Educational disparities in joint pain within and across US states: do macro sociopolitical contexts matter?
Educational disparities in joint pain within and across US states: do macro sociopolitical contexts matter?
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美国各州内外的关节痛苦中的教育差异：宏观社会政治背景是否重要？
DOI：
10.1097/j.pain.0000000000002945
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发表时间：
2023-10-01
期刊：
影响因子：
7.4
通讯作者：
中科院分区：
文献类型：
--
作者：
补充数字内容在文本中可用。我们记录了美国各州关节炎引起的关节疼痛和教育差异的实质性变化，并确定了塑造这些疼痛结果的州一级背景因素/政策。尽管人们越来越认识到社会、经济和政治背景对人口健康和健康不平等的重要性，但对疼痛差异的研究在很大程度上依赖于个人层面的数据，而忽视了国家层面的政策和特征等宏观因素。关注中度或重度关节炎引起的关节疼痛-一种严重损害个人生活质量的常见疼痛形式-我们（1）比较了美国各州关节疼痛的患病率;（2）估计了各州关节疼痛的教育差异;（3）评估了州社会政治背景是否有助于解释这两种形式的跨州差异。我们将来自2017年行为风险因素监测系统的407，938名成年人（年龄在25-80岁之间）的个人数据与6项措施的州级数据（例如，补充营养援助计划[SNAP]，收入所得税抵免，基尼指数和社会凝聚力指数）联系起来。我们进行了多层次逻辑回归，以确定关节疼痛的预测因素和其中的不平等。美国各州关节疼痛的患病率差异显著：经年龄调整的患病率范围从明尼苏达州的6.9%到西弗吉尼亚州的23.1%。关节疼痛的教育梯度存在于所有国家，但在幅度上有很大差异，主要是由于受教育程度最低的疼痛患病率的变化。在所有教育水平上，在疼痛方面教育差异较大的州的居民比教育差异较小的州的同龄人疼痛的风险要高得多。更慷慨的SNAP计划（比值比[OR] = 0.925; 95%置信区间[CI]：0.963-0.957）和更高的社会凝聚力（OR = 0.819; 95% CI：0.748-0.896）预测整体疼痛患病率较低，州一级的基尼系数预测教育程度的疼痛差异较高。
Supplemental Digital Content is Available in the Text. We document substantial variation in arthritis-attributable joint pain and educational disparities therein, across US states, and identify state-level contextual factors/policies that shape these pain outcomes. Despite growing recognition of the importance of social, economic, and political contexts for population health and health inequalities, research on pain disparities relies heavily on individual-level data, while neglecting overarching macrolevel factors such as state-level policies and characteristics. Focusing on moderate or severe arthritis-attributable joint pain—a common form of pain that considerably harms individuals' quality of life—we (1) compared joint pain prevalence across US states; (2) estimated educational disparities in joint pain across states; and (3) assessed whether state sociopolitical contexts help explain these 2 forms of cross-state variation. We linked individual-level data on 407,938 adults (ages 25-80 years) from the 2017 Behavioral Risk Factor Surveillance System with state-level data on 6 measures (eg, the Supplemental Nutrition Assistance Program [SNAP], Earned Income Tax Credit, Gini index, and social cohesion index). We conducted multilevel logistic regressions to identify predictors of joint pain and inequalities therein. Prevalence of joint pain varies strikingly across US states: the age-adjusted prevalence ranges from 6.9% in Minnesota to 23.1% in West Virginia. Educational gradients in joint pain exist in all states but vary substantially in magnitude, primarily due to variation in pain prevalence among the least educated. At all education levels, residents of states with greater educational disparities in pain are at a substantially higher risk of pain than peers in states with lower educational disparities. More generous SNAP programs (odds ratio [OR] = 0.925; 95% confidence interval [CI]: 0.963-0.957) and higher social cohesion (OR = 0.819; 95% CI: 0.748-0.896) predict lower overall pain prevalence, and state-level Gini predicts higher pain disparities by education.
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DOI：
10.1016/j.rdc.2020.09.001
发表时间：
2021-03
期刊：
Rheumatic diseases clinics of North America
影响因子：
--
作者：
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通讯作者：
Golightly Y
影响因子：
12.7
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影响因子：
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作者：
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影响因子：
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作者：
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影响因子：
5
作者：
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