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

Abstract

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 osteoarthritis (OA) Methods: We conducted a 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 and 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 and used a validated tool to estimate income quintile, as well as education level and occupation type, for both the patient and their parents. Results: We recruited 154 patients and excluded 8 patients. 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 association for estimated income and all scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension. Maternal education was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES measures. Conclusions Current and – to a lesser extent – childhood Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. Awareness of life–course SES can help identify patients at risk for worse outcomes.

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

“…In this regard, one of several recent papers, such as that by Rahman et al, 36 show that even if surgery is forthcoming, a past experience of greater deprivation than not tends to be significantly associated with an increased post operative length of stay, non-home discharge sites, emergency department visits, and readmissions This was a finding that was more stark than that of Edwards et al, 37 and Pollard et al, 23 but one supported by the observations of Jordan et al 38 According to Pisarty-Alatorre et al, 39 current socioeconomic status does impact functional status, quality of life and disability amongst cases with osteoarthritis and more research to elucidate the relationships between childhood socioeconomic status indicators and osteoarthritis outcomes as assessed over the life course may prove useful in identifying patients at risk for worse outcomes, a notion supported by Kemp et al, 40 who investigated whether adults with multiple possible social disadvantage experiences would tend to have poorer outcomes following attendance in an osteoarthritis management program, and if so, what might determine this result, and Sheth et al, 41 More equitable resource access and targeted early intervention is also indicated 31,[42][43][44] to avert a perpetual cycle of deprivation that limits opportunities, literacy, education, and service options, and/or forces or reinforces an adult to undertake stressful work or repetitive work. 45 On the other hand, a state of perpetual deprivation may further impact joint vulnerability and osteoarthritis risk and outcomes due to its immeasurable impact on expectations, self-perceptions, pain and self beliefs 46,47 and possible mechanical loading and excess joint stress of occupational or obesity origin or both.…”