Severity of musculoskeletal pain: relations to socioeconomic inequality
Introduction
There is growing evidence of a widening health gap related to socioeconomic inequality even in western democracies (Mackenbach, Kunst, Cavelaars, Groenhof, & Geurts, 1997; Ross et al., 2000; Shaw, Orford, Brimblecomb, & Dorling, 2000). Norway is an affluent social democracy, where economic equalization and universal access to health care have been central political goals for decades. In spite of this, health-related inequalities still exist (Rognerud, Strand, & Hesselberg, 2000). These are most easily observed in the capital, Oslo, which is the biggest city of Norway with 500,000 inhabitants. The mortality rate for men is 3.3 times higher in the least compared to the most affluent area of Oslo, and for women the ratio is 2.2 (Rognerud, Krüger, Gjertsen, & Thelle, 1998). Thus the current male life expectancy is 69 years in the inner eastern area of the city, compared to 76 years in the western areas. Oslo is divided into 25 local authority districts, each maintaining their own schools, primary health care and social services. The inequalities in mortality are strongly correlated to the districts’ socioeconomic status. Well-known risk factors for atherosclerotic disease like smoking, physical inactivity and overweight, as well as the incidence of these diseases and of several forms of cancer, show similar correlation (Jenum, Thelle, Stensvold, & Hjerman, 1998).
We thus have ample data on socioeconomic inequality regarding mortality and morbidity, but we know far less about inequalities in the dimension of disease severity, in Oslo as elsewhere (Eachus, Chan, Pearson, Propper, & Smith, 1999). In a previous study we found that patients with rheumatoid arthritis living in two socioeconomically contrasting areas of Oslo were equal regarding objective disease process and joint damage measures, while in measures reflecting perceived physical and psychosocial health status, patients in the less affluent area reported higher levels of disease severity (Brekke, Hjortdahl, Thelle, & Kvien, 1999). The present study expands this research by investigating possible relations between socioeconomic environment and disease severity in a totally different patient group: persons with non-inflammatory musculoskeletal pain. Our hypothesis was that persons in a deprived environment experienced more severe pain and were more disabled than persons in a more affluent area. Our primary objective was therefore to investigate the severity of self-reported pain and disability related to geographical area, and the secondary was to explore mental distress, use of and satisfaction with health care across the two areas.
Section snippets
The areas
Oslo's 25 local authority districts can be ranked according to socioeconomic variables: income level, education, employment, industrial insurance disability, mortality, housing standard and number of third world immigrants. Some of these factors are specified for age groups and gender, giving rise to 18 indicators (Høverstad, 1992). Three districts in the western part of the city are on the top of this ranking list, indicating the best socioeconomic conditions (districts No 23, 24 and 25—here
Results
After persons reporting an inflammatory disease had been excluded, 493 out of 870 respondents in “east” and 493 out of 892 respondents in “west” reported pain during the last month. Between area differences regarding demographic and lifestyle measures were consistent in respondents with and without pain: Respondents in “west” were older than in “east”, they were better educated, a larger proportion was married, they smoked less and exercised more often. Gender distribution and the percentage
Discussion
Even if good epidemiological studies have been difficult to do, we know that chronic pain is a major problem in the community, and that pain in back, joints or muscles are the most common reported types of chronic pain (Elliott, Smith, Penny, Smith, & Chambers, 1999). Analyses of sociodemographic factors have identified high age, female gender, poor housing tenure, bad working conditions and unemployment as factors significantly associated with chronic pain (Urwin et al., 1998), and studies
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