title: Socioeconomic inequities in perceived health among patients with musculoskeletal disorders compared with other chronic disorders: results from a cross-sectional Dutch study.
abstract: OBJECTIVE
  To explore the impact of socioeconomic factors on physical and mental health of patients with musculoskeletal disorders (MSKDs) and compare it across patients with other disorders.
  
  
  METHODS
  A representative sample of the Dutch population (n=8904) completed a survey on sociodemographics, physician-diagnosed (co-) morbidities, and physical (physical component summary, PCS) and mental (mental component summary, MCS) subscales of SF-12 (outcome variables). Regression models were computed first in the total group of patients with MSKDs, with education, age, gender, origin and place of residence as independent variables, and, second, in individuals expected to have paid work, adding a variable on social status. Models were repeated for five other subgroups of chronic disorders (cardiovascular (CVD), diabetes, cancer, mental and respiratory) and for healthy individuals.
  
  
  RESULTS
  MSKDs confirmed by a physician were reported by 1766 (20%) participants (mean age 59 years, 38% male), 547 (6%) respondents reported to have diabetes, 1855 (21%) CVD, 270 (3%) cancer, 526 (6%) mental disorders, 679 (8%) respiratory disorders and 4525 (51%) did not report any disease. In patients with MSKDs, (primary school vs university education (-5.3 (PCS) and -3.3 (MCS)) and having a state subsidy vs paid work (-5.3 (PCS) and -4.7 (MCS)) were consistently associated with worse physical and mental health. Gender was only relevant for PCS (female vs male -2.1). Comparable differences in health by education and social status were observed in the other diseases, except for cancer.
  
  
  CONCLUSIONS
  Education and social status in MSKD have the same strong and independent association with health as in other chronic diseases. These health gradients are unfair and partly avoidable, and require consorted attention and action in and outside healthcare.
authors.affiliation: Department of Rheumatology , Maastricht University Medical Center , CAPHRI School for Public Health and Primary care, Maastricht , The Netherlands ; Department of Health Promotion, Maastricht University , CAPHRI School for Public Health and Primary care , Maastricht , The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Putrik
authors.affiliation: Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center , Amsterdam , The Netherlands ; Department of Rheumatology , Hospital Garcia de Orta , Almada , Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Netherlands Organization for Applied Scientific Research , Leiden , The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Chorus
authors.affiliation: Department of Medical Informatics , Uniklinik RWTH Aachen University , Aachen , Germany.
authors.forename: A P
authors.initials: AP
authors.lastname: Keszei
authors.affiliation: Department of Rheumatology , Maastricht University Medical Center , CAPHRI School for Public Health and Primary care, Maastricht , The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Boonen
keywords: Epidemiology; Multidisciplinary team-care; Outcomes research