The Social Gap Index and the prevalence of osteoarthritis in the community: a cross-sectional multilevel study in Mexico
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Abstract
Multilevel studies have gained importance for highlighting social inequalities in health. These associations have been reported previously in diseases such as arthritis and chronic pain. We conducted a cross-sectional study using multilevel analysis to identify individual and contextual factors associated with the variation of prevalence of osteoarthritis (OA) in the Mexican population. The sample included 17,566 individuals of which 10,666 (60.7 %) were women. The relationship between individual and contextual factors and OA were analyzed with a multilevel strategy. From the total population, 1,681 individuals had OA. Multilevel analysis showed that individual variables such as female gender (odds ratio (OR) = 1.3, 95 % confidence interval (CI) 1.1, 1.4), age range 55–65 years (OR = 1.6, 95 % CI 1.3, 2.0), musculoskeletal pain in the last 7 days (OR = 2.6, 95 % CI 2.3, 3.0), and use of pain treatments (OR = 1.4, 95 % CI 1.2, 1.7) were associated with OA. At the regional level, the Social Gap Index (SGIx) was associated with the diagnosis of OA (coefficient 0.5, 95 % CI 0.2–1.1). The SGIx contextual variable was positively associated with the regional prevalence of OA and the variation in prevalence of OA in different regions. The larger the social gap, the greater the variation in OA prevalence. These factors were independently associated with the prevalence of OA: female gender, pain intensity, physical limitation, and the use of pain treatments were individual variables associated with OA. The association between OA prevalence and regional variations with SGIx reflects inequities in health provisions that should be considered in health programs.
Keywords
Epidemiology Health inequity Multilevel analysis OsteoarthritisNotes
Acknowledgments
The authors wish to thank Dr. Adolfo Hernandez-Garduño for his thorough review of the methodology and statistical analysis and Sergio Lozano-Rodriguez, M.D. for his review of the manuscript.
Funding
Consejo Nacional de Ciencia y Tecnología (CONACYT). CONACYT-Salud 2007-C01-69439, CONACYT-Salud 2007-C01 69765 and the Fundación Mexicana para Enfermos Reumáticos (FUMERAC) who receives unconditional financial support from Abbot, Novartis, Roche, Sanofi-Aventis, and Schering-Plough.
Contributors
RA-J and PB-I were involved in the conception and design of the study, acquisition of data and/or analysis and interpretation of data; drafting of manuscript and revising it critically for important intellectual content; final approval of the version to be published. MM-J, AN-J,GR-MV,SL-H, BV-R,GE-M,MM, CM-H were involved in the conception of the study; drafting of manuscript and revising it critically for important intellectual content; final approval of the version to be published. MMJ, PB-I performed the biostatistical analysis.
Conflict of interest
Dr. Burgos-Vargas has received grant/research support from Abbvie; has been a consultant for Abbvie, Bristol Myers Squibb, Janssen, Pfizer, Roche, UCB; and participated as a speaker for Abbvie, BMS, Janssen, MSD, Pfizer, Roche, UCB. Dr. Cardiel has received honoraria for consultations and/or speaking for Pfizer, Lilly, Bristol Myers Squibb, and GSK. Dr. Garza-Elizondo has been a consultant and/ or speaker for MSD, Pfizer, Bristol Myers Squibb, and UCB.
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