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Cañizares M, Power JD, Perruccio AV, Badley EM. Association of regional racial/cultural context and socioeconomic status with arthritis in the population: A multilevel analysis. Arthritis Rheum. 2008 Feb 29;59(3):399-407. [Pub Med ID 18311772]

Objective

To examine the extent to which differences in individual- and regional-level socioeconomic status and racial/cultural origin account for geographic variations in the prevalence of self-reported arthritis, and to determine whether regional characteristics modify the effect of individual characteristics associated with reporting arthritis.

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Methods

Analyses were based on the 2000-2001 Canadian Community Health Survey (>15 years, n = 127,513). Arthritis was self-reported as a long-term condition diagnosed by a health professional. A 2-level logistic regression model was used to identify predictors of reporting arthritis. Individual-level variables included age, sex, income, education, immigration status, racial/cultural origin, smoking, physical activity, and body mass index. Regional-level variables included the proportion of low-income families, low education, unemployment, recent immigrants, Aboriginals, and Asians.

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Results

At the individual level, age, sex, low income, low education, Aboriginal origin, current smoking, and overweight/obesity were positively associated with reporting arthritis; recent immigration and Asian origin were negatively associated with reporting arthritis. At the regional level, percentages of low-income families and the Aboriginal population were independently associated with reporting arthritis. Regional income and racial/cultural origin moderated the effects of individual income and racial/cultural origin; low-income individuals residing in regions with a higher proportion of low-income families reported arthritis more than low-income individuals living in better-income regions.

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Conclusion

Both individual and regional factors were found to contribute to variations in the prevalence of arthritis, although significant unexplained variation remained. Further research is required to better understand the mechanisms that underlie these regional effects and to identify other contributing factors to the remaining variation.

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List of Tables and Figures (in the publication)

  • Figure 1. Description of the multilevel models examined.
  • Table 1. Description of individual outcome, socioeconomic, and ethnicity variables used to assess differences in the prevalence of arthritis in Canada.
  • Table 2. Results from multilevel models.
  • Table 3. Associations of regional and individual variables in multilevel models.

Selected Tables from the Publication (with interpretation)

The overall prevalence of arthritis was 16% and varied considerable across regions.

The range of arthritis prevalence and individual characteristics across regions are shown in Table 1.

Significant variation across regions remained, even after controlling for the remaining individual-level variables (i.e., lifestyle factors, SES, and racial/cultural origin) with an estimated median OR of 1.22 (see Table 2, Model 2). Increasing age, female sex, and being overweight or obese were each significantly and positively associated with reporting arthritis. A strong association was also found for the effect of smoking status. There was a strong individual income gradient for reporting arthritis and a gradient of effect was observed for level of education. Recent immigrants (<10 years) were 47% less likely to report arthritis than non-immigrants. However, immigrants who lived in Canada in excess of 10 years were just as likely to report arthritis as non-immigrants. Aboriginals were 40% more likely to report arthritis than white individuals, whereas Asians were 28% less likely.

The effect of the inclusion of regional characteristics is shown in Table 2, model 3. Inclusion of the regional variables had a minimal effect n the contribution of individual-level variables to the likelihood of reporting arthritis. Of the regional predictors examined, only regional income and proportion of Aboriginals were significantly associated with arthritis. Of the regional predictors examined, only regional income and proportion of Aboriginals were significantly associated with arthritis. Lower regional income was significantly associated with an increased likelihood of reporting arthritis, independent of an individualís income, with a 30% greater likelihood with every 10 percentage-point increase in the proportion of low-income families.

Supplementary Tables (with interpretation)

No supplementary information is available for this paper.