Background Although it is well-known that lower socio-economic (SE) status is associated with higher morbidity and mortality rates, the relative importance of various SE factors on the occurrence of different clinical conditions was not thoroughly explored.
Objectives To explore the association of PROGRESS-plus factors (an acronym for the major SE factors; Place of Residence, Race/Ethnicity, Occupation, Gender, Religion, Education, Socio-economic Status, and Social Capital, and Plus for additional factors such as Age, Disability, and Sexual Orientation and Literacy) with the occurrence of musculoskeletal, cardiovascular, mental diseases, and diabetes.
Methods Within an epidemiological study conducted in the Netherlands, 8904 subjects (>18 years, random population) completed a questionnaire including socio-demographic factors (age, gender, education, social status and origin) and self-reported physician-diagnosed diseases. A multivariable logistic regression model was computed to identify which of the available PROGRESS factors were significantly associated with the occurrence of musculoskeletal conditions (MSKC). Further, analyses were limited to individuals who were expected to have paid work (i.e. those having paid work, unemployed, or receiving assistance allowance). Interactions were tested. The two final models were then repeated for the occurrence of each of the three other conditions of interest, namely diabetes, cardiovascular (CVD) and mental disease, so that the ORs for the occurrence of diseases across PROGRESS factors could be compared.
Results 1766 people reported having a physician-diagnosed MSKC, 547 diabetes, 1855 CVD, and 526 indicated to have mental disorder. Lower education (OR 2.0), female gender (1.7) and older age (OR 0.99), but not origin, were independently significantly associated with the occurrence of MSKC. Subjects with lowest education compared to highest education had a 2 times higher odds of having a MSKC, after adjusting for age and gender. Gradients were also present for diabetes, CVD and mental disorders, with only diabetes having a stronger gradient than MSKC (Figure). In subjects that were expected to have a paid employment (n=5150), lower social status, age, and female gender, but not education or origin, increased risk for a MSKC. Subjects with an assistance allowance were 3 times more likely to have MSKC when compared to those having paid work and this was higher than the risk for CVD (OR 2.2) but lower than the risk for diabetes (OR 3.7) or a mental disease (OR 7.8).
Conclusions Physician-diagnosed MSKCs are prevalent and the risk is highly associated with socio-economic factors. The risk of having a MSKC is double in subjects with lowest education and three-fold in those receiving an assistance allowance and this is more pronounced compared to CVD. SE factors are a major driver of the occurrence of MSKCs, and it is essential to understand whether these disparities can be reduced.
Disclosure of Interest None Declared