Neighborhood disadvantage, individual‐level socioeconomic position, and self‐reported chronic arthritis: A cross‐sectional multilevel study

Abstract

Objective. To examine the association between individual-and neighborhood-level disadvantage and self-reported arthritis. Methods. We used data from a population-based cross-sectional study conducted in 2007 among 10,757 men and women ages 40 -65 years, selected from 200 neighborhoods in Brisbane, Queensland, Australia using a stratified 2-stage cluster design. Data were collected using a mail survey (68.5% response). Neighborhood disadvantage was measured using a census-based composite index, and individual disadvantage was measured using self-reported education, household income, and occupation. Arthritis was indicated by self-report. Data were analyzed using multilevel modeling. Results. The overall rate of self-reported arthritis was 23% (95% confidence interval [95% CI] 22-24). After adjustment for sociodemographic factors, arthritis prevalence was greatest for women (odds ratio [OR] 1.5, 95% CI 1.4 -1.7) and in those ages 60 -65 years (OR 4.4, 95% CI 3.7-5.2), those with a diploma/associate diploma (OR 1.3, 95% CI 1.1-1.6), those who were permanently unable to work (OR 4.0, 95% CI 3.1-5.3), and those with a household income <$25,999 (OR 2.1, 95% CI 1.7-2.6). Independent of individual-level factors, residents of the most disadvantaged neighborhoods were 42% (OR 1.4, 95% CI 1.2-1.7) more likely than those in the least disadvantaged neighborhoods to self-report arthritis. Cross-level interactions between neighborhood disadvantage and education, occupation, and household income were not significant. Conclusion. Arthritis prevalence is greater in more socially disadvantaged neighborhoods. These are the first multilevel data to examine the relationship between individual-and neighborhood-level disadvantage upon arthritis and have important implications for policy, health promotion, and other intervention strategies designed to reduce the rates of arthritis, indicating that intervention efforts may need to focus on both people and places.

Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003–10: data from the Australian Orthopaedic Association National Joint Replacement Registry

“…Similar associations between arthritis overall, and rheumatoid arthritis, and SES were observed Australia-wide in 2007–8 [10]. We have previously reported using multi-level analysis that a 42% increased likelihood of arthritis existed for those of greater social disadvantage compared to those who are more advantaged, even after accounting for disadvantage measured at the individual- and household-levels [5]. Furthermore, these differences were independent of advancing age and female sex; both factors that are associated with an increased prevalence of OA.…”

The Social Gap Index and the prevalence of osteoarthritis in the community: a cross-sectional multilevel study in Mexico

“…In contrast to our findings, some studies have shown that the prevalence of chronic pain was higher in individuals that live in urban areas characterized by poor education, social networks, and income [16,20], but high SGIx [15]. On the other hand, a multilevel model study developed in Australia showed a higher prevalence of arthritis in communities with a high SGIx [16].…”

“…On the other hand, a multilevel model study developed in Australia showed a higher prevalence of arthritis in communities with a high SGIx [16]. Explanations for this include the case definitions based on self-reports, the fact that these studies were conducted in developed countries where socioeconomic inequalities are not as marked as those in developing countries, and the use of different social indicators in each study.…”

Neighborhood disadvantage, individual-level socioeconomic position and physical function: A cross-sectional multilevel analysis

“…Previous studies have shown that income and education are likely to be closely linked, but with one influencing the other via distinct aetiological pathways. 47,48 Educational attainment for example, may influence the acquisition of knowledge about appropriate health practices, which may facilitate or constrain one's ability to maintain good physical function; whereas household income is likely to reflect the availability of resources to access health facilities and services. 47,49 This investigation is the first-known study to examine cross-level interactions epidemiological studies.…”

“…47,48 Educational attainment for example, may influence the acquisition of knowledge about appropriate health practices, which may facilitate or constrain one's ability to maintain good physical function; whereas household income is likely to reflect the availability of resources to access health facilities and services. 47,49 This investigation is the first-known study to examine cross-level interactions epidemiological studies. [50][51][52] For instance, people with disability who live outside major cities may fare worse than their counterparts living in major cities, or people with no disability who live outside major cities.…”