Article Text
PDF
Abstract
Background Numerous studies documented that lower socio-economic status (SES) is associated with increased morbidity and mortality. However, the impact of SE determinants on health of patients with a musculoskeletal condition (MSKC) received less attention.
Objectives To explore the impact of PROGRESS-plus factors (Place of Residence, Race/Ethnicity, Occupation, Gender, Religion, Education, SES, Social Capital, and Plus representing Age, Disability, Sexual Orientation and Literacy) on physical and mental health of patients with MSKCs.
Methods Analyses were based on a subgroup of patients with self-reported, physician-diagnosed MSKCs, who were part of an epidemiological study in a representative sample of the Dutch population. Participants (n=8904, >18 y.o.) completed a survey on socio-demographics, physician-diagnosed comorbidities, and the 12-Item Short-Form Health Survey (SF-12). To explore the impact of available PROGRESS factors on the SF-12 physical (PCS) and mental (MCS) subscales, a series of linear regression models were computed first entering as PROGRESS factors education (5 groups, from no education to university level), age, gender, origin (western vs. non-western) and secondly limiting analyses to persons expected to have paid work and entering the same explanatory variables and also work status (paid work, unemployed, or assistance allowance). All regressions were adjusted for the number of physician-diagnosed comorbidities (excluding MSKC). Interactions were tested.
Results MSKC confirmed by a physician was reported by 1766 (20%) participants (mean age 59 years, 38% male). PSC and MSC were 6.6 and 3.2 points, respectively, lower in patients with MSKC who had no education compared to those with a university education (model I, table, adjusted for factors as described). In patients with potential to work (Model II), education and work status were both associated with PCS, while these were not significantly associated with MCS. PCS in patients with lower education or receiving assistance allowance was 5.8 and 5.5 points lower than that of patients with university education or a paid job, respectively. Origin was never associated with health but experienced health was always strongly dependent on number of comorbidities.
Conclusions Of the PROGRESS factors explored among Dutch patients with MSKC, age, gender and education had a strong relation with both physical and mental health, while the role of work status and origin was less pronounced. The strong gradient by level of education is in principle unfair and requires attention and action.
Disclosure of Interest None Declared