Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs.

Anne Hammarström,Maria Wiklund,Inger Haukenes,Arja Lehti,Anncristine Fjellman Wiklund,Birgitta Evengård,Britt-Marie Stålnacke,Ruth Landau

doi:10.1371/journal.pone.0097134

Anne Hammarström, Maria Wiklund + Show 6 more

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https://doi.org/10.1371/journal.pone.0097134

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Journal: PloS one	Publication Date: May 21, 2014
Citations: 57	License type: CC BY 4.0

Affiliation: Umeå University, Norwegian Institute of Public Health

Abstract

BackgroundThere is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education.MethodsThe population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS).ResultsLow-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30–0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men.ConclusionOur findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.

Highlights

A large number of studies indicate that there is a gender bias to women’s disadvantage, i.e. an unintended and systematic neglect of women, in health care [1,2]
Gender bias in neck pain was found when Swedish interns were asked about the diagnosis and management of this group of patients
In order for a referred patient to be selected for assessment at the clinic the patients had to have a chronic disabling non-malignant diagnosis of chronic pain

Summary

Introduction

A large number of studies indicate that there is a gender bias to women’s disadvantage, i.e. an unintended and systematic neglect of women, in health care [1,2]. The study included gender-based quantitative analysis of treatment of all patients (n = 320 women, 421 men) referred to a dermatological clinic. Medically unjustified differences in the availability of examination and treatment for women compared to men have been demonstrated in connection with a number of other diseases, such as irritable bowel syndrome [1], renal transplantation, HIV and pain [6,7]. There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education

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