title: The association of socioeconomic status and symptom severity in persons with fibromyalgia.
abstract: OBJECTIVE
  Although persons with lower socioeconomic status (SES) generally have poorer health status for many medical conditions, the association of SES with symptom severity in fibromyalgia (FM) is unknown. The subjective symptoms of FM may be influenced by personal perceptions, and environmental and psychosocial factors. Therefore SES may influence symptom expression and severity.
  
  
  METHODS
  Data for this cross-sectional analysis were obtained from a real-life prospective cohort of 246 patients with FM categorized according to level of education: high school graduates or less (Group 1; n = 99), college graduates (Group 2; n = 84), and university graduates (Group 3; n = 63). The association between level of education, a well-validated measure of SES, and disease severity, functional status, and quality of life were examined.
  
  
  RESULTS
  Lower education was significantly associated with older age (p = 0.039), current unemployment (p < 0.001), and more severe disease, as measured by patient global assessment disease activity (p = 0.019), McGill Pain Questionnaire (p = 0.026), Pain Disability Index (p = 0.031), Pain Catastrophizing Scale (p = 0.015), Health Assessment Questionnaire (p = 0.001), and Fibromyalgia Impact Questionnaire (p = 0.002), but not pain level, anxiety, or depression. These associations remained significant even upon adjusting for age and sex differences.
  
  
  CONCLUSIONS
  Patients with FM and lower SES, as assessed by education level, reported greater symptom severity and functional impairment, despite reporting similar levels of pain, depression, and anxiety. Although FM spans all socioeconomic groups, factors other than specific disease characteristics or mental status, appear to play an important role in patients' perception of illness.
authors.affiliation: From the Division of Rheumatology, McGill University Health Centre, Montreal; JSS Medical Research, St-Laurent; Jewish General Hospital, McGill University, Montreal; and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; J.S. Sampalis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre. mary-ann.fitzcharles@muhc.mcgill.ca.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Fitzcharles
authors.affiliation: From the Division of Rheumatology, McGill University Health Centre, Montreal; JSS Medical Research, St-Laurent; Jewish General Hospital, McGill University, Montreal; and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; J.S. Sampalis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Rampakakis
authors.affiliation: From the Division of Rheumatology, McGill University Health Centre, Montreal; JSS Medical Research, St-Laurent; Jewish General Hospital, McGill University, Montreal; and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; J.S. Sampalis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ste-Marie
authors.affiliation: From the Division of Rheumatology, McGill University Health Centre, Montreal; JSS Medical Research, St-Laurent; Jewish General Hospital, McGill University, Montreal; and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; J.S. Sampalis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre.
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
authors.affiliation: From the Division of Rheumatology, McGill University Health Centre, Montreal; JSS Medical Research, St-Laurent; Jewish General Hospital, McGill University, Montreal; and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada.M.A. Fitzcharles, MB, ChB, Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; J.S. Sampalis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Shir
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012720:Severity of Illness Index; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: FIBROMYALGIA; SOCIOECONOMIC STATUS