Intersectional inequalities persist for OA, RA, gout diagnosis, not SpA
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Although there are considerable intersectional inequalities among various age, gender and socioeconomic groups in the likelihood of diagnosis for osteoarthritis, gout and rheumatoid arthritis, no such inequalities were found for spondyloarthritis diagnosis, according to findings published in Arthritis Care & Research.
“Common approach in health inequalities literature (including studies on chronic rheumatic diseases) is to investigate different [social status dimensions (SSD)] in isolation from another or treat them as additive distinct processes,” Ali Kiadaliri, PhD, and Martin Englund, MD, PhD, of Lund University, in Sweden, and colleagues wrote.
They added, “However, these approaches are being criticized for: 1) prioritize one axis of inequality over others ignoring the fact that people experience both dominant and subordinate SSDs simultaneously, 2) ignoring the fact that SSDs are interdependent, mutually constitutive, and reinforce one another, 3) treating SSDs as individual-level risk factors rather than proxies for social context that influences individuals over and above individual-level characteristics, 4) failing to capture the heterogeneous effects of SSDs on individuals, and 5) concentrate on between-group differences disregarding the typically significant variations within groups.”
In response to these critiques and the continued lack of progress in addressing these inequalities, some researchers have turned to a more intersectional approach, according to the researchers.
To evaluate how intersections of various sociodemographic statuses relate to individual heterogeneity in risk for osteoarthritis, gout, rheumatoid arthritis and spondyloarthritis, Kiadaliri and colleagues studied register data for the entire population of Skåne, Sweden. The researchers identified 342,542 individuals aged 40 to 65 years, who had resided in the town as of Dec. 31, 2013, and at least since Jan. 1, 2000. Using the register data, they analyzed residents with a diagnosis of OA, gout, RA or SpA between Jan. 1, 2014, and Dec. 31, 2015, with no previous history of their disease from 2000 to 2013.
In addition, the researchers created a total of 144 intersectional sociodemographic strata in categories that included age, gender, education, income, civil status and immigration. With included individuals nested within these strata, the researchers applied multilevel logistic regression models to examine the variance partition coefficient as a measure of discriminatory accuracy of the strata themselves, as well as predict the absolute risks for each individual stratum.
According to the researchers, 3.5% of the included population was diagnosed with OA, 0.5% were diagnosed with gout, and RA and SpA each claiming 0.2%. The variance partition coefficient ranged from 16.2% for gout to 0.5% for SpA. Gender accounted for the largest proportion of between-strata variation in the risks for RA, gout and SpA. Age was the most significant factor in the risk for OA. However, most betweenstrata differences in risks for the included chronic diseases were due to the additive main effects.
“In line with ‘proportionate universalism’ concept, the moderate discriminatory accuracy of intersectional strata in our study suggests that any interventions to reduce inequalities in chronic rheumatic diseases must be universal, not targeted, but with a scale and intensity that is proportionate to the degree of disadvantage,” Kiadaliri and colleagues wrote. – by Jason Laday
Disclosure: The authors report grant funding from the Greta and Kocks Foundation, the Crafoord Foundation, the Swedish Research Council, the Österlunds Foundation, the Faculty of Medicine Lund University, Governmental Funding of Clinical Research within National Health Service and Region Skåne.
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