Background Persons with lower socioeconomic status (SES) have poorer health status for many medical conditions. Reasons for this finding are multiple, but access to care, health related behaviours, and adherence likely play a role. As fibromyalgia (FM) is a clinical construct with psychosocial implications, it is possible that SES may influence symptom expression and severity.
Objectives To examine the effects of SES (measured as proxy by level of education) for disease severity in a cohort of FM patients.
Methods In a prospective cohort study of patients with FM followed at a tertiary care multidisciplinary clinic, patients were stratified according to education level: high school or less (Group 1; N=99), college (Group 2; N=84), and university (Group 3; N=63). Demographic and disease severity measures included pain visual analog scale (VAS), patient global assessment disease activity (PGA), Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), McGill Pain Questionnaire (MPQ), Pain Disability Index (PDI), Pain Catastrophizing Scale (PCS), and anxiety and depression by Arthritis Impact Measurement Scale (AIMS). Between-group differences in discrete and continuous variables were assessed for statistical significance with the Chi-Square test and one-way analysis of variance, respectively. Linear regression was used to assess between-group differences in disease activity while adjusting for potential confounders.
Results The cohort comprised 246 patients with a mean ± SD age of 47.8±10.4 years, disease duration of 10.8±9.8 years, and 91.1% female. Baseline values were: pain VAS 6.5±2.3, PGA 6.7±2.1, FIQ 67±17, HAQ 1.19±0.59, MPQ 41±15, PDI 38±14, PCS 29±12, AIMS anxiety 6.3±1.8, AIMS depression 4.9±1.8, with a mean medication count of 2.6±1.3 per patient. There were no significant differences between groups for the following parameters: disease duration, marital status, cigarette smoking, previous eating disorder or alcohol abuse, current medication categories, and total number of medications used per patient. Higher education was associated with greater use of alternative medicines (P<0.001) and chiropractic, massage or osteopathic treatments (P=0.021). Lower education level was significantly associated with older age (P=0.039), previous drug abuse (P=0.016), current unemployment (P<0.001) and higher score in the following measures of symptom severity: PGA (P=0.019), FIQ (P=0.002), HAQ (P=0.001), MPQ (P=0.026), PDI (P=0.031), and PCS (P=0.015). These associations remained significant even upon adjusting for age and gender differences. No significant differences in pain severity, anxiety, and depression were observed between groups.
Conclusions Similar to other health conditions, FM patients with lower SES reported greater symptom severity, functional impairment and unemployment, but not mood disorder. Although FM spans all socioeconomic groups, societal factors, rather than specific disease characteristics or mental status, appear to play an important role in patients' perception of illness.
Disclosure of Interest : M.-A. Fitzcharles Speakers bureau: Lilly, Pfizer, Purdue, Valeant, E. Rampakakis: None declared, P. Ste-Marie: None declared, J. Sampalis: None declared, Y. Shir Consultant for: McKesson Canada Corporation, Palladin Inc. Canada