title: Is financial hardship associated with reduced health in disability? The case of spinal cord injury in Switzerland.
abstract: OBJECTIVE
  To investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland.
  
  
  METHODS
  Observational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions.
  
  
  RESULTS
  Financial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18-5.21), comorbidities (OR 2.88, 95% CI 1.83-4.53) and pain (OR 3.32, 95% CI 2.21-4.99), whereas mental health (OR 0.23, 95% CI 0.15-0.36), participation (OR 0.30, 95% CI 0.21-0.43) and quality of life (OR 0.22, 95% CI 0.15-0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00-1.07) and higher quality of life (OR 1.06, 95% CI 1.02-1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship.
  
  
  CONCLUSIONS
  Suffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.
authors.affiliation: Swiss Paraplegic Research, Nottwil, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Fekete
authors.affiliation: Senior Professorship for Work Stress Research, Faculty of Medicine, University of Duesseldorf, Life Science Center, Duesseldorf, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Siegrist
authors.affiliation: Swiss Paraplegic Research, Nottwil, Switzerland ; Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, Sichuan Province, China.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Reinhardt
authors.affiliation: Swiss Paraplegic Research, Nottwil, Switzerland ; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
authors.forename: Martin W G
authors.initials: MW
authors.lastname: Brinkhof
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D013557:Switzerland