title: The association between neighbourhood socio-economic status and the onset of chronic widespread pain: results from the EPIFUND study.
abstract: BACKGROUND
  Cross-sectional studies have reported an inverse relationship between socio-economic status and the prevalence of chronic widespread pain (CWP). However, the extent to which this relationship is explained by psychological factors is unknown. The aim of this study was to examine the hypothesis that socio-economic status predicts the onset of CWP but that this relationship would be explained by psychological factors.
  
  
  METHODS
  Subjects from three diverse socio-economic areas were recruited into a population-based prospective survey of pain. Subjects completed a questionnaire at baseline that assessed pain status and psychological factors and occupation. Fifteen months later subjects completed a follow-up questionnaire which assessed pain status.
  
  
  RESULTS
  A total of 3489 subjects were free of CWP at baseline and eligible for follow-up, of whom 2782 (79.7%) participated. Of those, 281 (10%) subjects were classified as having new CWP. Logistic regression analysis revealed that compared to subjects from the most affluent socio-economic area, those from the moderate and least affluent areas were respectively, 1.47 (95% CI: 1.08-2.01) and 1.35 (95% CI: 1.00-1.82) times more likely to have new CWP. However, in a stepwise multivariate logistic regression analysis, controlling for psychological factors, the relationship between new onset CWP and socio-economic status was no longer evident.
  
  
  CONCLUSIONS
  This study has demonstrated that socio-economic status is related to new onset CWP, but the association is explained by psychological factors. Understanding the factors underlying the association between socio-economic status and pain should help to design intervention strategies which may reduce the burden of chronic pain in identified high risk population groups.
authors.affiliation: Arthritis Research Campaign (ARC), Epidemiology Unit, Research School of Translational Medicine, Stopford Building, University of Manchester, Manchester, United Kingdom. Kelly.davies@manchester.ac.uk
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Davies
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Silman
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.forename: Barbara I
authors.initials: BI
authors.lastname: Nicholl
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
authors.forename: David
authors.initials: D
authors.lastname: Ray
authors.forename: John
authors.initials: J
authors.lastname: McBeth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D055809:Illness Behavior; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010146:Pain / Q000191:economics* / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement; D018579:Patient Selection; D011153:Population; D012111:Residence Characteristics; D012923:Social Class; D011795:Surveys and Questionnaires; D055815:Young Adult
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