Independent associations of socioeconomic factors with disability and pain in adults with knee osteoarthritis

Abstract

BackgroundThe purpose of this study is to explore the relationship between function, pain and stiffness outcomes with individual and community socioeconomic status (SES) measures among individuals with radiographic knee osteoarthritis (rOA).MethodsCross-sectional data from the Johnston County Osteoarthritis Project were analyzed for adults age 45 and older with knee rOA (n = 782) and a subset with both radiographic and symptomatic knee OA (n = 471). Function, pain and stiffness were measured using the Western Ontario and McMasters Universities Index of Osteoarthritis (WOMAC). Individual SES measures included educational attainment (<12 years, ≥12 years) and occupation type (managerial, non-managerial), while community SES was measured using Census block group poverty rate (<12%, 12-25%, ≥25%). SES measures were individually and simultaneously examined in linear regression models adjusting for age, gender, race, body mass index (BMI), occupational physical activity score (PAS), comorbidity count, and presence of hip symptoms.ResultsIn analyses among all individuals with rOA, models which included individual SES measures were observed to show that occupation was significantly associated with WOMAC Function (β =2.91, 95% Confidence Interval (CI) = 0.68-5.14), WOMAC Pain (β =0.93, 95% CI = 0.26-1.59) and WOMAC Total scores (β =4.05, 95% CI = 1.04-7.05), and education was significantly associated with WOMAC Function (β =3.57, 95% CI = 1.25-5.90) and WOMAC Total (β =4.56, 95% CI = 1.41-7.70) scores. In multivariable models including all SES measures simultaneously, most associations were attenuated. However, statistically significant results for education remained between WOMAC Function (β =2.83, 95% CI = 0.38-5.28) and WOMAC Total (β =3.48, 95% CI = 0.18-6.78), as well as for the association between occupation and WOMAC Pain (β =0.78, 95% CI = 0.08-1.48). In rOA subgroup analyses restricted to those with symptoms, we observed a significant increase in WOMAC Pain (β =1.36, 95% CI = 0.07-2.66) among individuals living in a block group with poverty rates greater than 25%, an association that remained when all SES measures were considered simultaneously (β =1.35, 95% CI = 0.06-2.64).ConclusionsLower individual and community SES are both associated with worse function and pain among adults with knee rOA.

The Prevalence of Symptomatic Knee Osteoarthritis in China: Results From the China Health and Retirement Longitudinal Study

“…For example, the prevalence of symptomatic knee OA was higher among subjects who received less education compared with those who received more education (26,27) and among those who lived in communities with high poverty rates (28). Our study also demonstrated that symptomatic knee OA was more common among persons living in rural areas compared with urban areas in China; this finding was consistent with those of previous studies SYMPTOMATIC KNEE OSTEOARTHRITIS IN CHINA 651 (13,14).…”

“…Our study also demonstrated that symptomatic knee OA was more common among persons living in rural areas compared with urban areas in China; this finding was consistent with those of previous studies SYMPTOMATIC KNEE OSTEOARTHRITIS IN CHINA 651 (13,14). Given that residents living in less-developed or rural areas often have limited resources, including fewer clinics, safe options for public transportation, community centers, and safe places to exercise, as well as poorly kept sidewalks and less access to safe streets (28)(29)(30), studies of the impact of symptomatic knee OA on the residents in these communities are urgently needed. We demonstrated an apparent geographic variation in the prevalence of symptomatic knee OA in China.…”

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

“…The key demographic factors considered important to include in the Standard Set were patient age, sex, and socioeconomic status 35, 36, 37. Although many different indicators of socioeconomic status have been published in the literature, only education level as defined by the International Standard Classification of Education can be considered consistent across countries and cultures for international use 36, 38.…”

Musculoskeletal malignant neoplasms hospitalisation in Victoria

“…The Johnston County Project is an ongoing, longitudinal, population-based study of knee and hip osteoarthritis that includes both rural and urban communities in North Carolina. [5] Callahan et al [6] have shown that both low levels of education and living in a community with a household poverty rate greater than 25% are independently associated with the risk for radiographic and symptomatic knee osteoarthritis. Cleveland et al [5] found that individuals with knee osteoarthritis who are at the highest risk of developing disability and pain have lower SES.…”

“…[5] Callahan et al [6] have shown that both low levels of education and living in a community with a household poverty rate greater than 25% are independently associated with the risk for radiographic and symptomatic knee osteoarthritis. Cleveland et al [5] found that individuals with knee osteoarthritis who are at the highest risk of developing disability and pain have lower SES. Persons working in non-managerial occupations are more likely to have worse pain scores on the Western Ontario and McMaster Universities Index of Osteoarthritis compared to individuals in managerial positions.…”