Income-Related Inequality Changes in an Osteoarthritis First-Line Intervention: a Cohort Study. Battista, S., Kiadaliri, A., Jönsson, T., Gustafsson, K., Englund, M., Testa, M., & Dell'Isola, A. Archives of Physical Medicine and Rehabilitation, November, 2023.
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OBJECTIVE: To examine income-related inequality changes in the outcomes of an osteoarthritis (OA) first-line intervention. DESIGN: Retrospective cohort study. SETTING: Swedish healthcare system. PARTICIPANTS: We included 115,403 people (age: 66.2 ±9.7 years; female 67.8%) with knee (67.8%) or hip OA (32.4%) recorded in the 'Swedish Osteoarthritis Registry' (SOAR). INTERVENTIONS: Exercise and education. MAIN OUTCOME MEASURES: Erreygers' concentration index (E) measured income-related inequalities in 'Pain intensity,' 'Self-efficacy,' 'Use of NSAIDs,' and 'Desire for surgery' at baseline, 3-month, and 12-month follow-ups and their differences over time. E-values range from -1 to +1 if the health variables are more concentrated among people with lower or higher income. Zero represents perfect equality. We used entropy balancing to address demographic and outcome imbalances and bootstrap replications to estimate confidence intervals for E differences over time. RESULTS: Comparing baseline to 3 months, 'pain' concentrated more among individuals with lower income initially (E=-0.027), intensifying at 3 months (E=-0.011 [95% CI: -0.014; -0.008]). Similarly, the 'Desire for surgery' concentrated more among individuals with lower income initially (E = -0.009), intensifying at 3 months (E=-0.012 [-0.018; -0.005]). Conversely, 'Self-efficacy' concentrated more among individuals with higher income initially (E=0.058), intensifying at 3 months (E=0.008 [0.004; 0.012]). Lastly, the 'Use of NSAIDs' concentrated more among individuals with higher income initially (E=0.068) but narrowed at 3 months (E=-0.029 [-0.038; -0.021]). Comparing baseline to 12 months, 'pain' concentrated more among individuals with lower income initially (E=-0.024), intensifying at 12 months (E=-0.017 [-0.022; -0.012]). Similarly, the 'Desire for surgery' concentrated more among individuals with lower income initially (E=-0.016), intensifying at 12 months (E=-0.012 [-0.022; -0.002]). Conversely, 'Self-efficacy' concentrated more among individuals with higher income initially (E=0.059), intensifying at 12 months (E=0.016 [0.011; 0.021]). CONCLUSION: Our results highlight the increase of income-related inequalities in the SOAR over time.
@article{battista_income-related_2023,
	title = {Income-{Related} {Inequality} {Changes} in an {Osteoarthritis} {First}-{Line} {Intervention}: a {Cohort} {Study}},
	issn = {1532-821X},
	shorttitle = {Income-{Related} {Inequality} {Changes} in an {Osteoarthritis} {First}-{Line} {Intervention}},
	doi = {10.1016/j.apmr.2023.10.012},
	abstract = {OBJECTIVE: To examine income-related inequality changes in the outcomes of an osteoarthritis (OA) first-line intervention.
DESIGN: Retrospective cohort study.
SETTING: Swedish healthcare system.
PARTICIPANTS: We included 115,403 people (age: 66.2 ±9.7 years; female 67.8\%) with knee (67.8\%) or hip OA (32.4\%) recorded in the 'Swedish Osteoarthritis Registry' (SOAR).
INTERVENTIONS: Exercise and education.
MAIN OUTCOME MEASURES: Erreygers' concentration index (E) measured income-related inequalities in 'Pain intensity,' 'Self-efficacy,' 'Use of NSAIDs,' and 'Desire for surgery' at baseline, 3-month, and 12-month follow-ups and their differences over time. E-values range from -1 to +1 if the health variables are more concentrated among people with lower or higher income. Zero represents perfect equality. We used entropy balancing to address demographic and outcome imbalances and bootstrap replications to estimate confidence intervals for E differences over time.
RESULTS: Comparing baseline to 3 months, 'pain' concentrated more among individuals with lower income initially (E=-0.027), intensifying at 3 months (E=-0.011 [95\% CI: -0.014; -0.008]). Similarly, the 'Desire for surgery' concentrated more among individuals with lower income initially (E = -0.009), intensifying at 3 months (E=-0.012 [-0.018; -0.005]). Conversely, 'Self-efficacy' concentrated more among individuals with higher income initially (E=0.058), intensifying at 3 months (E=0.008 [0.004; 0.012]). Lastly, the 'Use of NSAIDs' concentrated more among individuals with higher income initially (E=0.068) but narrowed at 3 months (E=-0.029 [-0.038; -0.021]). Comparing baseline to 12 months, 'pain' concentrated more among individuals with lower income initially (E=-0.024), intensifying at 12 months (E=-0.017 [-0.022; -0.012]). Similarly, the 'Desire for surgery' concentrated more among individuals with lower income initially (E=-0.016), intensifying at 12 months (E=-0.012 [-0.022; -0.002]). Conversely, 'Self-efficacy' concentrated more among individuals with higher income initially (E=0.059), intensifying at 12 months (E=0.016 [0.011; 0.021]).
CONCLUSION: Our results highlight the increase of income-related inequalities in the SOAR over time.},
	language = {eng},
	journal = {Archives of Physical Medicine and Rehabilitation},
	author = {Battista, Simone and Kiadaliri, Ali and Jönsson, Thérése and Gustafsson, Kristin and Englund, Martin and Testa, Marco and Dell'Isola, Andrea},
	month = nov,
	year = {2023},
	pmid = {37935314},
	keywords = {Epidemiology, Health Policy, National Health Programs, Personal Health Services, Physical Therapy Specialty},
	pages = {S0003--9993(23)00607--X},
}
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