title: Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status.
abstract: BACKGROUND
  There is abundant evidence that low socioeconomic status (SES) is associated with worse health outcomes among people with Rheumatoid Arthritis (RA); however, the influence of socioeconomic disadvantage in early life has yet to be studied within that population.
  
  
  METHODS
  Data originated from the cross-sectional arm of the Consortium Evaluation of African-Americans with Rheumatoid Arthritis (CLEAR II), which recruited African-Americans with RA from six sites in the Southeastern United States. We used linear regression models to evaluate associations of parental homeownership status and educational level at participant time of birth with participant-reported fatigue (Visual Analog scale, cm), pain (Visual Analog scale, cm), disability (Health Assessment Questionnaire) and helplessness (Rheumatology Attitudes Index), independently of participant homeownership status and educational level. Models included random effects to account for intra-site correlations, and were adjusted for variables identified using backward selection, from: age, disease-duration, sex, medication use, body-mass index, smoking history.
  
  
  RESULTS
  Our sample included 516 CLEAR II participants with full data on demographics and covariates. 89% of participants were women, the mean age was 54.7 years and mean disease duration was 10.8 years. In age adjusted models, parental non-homeownership was associated with greater fatigue (β = 0.75, 95% CI = 0.36-1.14), disability (β = 0.12, 95% CI = 0.04-0.19) and helplessness (β = 0.12, 95% CI = 0.03-0.21), independently of participant homeownership and education; parental education had a further small influence on self-reported fatigue (β = 0.20, 95% CI = 0.15-0.24).
  
  
  CONCLUSIONS
  Parental homeownership, and to a small extent parental education, had modest but meaningful relationships with self-reported health among CLEAR II participants.
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, CB 7280 UNC, Chapel Hill, NC, 27599, USA.|Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Antoine R
authors.initials: AR
authors.lastname: Baldassari
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, CB 7280 UNC, Chapel Hill, NC, 27599, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Cleveland
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, CB 7280 UNC, Chapel Hill, NC, 27599, USA.
authors.forename: My-Linh N
authors.initials: MN
authors.lastname: Luong
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, CB 7280 UNC, Chapel Hill, NC, 27599, USA.|Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Beth L
authors.initials: BL
authors.lastname: Jonas
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Doyt L
authors.initials: DL
authors.lastname: Conn
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Moreland
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: S Louis
authors.initials: SL
authors.lastname: Bridges
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, CB 7280 UNC, Chapel Hill, NC, 27599, USA. leigh_callahan@med.unc.edu.|Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. leigh_callahan@med.unc.edu.|Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. leigh_callahan@med.unc.edu.
authors.forename: Leigh F
authors.initials: LF
authors.lastname: Callahan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000193:education / Q000208:ethnology*; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000208:ethnology* / Q000628:therapy; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D012307:Risk Factors; D057566:Self Report; D012923:Social Class; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000208:ethnology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome