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Neighborhood disadvantage, individual‐level socioeconomic position, and self‐reported chronic arthritis: A cross‐sectional multilevel study
Author(s) -
Brennan S. L.,
Turrell G.
Publication year - 2012
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21590
Subject(s) - demography , cross sectional study , confidence interval , multilevel model , medicine , odds ratio , socioeconomic status , disadvantage , disadvantaged , household income , odds , gerontology , population , logistic regression , environmental health , geography , sociology , statistics , mathematics , archaeology , pathology , political science , law
Objective To examine the association between individual‐ and neighborhood‐level disadvantage and self‐reported arthritis. Methods We used data from a population‐based cross‐sectional study conducted in 2007 among 10,757 men and women ages 40–65 years, selected from 200 neighborhoods in Brisbane, Queensland, Australia using a stratified 2‐stage cluster design. Data were collected using a mail survey (68.5% response). Neighborhood disadvantage was measured using a census‐based composite index, and individual disadvantage was measured using self‐reported education, household income, and occupation. Arthritis was indicated by self‐report. Data were analyzed using multilevel modeling. Results The overall rate of self‐reported arthritis was 23% (95% confidence interval [95% CI] 22–24). After adjustment for sociodemographic factors, arthritis prevalence was greatest for women (odds ratio [OR] 1.5, 95% CI 1.4–1.7) and in those ages 60–65 years (OR 4.4, 95% CI 3.7–5.2), those with a diploma/associate diploma (OR 1.3, 95% CI 1.1–1.6), those who were permanently unable to work (OR 4.0, 95% CI 3.1–5.3), and those with a household income <$25,999 (OR 2.1, 95% CI 1.7–2.6). Independent of individual‐level factors, residents of the most disadvantaged neighborhoods were 42% (OR 1.4, 95% CI 1.2–1.7) more likely than those in the least disadvantaged neighborhoods to self‐report arthritis. Cross‐level interactions between neighborhood disadvantage and education, occupation, and household income were not significant. Conclusion Arthritis prevalence is greater in more socially disadvantaged neighborhoods. These are the first multilevel data to examine the relationship between individual‐ and neighborhood‐level disadvantage upon arthritis and have important implications for policy, health promotion, and other intervention strategies designed to reduce the rates of arthritis, indicating that intervention efforts may need to focus on both people and places.