Abstract
ObjectiveTo investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland.MethodsObservational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions.ResultsFinancial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18–5.21), comorbidities (OR 2.88, 95% CI 1.83–4.53) and pain (OR 3.32, 95% CI 2.21–4.99), whereas mental health (OR 0.23, 95% CI 0.15–0.36), participation (OR 0.30, 95% CI 0.21–0.43) and quality of life (OR 0.22, 95% CI 0.15–0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00–1.07) and higher quality of life (OR 1.06, 95% CI 1.02–1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship.ConclusionsSuffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.
Highlights
An inverse association of socioeconomic circumstances with various health indicators is one of the most robust findings of social-epidemiological research [1,2,3]
Preliminary evidence in persons with disabilities [8] or general populations [12,13] indicates that financial hardship may limit functioning and health
We extend and enrich this research by (1) adding financial hardship as a key indicator of proximal socioeconomic disadvantage; (2) studying a comprehensive set of health indicators based on the framework of the International Classification of Functioning, Disability and Health (ICF) [21], and (3) using a population-based sample
Summary
An inverse association of socioeconomic circumstances with various health indicators is one of the most robust findings of social-epidemiological research [1,2,3]. Most studies on health inequalities among persons with disabilities used established individual-level indicators of socioeconomic circumstances (i.e., education [4,5,7,9], income [4], occupational status [5,9]) or macro-level indicators such as neighborhood indices [8,10,11]. While these indicators mirror peoples’ chronic and more distant social standing, more proximal and contemporary socioeconomic circumstances such as the perception of financial hardship may more accurately reflect their lived experience. Preliminary evidence in persons with disabilities [8] or general populations [12,13] indicates that financial hardship may limit functioning and health
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