Abstract
BackgroundAssociations of socioeconomic status (SES) with the prevalence of various forms of arthritis are well documented. Increasing evidence suggests that SES during childhood is a lasting determinant of health, but its association with the onset of arthritis remains unclear.MethodsCross-sectional data on 1276 participants originated from 22 family practices in North-Carolina, USA. We created 4-level (high, medium, low, lowest) current SES and childhood SES summary scores based on parental and participant education, occupation and homeownership. We investigated associations of individual SES characteristics, summary scores and SES trajectories (e.g. high/low) with self-reported arthritis in logistic regression models progressively adjusted for race and gender, age, then BMI, and clustered by family practice.ResultsWe found evidence for independent associations of both childhood and current SES with the reporting of arthritis across our models. In covariate-adjusted models simultaneously including current and childhood SES, compared with high SES participants in the lowest childhood SES category (OR = 1.39 [95% CI = 1.04, 1.85]) and those in the low (OR = 1.66 [95% CI = 1.14, 2.42]) and lowest (OR = 2.08 [95% CI = 1.16, 3.74]) categories of current SES had significantly greater odds of having self-reported arthritis.ConclusionsCurrent SES and childhood SES are both associated with the odds of reporting arthritis within this primary-care population, although the possibly superseding influence of existing circumstances must be noted. BMI was a likely mechanism in the association of childhood SES with arthritis onset, and research is needed to elucidate further pathways linking the socioeconomic environment across life-stages and the development of rheumatic diseases.
Highlights
Associations of socioeconomic status (SES) with the prevalence of various forms of arthritis are well documented
We evaluated associations between self-reported arthritis and SES using covariate adjusted logistic regressions across three approaches, as follows: (1) SES domains: for each domain of SES, participant and parental characteristics were included together in unadjusted models successively adding gender and race, age and Body mass index (BMI); (2) SES summary scores: categories of current and childhood SES summary scores were separately included in unadjusted models, and together with progressive adjustments for race and gender, age, BMI; (3) SES trajectories: all 9 SES trajectories were included in a fullyadjusted model
While analyses based on observational data have limited power to establish causal relations, BMI appeared to be a credible pathway linking the lowest childhood SES category and later arthritis onset, with a third of the demographics-adjusted association explained by the elevated BMI of participants reared in disadvantaged environments
Summary
Associations of socioeconomic status (SES) with the prevalence of various forms of arthritis are well documented. Increasing evidence suggests that SES during childhood is a lasting determinant of health, but its association with the onset of arthritis remains unclear. Contrary to the common perception of arthritis as an unavoidable symptom of aging, preventable risk-factors including excess body mass and musculoskeletal injuries play a major role in the onset of the disorder [1]. The importance of modifiable risk-factors is underscored by marked socioeconomic disparities in disease prevalence for self-reported arthritis [2,3], which includes all disease subtypes, and for specific forms, including osteoarthritis (OA) [4,5] and rheumatoid arthritis (RA) [6,7]. How socioeconomic status (SES) influences the onset of arthritis remains unclear, with socioeconomically patterned health-behaviors suspected as possible pathways [8,9].
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