Examining the Link Between Arthritis and Falling Into Poverty

Although prior research has found that persons with arthritis are more likely to live in poverty,¹ which variable comes first has yet to be defined until now. A paper published in Arthritis & Rheumatology and authored by a team of researchers from the University of Sydney reports on the first longitudinal study to investigate the association between arthritis and the risk of falling into income poverty and multidimensional poverty.²

Knowledge about the link between arthritis and poverty is important because the sheer number of people affected by arthritis has the potential to impact national poverty rates, according to the research team. The disease affects approximately 1 in 5 adults in the United States and is a major cause of morbidity worldwide.³

The researchers applied survival analysis, using Cox regression models, to nationally representative data obtained over a period of 6 years from the Household Income and Labour Dynamics in Australia (HILDA) data set. In the sample size of 3754 men and women, those with an arthritis diagnosis had a greater risk of falling into poverty than those without an arthritis diagnosis. Among the 240 patients in whom arthritis was diagnosed between January 1, 2007 and December 31, 2012, hazard ratios (HRs) for income poverty were 1.08 (95% confidence interval [95% CI] 1.06-1.09) in women and 1.15 (95% CI 1.13-1.16) in men, and HRs for multidimensional poverty were 1.15 (95% CI 1.14-1.17) in women and 1.88 (95% CI 1.85-1.91) in men.

“Being in income poverty means that your family’s income is below a certain income threshold, while being in multidimensional poverty, in this instance, means that you are in income poverty and that you also have one other type of disadvantage–either poor health or a low level of education attainment,” explained lead author Emily Callander, PhD, now a senior research fellow at James Cook University in Queensland, Australia, in an interview with Rheumatology Advisor. 

The increase in poverty could have been partially driven by the reduction or cessation of work hours due to pain- and disease-related restrictions, according to Dr Callander. “This means either a reduction or cessation of wages and reliance either on savings or welfare payments, which would often place persons below the income poverty line,” she said.

Although the researchers included age, marital status, homeownership, and location as possible confounding factors, other variables may be unaccounted for in this study. Additional limitations include the use of a self-reported survey (although the survey did ask respondents whether a doctor or nurse had told them that they had arthritis and the lack of differentiation between arthritis types.

Summary and Clinical Applicability

This longitudinal study suggests that the diagnosis of arthritis increases the risk of falling into income poverty and multidimensional poverty both in men and in women.

In light of these findings, clinicians should consider a patient’s ability to pay out-of-pocket fees when determining a course of treatment for arthritis. Clinicians should also be aware that patients may need assistance with pain management, workplace modifications, or other resources that can help them retain employment. 

“Although clinicians do not have control over what happens at the patient’s workplace, they are the ones who have a detailed understanding of the patient’s medical condition and the limitations he or she will face,” said Dr Callander. Having discussions with patients about their financial and health limitations can help assist them in working through difficulties and maintaining employment, she concluded.

References

1. Schofield DJ, Callander EJ, Shrestha RN, et al. Labour force participation and the influence of having arthritis on financial status. Rheumatol Int. 2015;35(7):1175-81.

2. Callander EJ, Shofield DJ. Arthritis and the risk of falling into poverty: a survival analysis using Australian data. Arthritis Rheumatol. 2016;68(1):255-62.

3. Arthritis-Related Statistics. Centers for Disease Control and Prevention (CDC) website http://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm. Updated January 25, 2016. Accessed February 26, 2016.