Webb Jason, Emmert Ryan, Reddy Arjun, Sajjadi Nicholas B, Greiner Ben, Bray Natasha, Hartwell Micah
College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA.
Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA.
J Osteopath Med. 2023 Oct 23;124(2):69-75. doi: 10.1515/jom-2022-0162. eCollection 2024 Feb 1.
Social determinants of health (SDOH) are economic, social, and political conditions that affect a person's overall health or the health of a group of people. Researchers have investigated the effects of SDOH on various diseases, such as asthma, obesity, and chronic stress, but few publications have been made regarding its effects on arthritis.
Our primary objective was to analyze the implications of SDOH on disease severity relating to pain levels and limitations experienced among people with diagnosed arthritis.
We performed a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS). We included individuals who reported having arthritis, were over the age of 45, and who also completed the SDOH module. Pain scores from the four-question Arthritis Burden Module were correlated to question responses pertaining to SDOH to determine their associations.
For the analysis, our sample size was 25,682, with response rates varying slightly among the SDOH questions. Individuals diagnosed with arthritis were more likely to report functional limitations if they experienced food insecurity (χ=234.0, p<0.001), financial instability (χ=149.7, p<0.001), or frequent stress (χ=297.6, p<0.001). Further, we found that individuals with arthritis experiencing any domain of SDOH reported higher mean pain scores than those not experiencing that domain, with the highest pain score difference among those reporting frequent stress (Coefficient: 1.93, CI=1.74-2.13, t=19.43, p<0.001).
Our results show that SDOH profoundly impact pain levels and limitations experienced by patients with arthritis. Although work has already begun to help alleviate burdens associated with SDOH, more research and actions are required to create equitable health throughout the population.
健康的社会决定因素（SDOH）是影响个人整体健康或一群人健康的经济、社会和政治条件。研究人员已经调查了SDOH对各种疾病的影响，如哮喘、肥胖和慢性应激，但关于其对关节炎影响的出版物却很少。
我们的主要目的是分析SDOH对与确诊关节炎患者经历的疼痛程度和功能受限相关的疾病严重程度的影响。
我们对2017年行为危险因素监测系统（BRFSS）进行了横断面分析。我们纳入了报告患有关节炎、年龄超过45岁且完成了SDOH模块的个体。来自四个问题的关节炎负担模块的疼痛评分与与SDOH相关的问题回答相关联，以确定它们之间的关联。
在分析中，我们的样本量为25682，SDOH问题的回答率略有不同。被诊断患有关节炎的个体如果经历粮食不安全（χ=234.0，p<0.001）、财务不稳定（χ=149.7，p<0.001）或频繁应激（χ=297.6，p<0.001），则更有可能报告功能受限。此外，我们发现经历任何SDOH领域的关节炎患者报告的平均疼痛评分高于未经历该领域的患者，在报告频繁应激的患者中疼痛评分差异最大（系数：1.93，CI=1.74-2.13，t=19.43，p<0.001）。
我们的结果表明，SDOH对关节炎患者经历的疼痛程度和功能受限有深远影响。尽管已经开始开展工作以帮助减轻与SDOH相关的负担，但仍需要更多的研究和行动来在整个人口中创造公平的健康状况。
