INTRODUCTION

Patient education is an important part of the management of rheumatic and musculoskeletal diseases. Given that patients with diverse diseases do not have the same needs, it is crucial to assess the educational requirements of targeted groups to provide tailored educational interventions. The aim of our study was to assess educational needs of a large cohort of patients with different rheumatic and musculoskeletal diseases attending a health facility in Austria.

METHODS

We assessed educational needs, via an online survey of patients with fibromyalgia (FMS), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) recruited from an Austrian health-care facility, using the Austrian version of the Educational Needs Assessment Tool (OENAT).

RESULTS

For our sample of 603 patients, AS (62%), RA (15%), and FMS (24%), there were no educational need differences for the domains of movements, disease process, and self-help measures. Patients with FMS had less need for pain management education and greater need for education about feelings, than other disease groups. Patients with RA had a greater need for education related to treatments than other groups, and patients with AS had a greater need for treatment education than patients with FMS. Patients with AS reported greater need for support system education than other patient groups.

CONCLUSION

Educational needs vary by disease groups, suggesting that health-care professionals should assess disease-specific needs for education to provide optimal assistance in disease management for patients.

[Osteoarthrosis in the clinic of internal and occupational diseases: differential diagnostic aspects]

Osteoarthritis is a common pathology, which indicates the great medical and social significance of this disease. The article discusses the issues of pathogenesis, risk factors and diagnosis of professional and professionally caused osteoarthritis: the age of onset of the disease, the specifics of work, the localization of joint damage. Differential diagnosis issues are discussed.

Household air pollution and arthritis in low-and middle-income countries: Cross-sectional evidence from the World Health Organization's study on Global Ageing and Adult Health

Background

Evidence points to a clear link between air pollution exposure and several chronic diseases though investigations regarding arthritis are still lacking. Emerging evidence suggests an association between ambient air pollution and rheumatoid arthritis. Household air pollution exposure, conversely, is largely unstudied but may be an important consideration for arthritis, particularly in low- and middle-income countries (LMICs), where cooking and heating activities can generate high indoor air pollutant levels.

Methods

We investigated the association of household air pollution (electricity vs. gas; kerosene/paraffin; coal/charcoal; wood; or agriculture/crop/animal dung/shrubs/grass as the main fuel used for cooking) and arthritis in six LMICs (China, Ghana, India, Mexico, the Russian Federation, South Africa) using data from Wave I of the World Health Organization Study on Global AGEing and Adult Health (SAGE) (2007–2010). Multivariable analyses were adjusted for sociodemographic, household and lifestyle characteristics and several comorbidities.

Results

The use of gas (aOR = 1.76, 95%CI: 1.40–2.21); coal (aOR = 1.74, 95%CI: 1.22–2.47); wood (aOR = 1.69, 95%CI: 1.30–2.19); or agriculture/crop/animal dung/shrubs/grass: aOR = 1.95 (1.46–2.61) fuels for cooking were strongly associated with an increased odds of arthritis, compared to electricity in cluster and stratified adjusted analyses. Gender (female), age (≥50 years), overweight (25.0 ≤BMI<30.0 kg/m²), obesity (BMI ≥30.0 kg/m²), former and current alcohol consumption, and the comorbidities angina pectoris, diabetes, chronic lung disease, depression and hypertension were also associated with a higher odds of arthritis. Underweight (BMI<18.5 kg/m²) and higher education levels (college/university completed/post-graduate studies) were associated with a lower odds of arthritis.

Conclusions

These findings suggest that exposure to household air pollution from cook fuels is associated with an increased odds of arthritis in these regions, which warrants further investigation.

Identifying Barriers of Arthritis-Related Disability on Food Behaviors to Guide Nutrition Interventions

OBJECTIVE

To describe the impact of arthritis-related disability on aspects of food insecurity and to gain insight into the incentives and barriers to participating in a nutrition intervention.

DESIGN

Four focus groups were held in April to May, 2018. Participants completed questionnaires about socioeconomic status, diet, and health.

SETTING

The Perform Centre, Concordia University, Montreal, Canada.

PARTICIPANTS

A convenience sample of 27 adults diagnosed with arthritis.

PHENOMENON OF INTEREST

Perceived impact of arthritis-related disability on food behaviors as well as incentives and deterrents to participating in a nutrition intervention.

ANALYSIS

Transcriptions of the focus group discussions were coded using the constant comparative method. Basic descriptive statistics were used to analyze the questionnaire data.

RESULTS

The themes of pain, fatigue, knowledge, and social support emerged in discussions on food choices, procurement, preparation, consumption, and other lifestyle behaviors. Participants reported common barriers, although the extent to which they were affected varied. Questionnaire results revealed low disability. Timing, cost, and information quality were important incentives to participate in a nutrition intervention.

CONCLUSIONS AND IMPLICATIONS

Results highlight the need for further research among people with greater limitations related to arthritis and adapted nutrition interventions that provide both knowledge and experience to help individuals overcome the challenges of arthritis.

Relationship of Occupational Category With Risk of Physical and Mental Health Problems

Objectives

We evaluated the physical and mental health problems of waged workers in Korea who had different classes of occupation.

Methods

We used data from the Korean National Health and Nutrition Examination Survey (2007–2017) to examine 22,788 workers who were waged employees and categorized these workers into 5 occupational classes.

Results

“Unskilled manual workers” were more likely to be older, less educated, have lower monthly income, and work fewer hours per week. Among men and relative to “managers and professionals” (reference group), “skilled manual workers” were more likely to have physician-diagnosed osteoarthritis, “clerks” were less likely to report suicidal ideation, and “unskilled manual workers” were more likely to report suicidal ideation. Among women and relative to “managers and professionals” (reference group), “service and sales workers” and “unskilled manual workers” were more likely to report physician-diagnosed osteoarthritis, depressive feelings, and suicidal ideation. However, hypertension, hyperlipidemia, diabetes, and cardiovascular diseases did not differ among the occupational classes for men and women.

Conclusion

We identified differences between men and women and among those in different occupational classes regarding employment status, physical health, and mental health. “Unskilled manual workers” of both genders were more likely to be older, less educated, have less monthly income, work fewer hours per week, and have suicidal ideation. Female “service and sales workers” were more likely to have osteoarthritis, depressive feelings, and suicidal ideation.

An Update on Arthritis in Canada - National and Provincial Data Regarding the Past, Present, and Future

OBJECTIVE

To provide updated arthritis estimates for Canada given a change in wording in the 2015 Canadian Community Health Survey (CCHS) arthritis question.

METHODS

Prevalence data from the 2000 to 2016 CCHS were used to document trends in the prevalence of arthritis over time. Projections of arthritis prevalence were also calculated using data from CCHS 2015 in conjunction with Statistics Canada's published population projections. Data for 2015 were also used to provide summary data on the effect of arthritis.

RESULTS

Between 2000 and 2014 there were some fluctuations in the prevalence of arthritis (age ≥ 15 yrs), with the range of prevalence varying between 15.4% and 17.6%. There was a significant increase in overall prevalence to over 20% with the 2015 and 2016 surveys (6 million Canadians), coinciding with a revised wording of the arthritis question. This increase was observed in all age and sex groups, except for men aged 85+. The overall characteristics of the 2015 arthritis population were similar to those in 2007/08. Using the updated 2015 CCHS arthritis data, projection estimates suggest the population prevalence of arthritis will increase to just over 24% by 2040, with the number of Canadians living with arthritis projected to increase by about 50% from 2015 to 2040.

CONCLUSION

The revised question likely increased ascertainment of arthritis owing to inclusion of examples of arthritis diagnoses in the CCHS question and more explicit wording in the French version, resulting in a large increase in the estimated prevalence and numbers of people with arthritis in Canada.

Characterizing the demographics of chronic pain patients in the state of Maine using the Maine all payer claims database

BACKGROUND

Chronic pain is currently a significant health problem in the United States. A comprehensive strategy is needed to increase prevention of chronic pain and to improve care for chronic pain patients. However, development of a successful strategy relies, in part, on a better understanding of the demographics and socioeconomics of patients living with chronic pain conditions. The current study was designed to understand the burden of chronic pain in the state of Maine by identifying the prevalence of chronic pain and its relationship with selected demographic and socioeconomic factors in Maine.

METHODS

The Maine All Payer Claims Database (MEAPCD) (2006-2011) was used in the secondary data analysis to assess the demographic characteristics (such as age, sex, insurance type, and county of residence) of chronic pain patients in Maine. Chronic pain patients were identified based on the presence of pre-identified chronic pain-associated ICD-9 code(s) and opioid prescription information. Potential associations between the prevalence of chronic pain and a number of socioeconomic factors were determined by comparisons to Maine Census data.

RESULTS

More women in the state were identified as having chronic pain across all counties and all age groups (> 10 years old). Surprisingly, the majority of chronic pain patients were identified based on the diagnostic code criteria and not the opioid prescription criteria. A greater utilization of public health insurance was seen within the chronic pain patients. At the county level, although neither education level nor income were associated with the prevalence of chronic pain, these factors significantly correlated with the usage of public health insurance.

CONCLUSIONS

Further detailed characterization of the chronic pain patient population in the state of Maine, using multiple data sources, can help design population-targeted strategies to prevent and manage chronic pain.

[The feasibility of the application of cryotherapy and radonotherapy for the treatment of the patients presenting with osteoarthritis]

Osteoarthritis (OA) is currently considered to be one of the most widespread diseases. Its main clinical symptoms include pain and dysfunction of joints. In the present review of the foreign and domestic literature, the questions of pathogenesis and risk factors underlying the development of osteoarthritis are discussed. The understanding of OA pathogenesis have altered essentially in the recent years which made necessary the search for the novel approaches to the treatment of this pathology. According to the modern views of OA origin and progression, its therapy should be based on the application of the combination of medicamentous and non-medicamentous modalities including, in particular, collective and individual activities focused on the implementation of the programs of therapeutic physical training as an obligatory component of ОА prophylaxis and treatment. The present review gives evidence of the feasibility of the application of the methods of cryotherapy and radonotherapy for the management of the patients suffering from osteoarthritis. It is emphasized that many recent publications report extensive investigations of the clinical and pathogenetic aspects of the application of these methods for the combined regenerative treatment of the patients presenting with gonarthrosis. The influence of cryotherapy and radonotherapy on the neuroendocrine and immune systems is discussed with special reference to the possibility of regulation of the metabolic processes and retardation of inflammation. It is concluded that the introduction of the above methods into the compulsory individual program for the regenerative treatment of patients presenting with osteoarthritis is pathologically substantiated since it greatly contributes to the reduction of pain and retardation of the progress of the disease. The main pharmaceutical preparations for the OA treatment remain to be slow-acting symptomatic medicines possessed of the chondro-protective effect.

Does the social gradient remain in the dietary habits of a health-conscious population? A study of Seventh-Day Adventists in West Malaysia

Background

Socioeconomic status (SES) is a strong predictor of health, and individuals with higher SES generally have better health than those with lower SES. One of the pathways that SES influences health is through health behaviors, such as dietary intake, and a higher SES has been associated with a better diet. The purpose of this study was to determine whether there was a social gradient in dietary habits among the Seventh-Day Adventists, a group of conservative Christians, where healthy eating is part of the doctrinal teaching.

Methods

Data from a survey of 574 Adventists residing in West Malaysia, aged 18-80 years, were analyzed. Dietary habits were measured using the Nutrition subscale of Health Promoting Lifestyle Profile II.

Results

Education and income were significantly associated with dietary habits before and after controlling for demographics. There was a gradient of association; a higher level of education and higher income were associated with better dietary habits. However, only education remained significantly associated with dietary habits when the other two socioeconomic variables were included. Employment was not significantly associated with dietary habits before or after controlling for demographic variables and the other two sociodemographic variables.

Conclusions

This study showed that education is the strongest predictor of healthy diet, and a social gradient in dietary habits still exists even among health-conscious population.

Assessment of chronic pain and access to pain therapy: a cross-sectional population-based study

Background

Chronic pain (CP) has been shown as an important public health problem, and several studies emphasize the need to strengthen the health care and social systems to reduce its marginalization. This study aimed to: evaluate the epidemiology of CP in the general population in an Italian area; and assess the awareness of a specific law, unanimously approved in Parliament, which provides citizens the right to access pain management (Italian Law 38/2010).

Methods

A cross-sectional population-based study carried out during the spring of 2014 at Narni, Umbria, Italy. All the citizens residing in that area, aged >18, were enrolled in the study. Outcome measures were: prevalence of CP and therapies. The awareness of the Italian Law 38/2010 was also recorded.

Results

Data of 1293 questionnaires were analyzed. The prevalence of CP was 28.4%. In 51.5% of cases, pain was severe, with higher prevalence in females (p<0.001). Moreover, pain was generally increasing with age (p<0.001). The risk of suffering from severe pain was modeled using logistic regression. Significant predictors were female gender (OR 2.59; 95% CI: 1.77–3.79), living in an urban area (OR 0.63; 95% CI 0.45–0.88), and age (OR 1.06; 95% CI: 1.04–1.08). Among people with CP, 77.9% were receiving therapy; the proportion of individuals in therapy for severe pain significantly increased with age (OR 1.03; 95% CI: 1.02–1.05) and was smaller in individuals with light pain (OR 0.21; 95% CI: 0.07–0.66). The majority of subjects (61.9%) are not aware of the existence of a specific law stating their rights to receive pain management.

Conclusion

CP, at least in the rural part of the community investigated in Italy, is not perceived as a chronic disease in its own right. A socio-cultural transformation in patients and in the health care system seems necessary.

Population-Based Study of Changes in Arthritis Prevalence and Arthritis Risk Factors Over Time: Generational Differences and the Role of Obesity

OBJECTIVE

To investigate cohort effects in arthritis prevalence across 4 birth cohorts: World War II (born 1935-1944), older and younger baby boomers (born 1945-1954 and 1955-1964, respectively), and Generation X (born 1965-1974), and to determine whether birth cohort effects in arthritis prevalence were associated with differences in risk factors over time or period effects.

METHODS

Analysis of biannually collected data from the longitudinal Canadian National Population Health Survey, 1994-2011 (n = 8,817 at baseline). Data included self-reported arthritis diagnosed by a health professional, risk factors (years of education, household income, smoking, physical activity, sedentary behavior, body mass index [BMI]), and survey year as an indicator of period. We used hierarchical age-period-cohort analyses to compare the age trajectory of arthritis by birth cohort and to examine the contribution of changes in risk factors and period to cohort differences.

RESULTS

More recent cohorts had successively a greater prevalence of arthritis. Risk factors were significantly associated with arthritis prevalence independently of cohort differences. The effects of increasing education and income over time on potentially reducing the arthritis prevalence were almost counter-balanced by effects of increasing BMI. Significant cohort-BMI and age-BMI interactions indicated an earlier age of arthritis onset for obese individuals than those of normal weight.

CONCLUSION

Projections that only take into account the changing age structure of the population may underestimate future trends. Our understanding of the impact of BMI on arthritis is likely an underestimate. Cohort differences focus attention on the need to target arthritis management education to young and middle-aged adults.

Association of regional and cultural factors with the prevalence of rheumatoid arthritis in the Mexican population: a multilevel analysis

BACKGROUND

The overall estimated prevalence of rheumatoid arthritis (RA) in Mexico is 1.6%, but there are major variations in different geographic areas of the country.

OBJECTIVE

This study aimed to determine the impact of individual and regional variables on the geographic distribution of RA in Mexico.

METHODS

This multilevel analysis used data from a cross-sectional study that investigated the prevalence of RA among 19,213 individuals older than 18 years throughout 5 geographic regions in Mexico. Logistic regression models were used to determine predictors of RA, including individual and regional variables as well as cultural factors. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were determined.

RESULTS

The prevalence of RA varied from 0.77% to 2.8% across the 5 regions. Individual factors associated with RA were sex (OR, 2.32; 95% CI, 1.74-3.07), previous medical diagnosis of RA ( OR 3.3, 95%CI: 2919–5.1 [corrected]), disability (OR, 2.07; 95% CI, 1.48-2.93), and the 56- to 65-year age group (OR, 1.95; 95% CI, 1.08-3.74). The regional factor of speaking an indigenous language had an OR of 2.27 (95% CI, 1.13-4.55).

CONCLUSIONS

Various individual and regional factors were associated with variations in the prevalence of RA in the Mexican population.

The impact of arthritis on the physical function of a rural Maya-Yucateco community and factors associated with its prevalence: a cross sectional, community-based study

This study aims to evaluate the impact of arthritis on the physical function of people living in a Maya-Yucateco rural community and to assess the association of known modifiable risk factors with the prevalence of overall arthritis and its main types (osteoarthritis and rheumatoid arthritis). Using a cross-sectional, community-based census design, data collected from the adult population (≥18 years) of the Municipality of Chankom, Yucatán, México, were analyzed (n = 1523). Participants’ physical function was assessed using a culturized version of the health assessment questionnaire disability index. Social, physical, and behavioral factors linked to overall arthritis, osteoarthritis, and rheumatoid arthritis, were assessed through the “Community-Oriented-Program-for-the-Control-of-Rheumatic-Diseases [COPCORD]” questionnaire. A physiatrist and a rheumatologist confirmed all osteoarthritis and rheumatoid arthritis cases using the American College of Rheumatology criteria. Arthritis was confirmed in 169 cases (22 %, 95 % confidence interval (CI) 19–25) of those assessed for musculoskeletal symptoms (n = 779): osteoarthritis = 144, rheumatoid arthritis = 17, and non-specific arthritis = 8. Arthritis was associated with a higher prevalence of disability after controlling for age, gender, and number of comorbidities (odds ratio = 4.0, 95 % CI 3.0–6.0). Higher level of wealth was associated with lower arthritis prevalence (odds ratio = 0.9, 95% CI 0.8–0.9). Higher body mass index was associated with higher hip and/or knee osteoarthritis prevalence (odds ratio = 1.1, 95 % CI 1.03–1.1). Arthritis is highly associated with disability in the Mayan people living in Chankom. The prevalence of arthritis in Chankom is associated with social factors, such as people’s level of wealth, while the prevalence of low-extremity osteoarthritis is associated with people’s body mass index.

Socio-economic status and the risk of developing hand, hip or knee osteoarthritis: a region-wide ecological study

OBJECTIVE

To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level.

DESIGN

Retrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009-2012) were eligible.

OUTCOMES

Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes.

RESULTS

Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93-1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively.

CONCLUSIONS

Deprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities.

Individual and community socioeconomic status: impact on mental health in individuals with arthritis

To examine the impact of individual and community socioeconomic status (SES) measures on mental health outcomes in individuals with arthritis, participants with self-reported arthritis completed a telephone survey assessing health status, health attitudes and beliefs, and sociodemographic variables. Regression analyses adjusting for race, gender, BMI, comorbidities, and age were performed to determine the impact of individual and community level SES on mental health outcomes (i.e., Medical Outcomes Study SF-12v2 mental health component, the Centers for Disease Control and Prevention Health-Related Quality of Life Healthy Days Measure, Center for Epidemiological Studies Depression [CES-D] scale). When entered singly, lower education and income, nonmanagerial occupation, non-homeownership, and medium and high community poverty were all significantly associated with poorer mental health outcomes. Income, however, was more strongly associated with the outcomes in comparison to the other SES variables. In a model including all SES measures simultaneously, income was significantly associated with each outcome variable. Lower levels of individual and community SES showed most consistent statistical significance in association with CES-D scores. Results suggest that both individual and community level SES are associated with mental health status in people with arthritis. It is imperative to consider how interventions focused on multilevel SES factors may influence existing disparities.

The pathway to orthopaedic surgery: a population study of the role of access to primary care and availability of orthopaedic services in Ontario, Canada

OBJECTIVE

To examine the impact of access to primary care physicians (PCPs), geographic availability of orthopaedic surgeons, socioeconomic status (SES), proportion of older population (≥65 years) and proportion of rural population on orthopaedic surgeon office visits and orthopaedic surgery.

DESIGN

Population multilevel study.

SETTING

Ontario, Canada.

PARTICIPANTS

Ontario residents 18 years or older who had visits to orthopaedic surgeons or an orthopaedic surgery for musculoskeletal disorders in 2007/2008.

PRIMARY AND SECONDARY OUTCOMES

Office visits to orthopaedic surgeons and orthopaedic surgery.

RESULTS

Access to PCPs and the index of geographic availability of orthopaedic surgeons, but not SES, were significantly associated with orthopaedic surgeon office visits. There was a significant interaction between access to PCPs and orthopaedic surgeon geographic availability for the rate of office visits, with access to PCPs being more important in areas of low geographic availability of orthopaedic surgeons. After controlling for office visits with orthopaedic surgeons, the index of geographic availability of orthopaedic surgeons was no longer significantly associated with orthopaedic surgery.

CONCLUSIONS

The findings suggest that, particularly, in areas with low access to PCPs or with fewer available orthopaedic surgeons, residents are less likely to have orthopaedic surgeon office visits and in turn are less likely to receive surgery. Efforts to address adequate access to orthopaedic surgery should also include improving and facilitating access to PCPs for referral, particularly in geographic areas with low orthopaedic surgeon availability.

Associations of alcohol consumption and mental health with the prevalence of arthritis among US adults: data from the 2012 National Health Interview Survey

The findings of association between alcohol consumption and arthritis are mixed while little is known about age differences in the associations of mental health and behavioral factors with arthritis. This study aimed to estimate the prevalence and associated factors of arthritis among US adults using data from the 2012 National Health Interview Survey. In total, 8,229 adults with arthritis and 26,256 controls were selected from the adult respondents. Weighted univariate and multiple logistic regression analyses were used to estimate the odds ratios (ORs) with 95 % confidence intervals. The overall prevalence of arthritis was 22.1 %. The prevalence increased with age (6.8, 29.6, and 47.9 % for 18-49, 50-64, and 65+ years of age, respectively). The prevalence of mental problems was higher in cases than controls [4 vs. 1 % for serious psychological distress (SPD), 29 vs. 16 % for anxiety, and 26 vs. 11 % for depression, respectively]. Multiple logistic regression analyses showed that being female, older age, smoking, alcohol consumption, obesity, SPD, depression, and anxiety were positively associated with arthritis. Stratified by age, SPD was associated with arthritis only in young adults (18-49 years old) while the ORs of anxiety and depression with arthritis decreased as age increased. Alcohol consumption revealed stronger associations in middle-aged adults and elderly. Using a large nationally representative sample in the USA, alcohol consumption, smoking, SPD, anxiety, and depression were associated with arthritis, and the associations varied across different age groups.

The Association between a History of Parental Addictions and Arthritis in Adulthood: Findings from a Representative Community Survey

Aims. To examine the relationship between a history of parental addictions and the cumulative lifetime incidence of arthritis while controlling for age, sex, race, and four clusters of risk factors: (1) other adverse childhood experiences, (2) adult health behaviors (i.e., smoking, obesity, inactivity, and alcohol consumption), (3) adult socioeconomic status and (4) mental health. Materials and Methods. Secondary analysis of 13,036 Manitoba and Saskatchewan respondents of the population-based 2005 Canadian Community Health Survey. Sequential logistic regression analyses were conducted. Findings. After controlling for demographic characteristics, including age, gender, and race, respondents who reported a history of parental addictions had significantly higher odds of arthritis in comparison to individuals without (OR=1.58; 95% CI 1.38–1.80). Adjustment for socioeconomic status, adult health behaviors, and mental health conditions had little impact on the parental addictions and arthritis relationship. The association between parental addictions and arthritis was substantially reduced when adverse childhood experiences (OR=1.33; 95% CI 1.15–1.53) and all four groups of risk factors collectively (OR=1.30; 95% CI = 1.12–1.51) were included in the analyses; however, the relationship remained statistically significant. Conclusions. A robust association was found between parental addictions and cumulative lifetime incidence of arthritis. This link remained even when controlling for four groups of potential risk factors.

Chronic pain epidemiology - where do lifestyle factors fit in?

Chronic pain is common and complex and has a large impact on individuals and society. Good epidemiological pain data provide key information on the use of resources (both in general practice and in specialist clinics), insight into factors that lead to or favour chronicity and the design of interventions aimed at reducing or preventing the effects of chronic pain. This review aims to highlight the important factors associated with chronic pain, including those factors which are amenable to lifestyle intervention.

Associations of educational attainment, occupation, and community poverty with hip osteoarthritis

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% white 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 and symptomatic OA in one or both hip joints. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of each hip OA outcome with each SES variable separately, and then with all SES measures simultaneously. Associations between hip OA outcomes and SES variables were evaluated for effect modification by race and sex.

RESULTS

Living in a community of high household poverty rate showed independent associations with hip radiographic OA in one or both hips (OR 1.50, 95% CI 1.18-1.92) and bilateral (both hips) radiographic OA (OR 1.87, 95% CI 1.32-2.66). Similar independent associations were found between low educational attainment among those with symptomatic OA in one or both hips (OR 1.44, 95% CI 1.09-1.91) or bilateral symptomatic OA (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 sex modify the associations.

CONCLUSION

Our data provide evidence that hip OA outcomes are associated with both education and community SES measures, associations that remained after adjustment for covariates and all SES measures.

Comparison of health-related outcomes for arthritis, chronic joint symptoms, and sporadic joint symptoms: a population-based study

OBJECTIVE

To examine predictors and health outcomes for individuals reporting arthritis, chronic joint symptoms (CJS), or sporadic joint symptoms (SJS) compared to those without arthritis or joint symptoms.

METHODS

Data from the 2008 Canadian Community Health Survey (n = 63,134, ages ≥15 years) were used for the analyses. Respondents not reporting arthritis as a long-term chronic health condition diagnosed by a health professional were asked about joint symptoms, excluding the back and neck, over the past 12 months and whether these symptoms were present on most days in the past month (CJS) or not (SJS). Log Poisson regression was used to estimate prevalence ratios (PRs) for reporting arthritis, CJS, and SJS, and for reporting health outcomes (physical activity, pain that limits activity, activity limitation, poor/fair self-rated health, and poor/fair self-rated mental health) and health service use (visits to primary care physicians, specialists, physiotherapists, and chiropractors, and overnight hospital stays).

RESULTS

Arthritis was reported by 16.0% of the population, CJS by 10.1%, and SJS by 11.6%. Individuals with arthritis were older than those with CJS or SJS. Women reported arthritis and CJS more often. After adjusting for age, sex, socioeconomic status, lifestyle factors, and comorbidities, PRs of all outcomes were higher for the arthritis and CJS groups than the SJS group, with no significant differences in PRs for the arthritis and CJS groups, except for pain that limits activity.

CONCLUSION

CJS were reported by 10% of the adult population. Similarities in outcomes to arthritis suggest that CJS have a substantial impact in the population, and that arthritis management advice is likely needed for this group.

Social determinants and osteoarthritis outcomes

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.

Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: results from the World Health Survey

BACKGROUND

Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups.

METHODS

Using 2002-04 World Health Survey data from 41 low- and middle-income countries, the prevalence estimates of angina, arthritis, asthma, depression, diabetes and comorbidity in adults aged 18 years or above are presented for wealth quintiles and five education levels, by sex and country income group. Symptom-based classification was used to determine angina, arthritis, asthma and depression rates, and diabetes diagnoses were self-reported. Socioeconomic inequalities according to wealth and education were measured absolutely, using the slope index of inequality, and relatively, using the relative index of inequality.

RESULTS

Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality.

CONCLUSIONS

Noncommunicable diseases are not necessarily diseases of the wealthy, and showed unequal distribution across socioeconomic groups in low- and middle-income country groups. Disaggregated research is warranted to assess the impact of individual noncommunicable diseases according to socioeconomic indicators.

Associations of educational attainment, occupation and community poverty with knee osteoarthritis in the Johnston County (North Carolina) osteoarthritis project

Introduction

The purpose of this study was to examine data from the Johnston County Osteoarthritis (OA) Project for independent associations of educational attainment, occupation and community poverty with tibiofemoral knee OA.

Methods

A cross-sectional analysis was conducted on 3,591 individuals (66% Caucasian and 34% African American). Educational attainment (< 12 years or ≥12 years), occupation (non-managerial or not), and Census block group household poverty rate (< 12%, 12 to 25%, > 25%) were examined separately and together in logistic models adjusting for covariates of age, gender, race, body mass index (BMI), smoking, knee injury and occupational activity score. Outcomes were presence of radiographic knee OA (rOA), symptomatic knee OA (sxOA), bilateral rOA and bilateral sxOA.

Results

When all three socioeconomic status (SES) variables were analyzed simultaneously, low educational attainment was significantly associated with rOA (odds ratio (OR) = 1.44, 95% confidence interval (CI) 1.20, 1.73), bilateral rOA (OR = 1.43, 95% CI 1.13, 1.81), and sxOA (OR = 1.66, 95% CI 1.34, 2.06), after adjusting for covariates. Independently, living in a community of high household poverty rate was associated with rOA (OR = 1.83, 95% CI 1.43, 2.36), bilateral rOA (OR = 1.56, 95% CI 1.12, 2.16), and sxOA (OR = 1.36, 95% CI 1.00, 1.83). Occupation had no significant independent association beyond educational attainment and community poverty.

Conclusions

Both educational attainment and community SES were independently associated with knee OA after adjusting for primary risk factors for knee OA.

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

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.

METHODS

From 2004-2005, 968 participants completed a telephone survey assessing health status, chronic conditions, community characteristics, and sociodemographic variables. Individual-level SES measures used included homeownership, occupation (professional or not), educational attainment (less than high school, high school degree, and more than high school), and income (<$15,000, $15,000-$45,000, and >$45,000). Community poverty (2000 US Census block group percentage of individuals living below the poverty line [low, medium, and high]) was used as a community-level SES measure. Outcomes were physical functioning (Medical Outcomes Study Short Form 12 version 2 physical component summary [PCS]), functional disability (Health Assessment Questionnaire [HAQ]), and the Centers for Disease Control and Prevention (CDC) Health-Related Quality of Life (HRQOL) Healthy Days physical and limited activity days, and were analyzed via multivariable regressions.

RESULTS

When entered separately, all individual-level SES variables were significantly (P < 0.01) associated with poorer PCS, HAQ, and CDC HRQOL scores. A higher magnitude of effect was seen for household income, specifically <$15,000 per year in final models with all 4 individual SES measures and community poverty. The magnitude of effect for education is reduced and marginally significant for the PCS and number of physically unhealthy days. No effects were seen for occupation, homeownership, and community poverty.

CONCLUSION

Findings confirm that after adjusting for important covariates, lower individual- and community-level SES measures are associated with poorer physical health outcomes, while household income is the strongest predictor (as measured by both significance and effect) of poorer health status in final models. Studies not having participant-reported income available should make use of other SES measures, as they do independently predict physical health.

Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: a multilevel model

Background

Diarrhoea disease which has been attributed to poverty constitutes a major cause of morbidity and mortality in children aged five and below in most low-and-middle income countries. This study sought to examine the contribution of individual and neighbourhood socio-economic characteristics to caregiver's treatment choices for managing childhood diarrhoea at household level in sub-Saharan Africa.

Methods

Multilevel multinomial logistic regression analysis was applied to Demographic and Health Survey data conducted in 11 countries in sub-Saharan Africa. The unit of analysis were the 12,988 caregivers of children who were reported to have had diarrhoea two weeks prior to the survey period.

Results

There were variability in selecting treatment options based on several socioeconomic characteristics. Multilevel-multinomial regression analysis indicated that higher level of education of both the caregiver and that of the partner, as well as caregivers occupation were associated with selection of medical centre, pharmacies and home care as compared to no treatment. In contrast, caregiver's partners' occupation was negatively associated with selection medical centre and home care for managing diarrhoea. In addition, a low-level of neighbourhood socio-economic disadvantage was significantly associated with selection of both medical centre and pharmacy stores and medicine vendors.

Conclusion

In the light of the findings from this study, intervention aimed at improving on care seeking for managing diarrhoea episode and other childhood infectious disease should jointly consider the influence of both individual SEP and the level of economic development of the communities in which caregivers of these children resides.

Migration and health in Canada: health in the global village

BACKGROUND

Immigration has been and remains an important force shaping Canadian demography and identity. Health characteristics associated with the movement of large numbers of people have current and future implications for migrants, health practitioners and health systems. We aimed to identify demographics and health status data for migrant populations in Canada.

METHODS

We systematically searched Ovid MEDLINE (1996-2009) and other relevant web-based databases to examine immigrant selection processes, demographic statistics, health status from population studies and health service implications associated with migration to Canada. Studies and data were selected based on relevance, use of recent data and quality.

RESULTS

Currently, immigration represents two-thirds of Canada's population growth, and immigrants make up more than 20% of the nation's population. Both of these metrics are expected to increase. In general, newly arriving immigrants are healthier than the Canadian population, but over time there is a decline in this healthy immigrant effect. Immigrants and children born to new immigrants represent growing cohorts; in some metropolitan regions of Canada, they represent the majority of the patient population. Access to health services and health conditions of some migrant populations differ from patterns among Canadian-born patients, and these disparities have implications for preventive care and provision of health services.

INTERPRETATION

Because the health characteristics of some migrant populations vary according to their origin and experience, improved understanding of the scope and nature of the immigration process will help practitioners who will be increasingly involved in the care of immigrant populations, including prevention, early detection of disease and treatment.

The effects of rurality on mental and physical health

The effects of rurality on physical and mental health are examined in analyses of a national dataset, the Community Tracking Survey, 2000-2001, that includes individual level observations from household interviews. We merge it with county level data reflecting community resources and use econometric methods to analyze this multi-level data. The statistical analysis of the impact of the choice of definition on outcomes and on the estimates and significance of explanatory variables in the model is presented using modern econometric methods, and differences in results for mental health and physical health are evaluated.

The robust association between childhood physical abuse and osteoarthritis in adulthood: findings from a representative community sample

OBJECTIVE

Research suggests a role of early-life trauma in the development of arthritis. This study investigated the relationship between childhood physical abuse and osteoarthritis (OA) while controlling for age, sex, race, and socioeconomic status (SES), in addition to the following types of risk factors for OA: 1) concurrent childhood stressors, 2) adult health behaviors, and 3) depression.

METHODS

Data from the provinces of Manitoba and Saskatchewan were selected from the 2005 Canadian Community Health Survey (n = 13,093). Respondents with missing arthritis data or with arthritis types other than OA were excluded (n = 1,985). Of the 11,108 remaining respondents, 6.9% (n = 854) reported childhood physical abuse by someone close to them, and 10.1% (n = 1,452) reported that they had been diagnosed with OA by a health professional. The regional-level response rate was 84%.

RESULTS

When adjusting for all 3 types of risk factors, a significant association between childhood physical abuse and OA was found (odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.21-2.00). In contrast, when adjusting for age, sex, race, and SES only, the OR was 1.99 (95% CI 1.57-2.52).

CONCLUSION

The association between childhood physical abuse and OA remained significant, even after controlling for many risk factors that may mediate the relationship. Further research is needed to investigate potential pathways through which arthritis develops as a consequence of childhood physical abuse.

Association of functional outcome with both personal- and area-level socioeconomic inequalities in patients with inflammatory polyarthritis

Objective

To describe the relationship between baseline area- and person-level social inequalities and functional disability at 3 years in patients with early inflammatory polyarthritis (IP).

Methods

A total of 1,393 patients with new-onset IP were recruited and allocated an Index of Multiple Deprivation (IMD) 2004 score based on their area of residence, and a social class based on baseline self-reported occupation. Differences in the Health Assessment Questionnaire (HAQ) score at baseline and 3 years by IMD or social class were tested. The mean 3-year change in HAQ score was compared by IMD and social class, and interactions between these measures examined.

Results

Patients from more deprived areas had poorer 3-year HAQ outcome than those from less deprived areas (P = 0.019, adjusted for baseline HAQ score, age, sex, and symptom duration). The mean difference in HAQ change was most notable between the most deprived (IMD4) and least deprived areas (IMD1) (0.22; 95% confidence interval [95% CI] 0.11, 0.34). There was also a significant difference in HAQ score change between patients of the highest (SCI and II) and lowest social class (SCIV and V) (0.11; 95% CI 0.02, 0.20). For the mean (95% CI) 3-year change in HAQ score, a significant interaction exists between IMD score and social class and their association with HAQ scores (P = 0.001) to modify outcome: IMD1/SC I and II −0.23 (95% CI −0.40, −0.06) versus IMD 4/SC IV and V 0.15 (95% CI −0.05, 0.34).

Conclusion

Person- and area-level inequalities combine to modify outcome for rheumatoid arthritis. A person's social circumstance and residential environment have independent effects on outcome and are not just alternative measures of the same exposure.

Arthritis in the family practice setting: associations with education and community poverty

OBJECTIVE

To examine associations of self-reported arthritis in 25 urban and rural family practice clinics with education (individual socioeconomic status) and community poverty (community socioeconomic status).

METHODS

A total of 7,770 patients at 25 family practice sites across North Carolina self-reported whether they had arthritis. Education was measured as less than a high school (HS) degree, a HS degree, and more than a HS degree. The US Census 2000 block group poverty rate (percentage of households in poverty in that block group) was grouped into low, middle, and high tertiles. We assumed heterogeneity by race (non-Hispanic white and African American) for the effects of these sociodemographic variables, and therefore stratified by race. Multilevel analyses were performed using a 2-level mixed logistic model to examine the independent associations and joint effects of education and poverty with self-reported arthritis as the outcome, adjusting for age, sex, and body mass index.

RESULTS

White participants with less than a HS degree living in block groups with high poverty had 1.55 times the odds (95% confidence interval [95% CI] 1.10-2.17) of reporting arthritis compared with white participants with more than a HS degree and low poverty rates. African American participants with less than a HS degree and high poverty rates had 2.06 times the odds (95% CI 1.16-3.66) of reporting arthritis compared with African American participants with more than a HS degree and low poverty rates.

CONCLUSION

In the family practice setting, both disadvantaged white and African American participants showed increased odds of self-reported arthritis, with stronger associations in African Americans.