The impact of socioeconomic status and social deprivation on musculoskeletal limitations

Abstract

BackgroundObjective (SES) and subjective socioeconomic status (SSS) affect symptom intensity and magnitude of limitations. Identification of potentially modifiable social risk factors might contribute to additional opportunities for optimizing musculoskeletal health. Questions/purposes(1) There are no correlations between magnitude of limitations (as measured with Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF computer adaptive test]) and components of SES or SSS in people with musculoskeletal disease; (2) There are no factors (including level of social deprivation) independently associated with PROMIS PF. MethodsOne hundred and fifty-nine patients presenting to clinicians specializing in the treatment of a broad variety of musculoskeletal conditions were prospectively enrolled in the study. We recorded patient demographics and assessed patients' socioeconomic status using the MacArthur Sociodemographic questionnaire and physical disability rating using PROMIS PF. Patients deprivation index was retrieved using their 9-digit ZIP codes. We used bivariate analysis to determine correlations between magnitude of limitations and socioeconomic status. We created a stepwise backward multivariable linear regression model to assess factors independently associated with PROMIS PF. ResultsWeak correlations were found on bivariate analysis of PROMIS PF with SSS measured as “Place in community” (r 0.28; P < 0.001) and “Place in the United States of America” (r 0.25; P = 0.002). In the multivariable models, the area deprivation index was not independently associated with physical limitations. Male gender (beta regression coefficient [β] 4.1; 95% CI 0.71 to 7.5; P = 0.018) and having net worth of $5000 - $19,999 (β 6.3; 95% CI 0.35 to 12; P = 0.038) or $20,000 - $99,999 (β 5.8; 95% CI 2.1 to 9.5; P = 0.003) when compared to having net worth of less than $4999 were independently associated with better physical function. Being unemployed or disabled and keeping house, being a student, or retired were independently associated with worse physical function (β −12; 95% CI -18 to −7.0; P < 0.001; β −5.6; 95% CI -9.9 to −1.4; P = 0.009, respectively), when compared to working full-time or part-time. ConclusionsObjective and subjective measures of socioeconomic status are associated with magnitude of physical limitations in patients with musculoskeletal illness. These factors should be considered when developing treatment plans for patients with musculoskeletal conditions. Level of evidenceLevel II prognostic study.