Rijk Léon, Kortlever Joost T P, Bandell David L J I, Zhang Juliana, Gallagher Sean M, Bozic Kevin J, Ring David
Department of Surgery and Perioperative Care, Dell Medical School - the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA.
J Orthop. 2020 Apr 20;22:135-142. doi: 10.1016/j.jor.2020.03.021. eCollection 2020 Nov-Dec.
Objective (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.
One 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.
Weak correlations were found on bivariate analysis of PROMIS PF with SSS measured as "Place in community" ( 0.28; P < 0.001) and "Place in the United States of America" ( 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.
Objective 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 II prognostic study.
客观社会经济地位（SES）和主观社会经济地位（SSS）会影响症状强度和受限程度。识别潜在可改变的社会风险因素可能有助于为优化肌肉骨骼健康提供更多机会。
问题/目的：（1）在患有肌肉骨骼疾病的人群中，受限程度（通过患者报告结局测量信息系统身体功能[PROMIS PF计算机自适应测试]测量）与SES或SSS的组成部分之间不存在相关性；（2）不存在与PROMIS PF独立相关的因素（包括社会剥夺水平）。
前瞻性招募了159名向专门治疗各种肌肉骨骼疾病的临床医生就诊的患者。我们记录了患者的人口统计学信息，并使用麦克阿瑟社会人口学问卷评估患者的社会经济地位，使用PROMIS PF评估身体残疾等级。使用患者的9位邮政编码获取患者剥夺指数。我们使用双变量分析来确定受限程度与社会经济地位之间的相关性。我们创建了一个逐步向后多变量线性回归模型，以评估与PROMIS PF独立相关的因素。
在对PROMIS PF与以“在社区中的地位”衡量的SSS进行双变量分析时发现了弱相关性（0.28；P <0.001）以及与“在美国的地位”（0.25；P = 0.002）。在多变量模型中，地区剥夺指数与身体受限没有独立相关性。与净资产低于4999美元相比，男性（β回归系数[β] 4.1；95%可信区间0.71至7.5；P = 0.018）以及净资产为5000 - 19999美元（β6.3；95%可信区间0.35至12；P = 0.038）或20000 - 99999美元（β5.8；95%可信区间2.1至9.5；P = 0.003）与更好的身体功能独立相关。与全职或兼职工作相比，失业或残疾并居家、是学生或退休与较差的身体功能独立相关（β -12；95%可信区间-18至-7.0；P <0.001；β -5.6；95%可信区间-9.
