A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
Diabetes prevalence is associated with low socioeconomic status (SES), but less is known about the relationship between SES and diabetes incidence.
Data from eight cycles of the National Population Health Survey (1994/1995 through 2008/2009) are used. A sample of 5,547 women and 6,786 men aged 18 or older who did not have diabetes in 1994/1995 was followed to determine if household income and educational attainment were associated with increased risk of diagnosis of or death from diabetes by 2008/2009. Three proportional hazards models were applied for income and for education--for men, for women and for both sexes combined. Independent variables were measured at baseline (1994/1995). Diabetes diagnosis was assessed by self-report of diagnosis by a health professional. Diabetes death was based on ICD-10 codes E10-E14.
Among people aged 18 or older in 1994/1995 who were free of diabetes, 7.2% of men and 6.3% of women had developed or died from the disease by 2008/2009. Lower-income women were more likely to develop type 2 diabetes than were those in high-income households. This association was attenuated, but not eliminated, by ethno-cultural background and obesity/overweight. Associations with lower educational attainment in unadjusted models were almost completely mediated by demographic and behavioural variables.
Social gradients in diabetes incidence cannot be explained entirely by demographic and behavioural variables.
To describe disease expression and damage accrual in systemic lupus erythematosus (SLE), and determine the influence of ethnicity and socioeconomic factors on damage accrual in a large multiethnic Canadian cohort.
Adults with SLE were enrolled in a multicenter cohort. Data on sociodemographic factors, diagnostic criteria, disease activity, autoantibodies, treatment, and damage were collected using standardized tools, and results were compared across ethnic groups. We analyzed baseline data, testing for differences in sociodemographic and clinical factors, between the different ethnic groups, in univariate analyses; significant variables from univariate analyses were included in multivariate regression models examining for differences between ethnic groups, related to damage scores.
We studied 1416 patients, including 826 Caucasians, 249 Asians, 122 Afro-Caribbeans, and 73 Aboriginals. Although the overall number of American College of Rheumatology criteria in different ethnic groups was similar, there were differences in individual manifestations and autoantibody profiles. Asian and Afro-Caribbean patients had more frequent renal involvement and more exposure to immunosuppressives. Aboriginal patients had high frequencies of antiphospholipid antibodies and high rates of comorbidity, but disease manifestations similar to Caucasians. Asian patients had the youngest age at onset and the lowest damage scores. Aboriginals had the least education and lowest incomes. The final regression model (R2=0.27) for higher damage score included older age, longer disease duration, low income, prednisone treatment, higher disease activity, and cyclophosphamide treatment.
There are differences in lupus phenotypes between ethnic populations. Although ethnicity was not found to be a significant independent predictor of damage accrual, low income was.
Rates and correlates of problems associated with the use of alcohol are reported from the 1993 General Social Survey in Canada. Approximately 1 in 11 drinkers (9.2%) reported that drinking has had an adverse effect on his or her social life, physical health, happiness, home life or marriage, work, or finances in the past year. The most commonly reported problems concerned physical health (5.1%), and financial position (4.7%). Approximately one in eight drinkers (12.9%) had driven a car within an hour after consuming two or more drinks in the previous year. Furthermore, more than two of every five respondents reported that they had experienced some problem due to other people's drinking. In a multivariate analysis, age, marital status, gender, religious attendance and employment status were the strongest predictors of problem drinking. The number of heavy drinking occasions is a stronger predictor of drinking problems than is overall level of consumption.
An analysis of the data from the 1981 census of Canada is presented concerning the aboriginal population aged 15 to 24, defined as including the Inuit, status Indian, non-status Indian, and Metis populations. Comparisons are made with the non-aboriginal population. Factors considered include geographic location, migration, family status, dependent children, educational status, labor force participation, unemployment, income, and industry.
While psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more. However, the relative role of SEP versus SES in chronic obstructive pulmonary disease (COPD) risk has still not been examined.
We investigated the association between SES/SEP and COPD risk among 667 094 older adults, aged 55 to 60, residing in Sweden between 2006 and 2011. Absolute income in five groups by population quintiles depicted SEP and relative income expressed as quintile groups within each absolute income group represented SES. We performed sex-stratified logistic regression models to estimate odds ratios and the area under the receiver operator curve (AUC) to compare the discriminatory accuracy of SES and SEP in relation to COPD.
Even though both absolute (SEP) and relative income (SES) were associated with COPD risk, only absolute income (SEP) presented a clear gradient, so the poorest had a three-fold higher COPD risk than the richest individuals. While the AUC for a model including only age was 0.54 and 0.55 when including relative income (SES), it increased to 0.65 when accounting for absolute income (SEP). SEP rather than SES demonstrated a consistent association with COPD.
Our study supports the materialistic theory. Access to material resources seems more relevant to COPD risk than the consequences of low relative income.
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Successful academic performance during adolescence is a key predictor of lifetime achievement, including occupational and social success. The present study investigated the important transition from primary to secondary schooling during early adolescence, when academic performance among youth often declines. The goal of the study was to understand how risk factors, specifically lower family resources and male gender, threaten academic success following this "critical transition" in schooling. The study involved a longitudinal examination of the predictors of academic performance in grades 7-8 among 127 (56 % girls) French-speaking Quebec (Canada) adolescents from lower-income backgrounds. As hypothesized based on transition theory, hierarchical regression analyses showed that supportive parenting and specific academic, social and behavioral competencies (including spelling ability, social skills, and lower levels of attention problems) predicted success across this transition among at-risk youth. Multiple-mediation procedures demonstrated that the set of compensatory factors fully mediated the negative impact of lower family resources on academic success in grades 7-8. Unique mediators (social skills, spelling ability, supportive parenting) also were identified. In addition, the "gender gap" in performance across the transition could be attributed statistically to differences between boys and girls in specific competencies observed prior to the transition, as well as differential parenting (i.e., support from mother) towards girls and boys. The present results contribute to our understanding of the processes by which established risk factors, such as low family income and gender impact development and academic performance during early adolescence. These "transitional" processes and subsequent academic performance may have consequences across adolescence and beyond, with an impact on lifetime patterns of achievement and occupational success.
Birch and Abelson  argue that non-income based barriers might explain differences in utilization of health services within and between income groups. Databases which contain utilization data rarely allow for the modelling of geographic variation. In the Ontario Health Survey (OHS), individual observations are georeferenced at the Public Health Unit (PHU) scale, but PHUs cannot easily be used because of the large coefficients of variation. To overcome this problem, a cluster analysis is performed to create a service environment variable, which reflects differences in service availability, population size and rurality. Utilization of health services is then modelled as a logistic regression equation where the independent variables are age, sex, service environment and income to test the Birch and Abelson argument. This argument is then extended by controlling for age, health and income status. Based on the modelling results, the importance of geography to access and utilization is assessed.
The aim of this study was to examine the effect of family income on accessibility to dental services among adults in Norway. The analysis was performed on a set of national data collected in 1989, which was representative of the non-institutionalized Norwegian population aged 20 years and above. The sample size was 1200 individuals. The data were analyzed according to a two-part model. The first part determined the probability of whether the consumer had demanded the services or not during the last year according to family income. The second part estimated how the amount of services utilized depended on family income, for those with demand. The elasticity of the odds of having demanded the services with respect to family income was 0.48. Family income had no effect on the amount of services utilized. Additional analyses also showed that there was no effect of family income on the probability of having received a filling or a crown when visiting the dentist. In Norway, almost all costs for dental services are paid by the consumer. It is not possible from the data alone to say whether subsidized dental care is an effective way of reducing the inequalities in demand.