Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs.
BACKGROUND
There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education.


METHODS
The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS).


RESULTS
Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men.


CONCLUSIONS
Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden.
Anne
A
Hammarström
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway.
Inger
I
Haukenes
Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
Anncristine
A
Fjellman Wiklund
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden.
Arja
A
Lehti
Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
Maria
M
Wiklund
Department of Clinical Microbiology, Division of Infectious Diseases, Umeå University, Umeå, Sweden.
Birgitta
B
Evengård
Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
Britt-Marie
BM
Stålnacke
D000328:Adult; D059350:Chronic Pain / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities / Q000941:ethics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D018579:Patient Selection / Q000941:ethics*; D011320:Primary Health Care / Q000941:ethics* / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012737:Sex Factors; D013548:Sweden