Educational inequalities in mortality associated with rheumatoid arthritis and other musculoskeletal disorders in Sweden

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Musculoskeletal (MSK) disorders are less likely to be reported as an underlying cause of death (UCD) and since cause of death studies are generally limited to the UCD, little is known about socioeconomic inequalities in MSK disorders as cause of death in the general population. Using multiple-cause-of-death data, we aimed to quantify and compare educational inequalities in musculoskeletal (MSK) disorders- with non-MSK disorders-related mortality.

METHODS: All residents aged 30-99 years in the Skåne region, Sweden, during 1998-2013 (n = 999,148) were followed until their 100th birthday, death, relocation outside Skåne, or end of 2014. We identified any mention of rheumatoid arthritis (RA) or other MSK disorders on death certificates using multiple-cause-of-death data. We retrieved and linked individual-level data from Statistics Sweden on highest level of education. We used Cox regression and additive hazards models with age as time-scale adjusted for sex, marital status, and country of birth to calculate slope and relative indices of inequality (SII/RII).

RESULTS: During a mean follow-up of 12.2 years, there were 1407 (0.8% of all deaths) and 3725 (2.1% of all deaths) death certificates with mention of RA and other MSK disorders, respectively, and 171,798 death certificates without any mention of a MSK disorder. Age-standardized RA mortality rate was 2.2 (95% confidence interval [CI]: 2.0-2.8) times greater in people with 0-9 years of education compared with those with > 12 years of education. Corresponding figure for other MSK disorders was 1.5 (95% CI: 1.4-1.6). Both RIIs and SIIs revealed statistically significant educational inequalities in RA/other MSK disorders mortality favouring high-educated people. The RIIs of MSK disorders-related deaths were generally greater than non-MSK disorders-related deaths.

CONCLUSION: We found substantial educational inequality in mortality from MSK disorders. Further research is needed to investigate underlying pathways driving these inequalities.

Details

Authors
Organisations
External organisations
  • Skåne University Hospital
  • Boston University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology
  • Orthopedics
Original languageEnglish
Number of pages6
JournalBMC Musculoskeletal Disorders
Volume20
Issue number1
Publication statusPublished - 2019 Feb 18
Publication categoryResearch
Peer-reviewedYes