Neighborhood disadvantage, individual-level socioeconomic position, and self-reported chronic arthritis: a cross-sectional multilevel study.
OBJECTIVE
To examine the association between individual- and neighborhood-level disadvantage and self-reported arthritis.


METHODS
We used data from a population-based cross-sectional study conducted in 2007 among 10,757 men and women ages 40-65 years, selected from 200 neighborhoods in Brisbane, Queensland, Australia using a stratified 2-stage cluster design. Data were collected using a mail survey (68.5% response). Neighborhood disadvantage was measured using a census-based composite index, and individual disadvantage was measured using self-reported education, household income, and occupation. Arthritis was indicated by self-report. Data were analyzed using multilevel modeling.


RESULTS
The overall rate of self-reported arthritis was 23% (95% confidence interval [95% CI] 22-24). After adjustment for sociodemographic factors, arthritis prevalence was greatest for women (odds ratio [OR] 1.5, 95% CI 1.4-1.7) and in those ages 60-65 years (OR 4.4, 95% CI 3.7-5.2), those with a diploma/associate diploma (OR 1.3, 95% CI 1.1-1.6), those who were permanently unable to work (OR 4.0, 95% CI 3.1-5.3), and those with a household income <$25,999 (OR 2.1, 95% CI 1.7-2.6). Independent of individual-level factors, residents of the most disadvantaged neighborhoods were 42% (OR 1.4, 95% CI 1.2-1.7) more likely than those in the least disadvantaged neighborhoods to self-report arthritis. Cross-level interactions between neighborhood disadvantage and education, occupation, and household income were not significant.


CONCLUSIONS
Arthritis prevalence is greater in more socially disadvantaged neighborhoods. These are the first multilevel data to examine the relationship between individual- and neighborhood-level disadvantage upon arthritis and have important implications for policy, health promotion, and other intervention strategies designed to reduce the rates of arthritis, indicating that intervention efforts may need to focus on both people and places.
The University of Melbourne, St. Albans, and Deakin University, Geelong, Victoria 3220, Australia. sbrennan@unimelb.edu.au
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D000328:Adult; D000368:Aged; D001168:Arthritis / Q000191:economics* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012111:Residence Characteristics; D057566:Self Report / Q000191:economics*; D012959:Socioeconomic Factors; D035862:Vulnerable Populations