An additional dimension to health inequalities: disease severity and socioeconomic position

Eachus, Jenny; Chan, Philip; Pearson, Nicky; Propper, Carol; Smith, George Davey

doi:10.1136/jech.53.10.603

Cited by 86 publications

(74 citation statements)

References 31 publications

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“…Disability, rather than experience of CP, was associated with social disadvantage in middle age [10], and with deprivation [11]. SES was more strongly associated with CP for men than for women.…”

Section: Does the Recent Evidence Support An Association Between Cp Andmentioning

confidence: 88%

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Socioeconomic Status and the Course and Consequences of Chronic Pain

Bonathan¹,

Hearn

Williams

2013

Pain Manage.

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This article consists of a brief overview of the relationship between chronic pain (CP) and socioeconomic status (SES), a review of recent studies conducted in 2010 and then a discussion of the psychological meaning of the findings in light of wider understanding about SES and health [Bonathan C, Unpublished Data]. Chronic or persistent pain affects people across their lifespan, with significant impact on all aspects of life. It is associated with economic and social disadvantage [1], loss of work [2] and reduced work effectiveness [3].The risk factors for CP are similar to those for many chronic health conditions [4], but while sex and age are routinely considered, less attention is paid to unhealthy behaviors, such as smoking [5], and to other markers of SES. The biopsycho social model describes interacting factors in the onset, experience and outcome of CP. It pays particular attention to the role of emotional states, health beliefs and pain-related behaviors [6]. The social aspects are arguably the least explored [3], and this article focuses on an important aspect of the social environment; SES. There are two dimensions: economic (financial and material wealth) and social (such as education and community standing). Socioeconomic factors, such as lower levels of education, low income and unemployment are associated with higher rates of chronic and disabling pain [7]. However, the nature of the relationship between chronic pain and SES is unclear. Review methodsGiven that a thorough review was conducted in 1998 [8], we searched for papers examining the link between chronic pain and SES dated from 1998 to the present time. Databases such as PsycINFO, MEDLINE and Embase were used. Searches for references of relevant papers, combining terms, such as chronic and persistent pain, and all categories of SES were carried out. Of the 143 studies retrieved, 75 measured only partial aspects of SES and/or did not explore its relationship with chronic pain, 39 described treatment outcome, and 22 fell short of the inclusion criteria in other ways. This left seven studies, to which six were added from reference lists of reviews. Adjusting and rerunning the search with terms used in these studies (e.g., 'disabling pain') produced no new studies.

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Section: Does the Recent Evidence Support An Association Between Cp Andmentioning

confidence: 88%

“…Two studies included area-level measures, such as the Townsend Index (a composite of home ownership, car ownership, unemployment and overcrowding) [10,11]. Both individual-and area-level factors have an impact on health and both can be targets for interventions [12].…”

Section: Does the Recent Evidence Support An Association Between Cp Andmentioning

confidence: 99%

Socioeconomic Status and the Course and Consequences of Chronic Pain

Bonathan¹,

Hearn

Williams

2013

Pain Manage.

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“…87,88 Furthermore, people living in adverse socioeconomic circumstances not only experience more pain; they also experience more severe pain. 89,90 There is some evidence to show that neighbourhood deprivation, low levels of education and (perceived) income inequalities are associated with the onset of pain interfering with daily activities. 91 In contrast, in the USA, higher neighbourhood socioeconomic status was associated with lower reporting of arthritic pain 92 and (in a separate study) better chronic pain outcomes at tertiary-level pain management.…”

Section: Non-modifiable Factors Associated With Painmentioning

confidence: 99%

Chronic pain epidemiology – where do lifestyle factors fit in?

Hecke

Torrance

Smith

2013

British Journal of Pain

149

104

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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.

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“…There is evidence that gender differences are linked to a range of factors, including variations in the physiology of pain processing and in the frequency of diseases that give rise to disability and pain, as well as cultural and social influences on illness and health care seeking [16]. Social inequalities that are present in the middle ages appear to continue beyond statutory retirement age and may contribute to the pattern of association between pain and mobility limitation in older people, through both higher rates of disease and poorer health that give rise to pain and disability, and social and educational barriers to gaining optimal health care [17][18][19][20][21][22][23]. Our fourth objective was to investigate whether these previously observed sociodemographic variations in pain and disability affect the link between pain and mobility limitation or explain the rise in mobility limitation with age.…”

Section: Introductionmentioning

confidence: 99%

Patterns of pain and mobility limitation in older people: cross-sectional findings from a population survey of 18,497 adults aged 50 years and over

et al. 2008

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Mobility limitation is the most common disability in the general population, and pain is a frequent symptom at older ages. We have investigated the association of different patterns of pain and mobility limitation in a large sample of older adults. A cross-sectional postal survey of all adults aged 50 years and over registered with eight general practices in North Staffordshire, UK, resulted in 18,497 respondents (adjusted response=70.8%). Information on demographics, recent pain and the self-reported level of mobility limitation was collected. Associations between pain and mobility limitation were assessed using a partial proportional odds model, taking into account age, gender and socio-economic status. Limitation in walking 100 yards was reported by 29% of respondents. Limitation increased sharply with age, and was higher in the female and lower socio-economic groups. Persons reporting pain were significantly more likely to report limitation. The relationship between mobility limitation and pain was stronger in the youngest age group, but proportionally more people in the oldest age groups have mobility limitation associated with pain. Lower limb and multiple pains present a potential target for the prevention of mobility limitation up to the oldest age groups.

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An additional dimension to health inequalities: disease severity and socioeconomic position

Cited by 86 publications

References 31 publications

Socioeconomic Status and the Course and Consequences of Chronic Pain

Socioeconomic Status and the Course and Consequences of Chronic Pain

Chronic pain epidemiology – where do lifestyle factors fit in?

Patterns of pain and mobility limitation in older people: cross-sectional findings from a population survey of 18,497 adults aged 50 years and over

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