Session Information
Date: Monday, November 9, 2015
Session Title: ACR/ARHP Combined Abstract Session: Epidemiology and Pubic Health
Session Type: ACR/ARHP Combined Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Understanding the
associations between education and health status among Hispanics with arthritis
and/or joint pain is crucial in adapting existing arthritis interventions for
this minority population. Nationwide, 35.3% of Hispanics lack a high school
diploma, (compared with 8.3% of non-Hispanic whites), indicating a need to
assess the differences in health status among higher and lower educated
Hispanics. The purpose of this study was to examine associations between education
and health status in Hispanics with self-reported joint pain.
Methods: Adult Hispanic participants (n=285)
were recruited from North Carolina clinics, churches, and a Mexican consulate
for a 6 week pre-post evaluation of a self-directed walking program.
Participants were recruited if they self-reported arthritis and/or joint pain
and were physically inactive. Descriptive characteristics of the population
include means and frequencies according to high school (HS) education level
(<HS diploma or ≥HS diploma). Multi-level logistic regression models
were used to explore associations between education and health status measures
at baseline. All models were adjusted for gender, age, obesity, marital status
and country of origin with study site adjusted for as a random effect.
Results: We found that 44% of participants had
less than a high school education. These participants were significantly more
likely to be born in Mexico (80.7%), be unmarried (14.4%), and speak only Spanish
(95.0%) compared with more educated participants (Table 1). Participants
lacking a high school diploma were also significantly more likely to have higher
levels of fatigue (OR=1.68; 95% CI=1.01-2.80) and stiffness (OR=1.69; 95%
CI=1.01-2.82), and poor general health (OR=3.11; 95% CI=1.78-5.42) (Table 2). Although
failing to reach statistical significance in multivariable regression models, less
educated participants also had a higher frequency of comorbidities, including heart
disease, circulation problems, and diabetes.
They were also more likely to have multiple chronic comorbid conditions
Conclusion: Compared to their more educated
counterparts, Hispanics who self-reported arthritis and/or joint pain and were
less educated had more severe joint symptoms and poorer general health. In
addition, the lower educated group also showed higher rates of comorbidity and
were more likely to have multiple comorbidities, which might account for some
of the disparity in health status. These findings may help inform the selection
and adaptation of arthritis interventions for Hispanics.
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Baseline Characteristic
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Total Cohort
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Education <HS
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Education ≥HS
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P-valueµ
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No. of Subjects |
285 |
126 (44.2%) |
159 (55.8%) |
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Demographic characteristics
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Age, mean (SD) |
47.0 (11.1) |
48.1 (17.5) |
46.1 (14.7) |
0.1445 |
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Female, % |
74.7 |
75.2 |
74.4 |
0.6289 |
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Marital status |
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Single, % |
13.4 |
14.0 |
12.9 |
<.0001 |
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Married, % |
68.6 |
69.5 |
67.8 |
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Other, % |
18.0 |
16.5 |
19.3 |
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BMI, mean (SD) |
30.0 (6.23) |
29.9 (8.56) |
30.2 (8.91) |
0.6607 |
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Obesity, % |
45.4 |
41.2 |
48.8 |
<.0001 |
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Acculturation variables
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Born in Mexico, % |
71.9 |
80.7 |
64.9 |
<.0001 |
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Speak Spanish only, % |
82.6 |
95.0 |
72.8 |
<.0001 |
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Self-report Health Status
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Fatigue VAS (>=60), % |
41.3 |
47.3 |
36.5 |
<.0001 |
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Pain VAS (>=60), % |
51.3 |
56.1 |
47.6 |
<.0001 |
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Stiffness VAS (>=60), % |
40.1 |
46.3 |
35.2 |
<.0001 |
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ASE score (<=7), % |
40.4 |
43.2 |
38.1 |
0.006 |
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HAQ score (>=0.5), % |
36.3 |
39.9 |
33.5 |
0.0004 |
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RAI score (>=2), % |
30.7 |
34.4 |
27.8 |
0.0001 |
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General health (fair/poor), % |
47.3 |
62.0 |
35.7 |
<.0001 |
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Comorbidities
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Number comorbidities, mean (SD) |
1.23 (1.55) |
1.46 (2.63) |
1.06 (1.88) |
0.0371 |
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High blood pressure, % |
25.4 |
28.6 |
22.7 |
0.0004 |
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Heart disease, % |
5.0 |
5.9 |
4.3 |
0.0503 |
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Circulation problems, % |
23.7 |
29.2 |
19.4 |
<.0001 |
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Stroke, % |
1.8 |
1.6 |
1.9 |
0.5019 |
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Diabetes, % |
13.6 |
19.3 |
9.0 |
<.0001 |
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Depression, % |
17.9 |
20.5 |
15.9 |
0.0017 |
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µChi-square p-value for categorical variables; T-test p-value for continuous variables |
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Table 2. Odds ratios (OR) and 95% confidence interval (CI) for the association between <HS educationµ and health status measures at baseline |
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Health Status
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<HS Education‡
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Self-report Health Status
|
OR (95% CI)
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Fatigue VAS (≥60) |
1.62 (0.95-2.76) |
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Pain VAS (≥60) |
1.68 (1.01-2.80) |
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Stiffness VAS (≥60) |
1.69 (1.01-2.82) |
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ASE score (≤7) |
1.45 (0.86-2.45) |
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HAQ score (≥0.5) |
1.26 (0.73-2.18) |
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RAI score (≥2) |
1.31 (0.76-2.28) |
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General health (fair/poor) |
3.11 (1.78-5.42) |
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Comorbidities
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Number of comorbidities (≥2) |
1.18 (0.67-2.06) |
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High blood pressure |
1.08 (0.59-1.99) |
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Heart disease |
1.46 (0.40-5.38) |
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Circulation problems |
1.59 (0.87-2.92) |
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Stroke |
1.19 (0.56-2.54) |
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Diabetes |
1.74 (0.81-3.73) |
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Depression |
1.37 (0.69-2.71) |
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µCompared with education ≥HS; used with multiply imputed data for missing covariates and predictors
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‡Adjusted for gender, age, obesity, marital status and country of origin; study site adjusted for as a random effect |
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To cite this abstract in AMA style:
Vilen L, Cleveland RJ, Rivadeneira A, Altpeter M, Hackney B, Sepulveda V, Callahan LF. Associations Between Education and Health Status Among Hispanics with Self-Reported Arthritis and/or Joint Pain [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/associations-between-education-and-health-status-among-hispanics-with-self-reported-arthritis-andor-joint-pain/. Accessed September 24, 2018.« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-between-education-and-health-status-among-hispanics-with-self-reported-arthritis-andor-joint-pain/