Community and environmental factors and arthritis outcomes.

Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hil 27599, USA.
North Carolina medical journal 68(6):439-43.
Source: PubMed
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Available from: Leigh Callahan
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    ABSTRACT: To examine associations between disability and socioeconomic status (SES) in persons with hip radiographic OA (rOA) or symptomatic OA (sxOA) in the Johnston County Osteoarthritis Project. Cross-sectional analyses were conducted on individuals with hip rOA (708) or sxOA (251). rOA was defined as Kellgren-Lawrence ≥ 2. Educational attainment (<12 years or ≥12 years) and occupation (managerial or non-managerial) were individual SES measures. Census block group poverty rate (<12%, 12-25%, ≥25%) was the community SES measure. Disability was measured by the HAQ-DI and the WOMAC (function, pain, total). Covariates included age, gender, race, BMI, and presence of knee symptoms. Analyses examined associations of disability with each SES effect separately, followed by multivariable analyses using all SES variables, adjusting for covariates. In models with single SES variables adjusted for covariates, WOMAC scores were associated significantly (p<0.05) with low educational attainment and non-managerial occupation in rOA and sxOA. HAQ was significantly associated with low educational attainment in rOA and sxOA and with high community poverty in rOA. In models including all SES variables, the patterns of association were similar although with diminished significance. There was indication that education was more strongly associated with HAQ and WOMAC function, while occupation was more strongly associated with WOMAC pain. Our data provide evidence that individual SES is an important factor to consider when examining disability and pain outcomes in older adults with hip OA.
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    ABSTRACT: Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual's socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one's neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.
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