Abstract
IntroductionApplying a cross-sectional analysis to a sample of 2,627 African-American and Caucasian adults aged ≥ 45 years from the Johnston County Osteoarthritis Project, we studied the association between educational attainment and prevalence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis.MethodsAge- and race-adjusted associations between education and osteoarthritis outcomes were assessed by gender-stratified logistic regression models, with additional models adjusting for body mass index, knee injury, smoking, alcohol use, and occupational factors.ResultsIn an analysis of all participants, low educational attainment (<12 years) was associated with higher prevalence of four knee osteoarthritis outcomes (unilateral and bilateral radiographic and symptomatic osteoarthritis). Women with low educational attainment had 50% higher odds of having radiographic knee osteoarthritis and 65% higher odds of symptomatic knee osteoarthritis compared with those with higher educational attainment (≥ 12 years), by using fully adjusted models. In the subset of postmenopausal women, these associations tended to be weaker but little affected by adjustment for hormone replacement therapy. Men with low educational attainment had 85% higher odds of having symptomatic knee osteoarthritis by using fully adjusted models, but the association with radiographic knee osteoarthritis was explained by age.ConclusionsAfter adjustment for known risk factors, educational attainment, as an indicator of socioeconomic status, is associated with symptomatic knee osteoarthritis in both men and women and with radiographic knee osteoarthritis in women.
Highlights
Applying a cross-sectional analysis to a sample of 2,627 African-American and Caucasian adults aged ≥ 45 years from the Johnston County Osteoarthritis Project, we studied the association between educational attainment and prevalence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis
Extensive research has been conducted on the relation between formal educational level and rheumatoid arthritis (RA) [7,8,10,11,12,13,14], but less is known about a possible association between educational attainment and osteoarthritis (OA)
We have extended the work of Hannan by examining associations between educational attainment and four knee OA-related outcomes in a cohort of participants from the baseline (1990 to 1997) enrollment in the Johnston County Osteoarthritis Project, a community-based study of OA in African American and Caucasian men and women aged ≥ 45 years in a rural, North Carolina county [34]
Summary
Applying a cross-sectional analysis to a sample of 2,627 African-American and Caucasian adults aged ≥ 45 years from the Johnston County Osteoarthritis Project, we studied the association between educational attainment and prevalence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis. Educational attainment has often been used as a surrogate for socioeconomic status (SES) in analyses of the role of SES in health outcomes [1] because it is unlikely to change in adults and is obtained in a clinical setting. Several studies have noted associations between lower educational attainment and both OA prevalence and poorer outcomes, including pain and disability [15,16,17,18,19,20]. In the first National Health and Nutrition Examination Survey (NHANES-I, 1971 to 1975), Hannan and colleagues [16]
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