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- Lindéus, Maria, et al.
(författare)
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Changes in educational inequalities in knee and hip osteoarthritis surgery and non-surgery specialist care visits over time in Sweden
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Ingår i: Osteoarthritis and Cartilage Open. - 2665-9131.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo examine changes in prevalence and socioeconomic inequalities in knee and hip OA outcomes, in more specific surgery and non-surgery specialist care visits, from 2001 to 2011 in Sweden and to what extent sociodemographic factors can explain the changes.DesignWe included all individuals aged ≥35 years resident in Sweden from 2001 to 2011. Individual-level data was retrieved from the Swedish Interdisciplinary Panel. Highest educational attainment was used as socioeconomic measure and the concentration index was used to assess relative and absolute educational inequalities. We used decomposition method to examine changes in prevalence and relative educational inequalities.ResultsA total of 4,794,693 and 5,359,186 people were included for the years 2001 and 2011, respectively. The crude prevalence of surgery and specialist visits for knee and hip OA was 36-83% higher in 2011 than in 2001. The increase in hip OA outcomes was largely explained by changes in the sociodemographic composition of the population, whereas for knee OA outcomes, changes in the strength of the associations with sociodemographic factors appeared more important. All outcomes were concentrated among people with lower education in all study years. The relative inequalities declined over the study period, while the absolute inequalities increased for knee OA outcomes and remained stable for hip OA.ConclusionOur findings show an increasing burden of all studied OA outcomes. Moreover, our findings suggest persistent educational inequalities with more surgeries and specialist visits among lower-educated individuals. Future research should incorporate additional variables to better understand and address these inequalities.
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| 2. |
- Lindéus, Maria, et al.
(författare)
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Does lower educational attainment increase the risk of osteoarthritis surgery? a Swedish twin study
- 2023
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data. Methods: From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1st 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between educational attainment and knee and hip OA surgery were estimated in models matched on twin pairs, using Weibull within-between (WB) shared frailty model. Results: For knee OA surgery, the analysis matched on MZ twins yielded a within-estimate hazard ratio (HR) per 3 years of education, of 1.06 (95% CI: 0.81, 1.32), suggesting no association between the outcome and the individual´s education. Rather, there seemed to be a so called familial effect of education, with a between-pair estimate of HR = 0.71 (95% CI: 0.41, 1.01). For hip OA surgery, the within- and between-pair estimates for MZ twins were 0.92 (95% CI: 0.69, 1.14) and 1.15 (95% CI: 0.87, 1.42), respectively. Conclusions: Our results suggest that the inverse associations between education and knee/hip OA surgery observed in cohort studies are potentially confounded by unobserved familial factors like genetics and/or early life exposures.
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| 3. |
- Lindéus, Maria, et al.
(författare)
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Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden
- 2020
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 48:1, s. 72-79
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the absolute and relative educational inequalities in mortality from hip and non-hip fractures in Skåne region, Sweden.METHODS: We conducted a population-based open cohort study. People aged 30-99 years, resident in the region during 1998-2013 ( n = 999, 148) were followed until death, their 100th birthday, relocation outside Skåne, or the end of 2014. We obtained individual-level data from the Statistics Sweden and the Swedish National Board of Health and Welfare's Cause of Death Register. Death certificates coded with any fracture diagnosis were defined as fracture-related deaths. Educational inequalities were assessed by slope and relative indices of inequality (SII and RII). Cox regression and additive hazard models were used to estimates these indices.RESULTS: During a mean follow-up of 12.2 years, there were 5,121 fracture-related deaths, of which 3,110 were associated with hip fracture. Age-standardized, hip fracture-related mortality rates per 100,000 person-years were 31, 95% confidence interval (CI) (30, 32) and 23 (20, 26) in people with low and high levels of education, respectively (rate ratio 1.4, 95% CI (1.2, 1.5)). Corresponding mortality rates for non-hip-fracture related deaths were 20 (18, 21) and 16 (14, 19) (rate ratio 1.2, 95% CI (1.0, 1.4)). SII and RII revealed educational inequalities in hip fracture-related mortality in favour of highly educated people. For non hip fracture-related mortality, there were statistically significant educational inequalities in people aged <70 years.CONCLUSIONS: We found higher fracture-related mortality with lower education suggesting preventative and therapeutic interventions for fractures should pay special attention to people with low-level education.
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| 4. |
- Lindéus, Maria, et al.
(författare)
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Socioeconomic inequalities in all‐cause and cause‐specific mortality among patients with osteoarthritis in the Skåne region, Sweden
- 2022
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 74:10, s. 1704-1712
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the association between education and all-cause and cause-specific mortality among patients with osteoarthritis (OA) in comparison to an OA-free reference cohort.Methods: Using data from the Skåne healthcare register, we identified all residents aged ≥45 years in the region of Skåne, with doctor-diagnosed OA of peripheral joints between 1998 and 2013 (n=123,993). We created an age and sex-matched reference cohort without OA diagnosis (n=121,318). Subjects were followed until death, relocation outside Skåne, or the end of 2014. The relative index of inequality (RII) and the slope index of inequality (SII) were estimated by the Cox model and Aalen´s additive hazard model, respectively.Results: We found an inverse association between education and mortality. The magnitude of relative inequalities in all-cause mortality were comparable in the OA (RII 1.53, 95% CI:1.46, 1.61) and reference cohorts (RII:1.54, 95% CI:1.47, 1.62). The absolute inequalities were smaller in the OA (SII 937 all-cause deaths per 100,000 person-years, 95% CI:811, 1063) compared with the reference cohort (SII 1265, 95% CI:1109, 1421). Cardiovascular mortality contributed more to the absolute inequalities in the OA than in the reference cohort (60.1% vs. 48.1%) while the opposite was observed for cancer mortality (8.5% vs. 22.3%).Conclusion: We found higher all-cause and cause-specific mortality in OA patients with lower education. The observed inequalities in the OA cohort reflect the inequalities in the population at large. The greater burden of cardiovascular diseases in OA patients suggests that proper management of cardiovascular risk factors in OA patients is important.
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| 5. |
- Lindéus, Maria
(författare)
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Socioeconomic inequalities in musculoskeletal disorders outcomes and care. Educational inequalities in fracture-related mortality and osteoarthritis.
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Musculoskeletal disorders (MSDs) are a major cause of disability worldwide, and two conditions that are major contributors to the overall burden of MSDs are fractures and osteoarthritis (OA). The Swedish Health and Medical Services Act (HSL 2017:30) states that the goal of all health care services is good health and health care on equal terms for the entire population. However, there exists a well-known association between SES and health, where people with lower SES, generally, tend to have poorer health and higher mortality. This association is seen for a wide range of diseases, including MSDs. However, the knowledge about inequalities in MSDs in the Swedish health care system is limited. Thus, the aim of this thesis was to determine the association between SES and outcomes in MSDs, with focus on fractures and osteoarthritis, in order to identify potential health inequalities. The studies in this thesis are based on individual-level register data from people resident in the Skåne region (study I and II) and the whole country of Sweden (study III and IV). Study I-III are open cohort studies, while study IV has a repeated cross-sectional design. In addition, study I and III have a multiple cause of death approach and co-twin control design, respectively. Educational attainment was used as an indicator for SES in all studies. Following data sources were used: Statistics Sweden, The National Board of Health and Welfare, The Skåne Healthcare Register, The Swedish Twin Registry (STR), and The Swedish Military Conscription Registry.In study I, absolute and relative educational inequalities in non-hip and hip fracture-related mortality were examined using the slope index of inequality (SII) and relative index of inequality (RII), respectively. The study period was between 1998-2014, and 999,148 people were included. Generally, the absolute as well as the relative inequalities revealed higher fracture-related mortality in people with low vs. high education, suggesting that preventative and therapeutic interventions of fractures in low educated people should be targeted.Study II assessed the association between education and all-cause and cause-specific mortality among patients with OA (123,993 people) in comparison to an OA-free reference cohort (121,318 people). The study period was from 1998 to 2014, and the inequalities were examined with SII and RII. The results showed that people with lower education, with or without OA, have higher all-cause and cause-specific mortality and that the inequalities observed in OA patients reflect the health inequalities in the population at large. In addition, the results suggest that OA patients, especially with lower education, have a greater burden of cardiovascular diseases, which implies that it is important to focus on the prevention and treatment of cardiovascular diseases in this group.The aim of study III was to examine the association between educational attainment and knee and hip OA surgery using twin data. In total, 67,071 twins from the STR were included and the studied time period was between 1987-2016. The main analysis was Weibull within-between shared frailty model. When adjusting for genetics and early-life environment, there was no association between educational attainment and knee and hip OA surgery. However, a confounding familial effect in the association between educational attainment and knee OA surgery was found.In study IV changes in prevalence and socioeconomic inequalities in knee and hip OA surgery and non-surgery specialist care visits were examined. The studied time period was 2001-2011, and the prevalence and inequalities were estimated for each year. The concentration Index was used to assess relative and absolute inequalities. The Blinder-Oaxaca decomposition method was used to examine the factors contributing to the changes between the years 2001 (4 794,693 people) and 2011 (5 359,186 people). The prevalence of all outcomes rose. Changes in the strength of the association between sociodemographic factors and OA outcomes contributed the most to the increase in knee OA outcomes. For hip OA outcomes, the increase was primarily due to changes in the characteristics of the populations over time. All outcomes were more concentrated among people with lower education. Absolute educational inequalities were either decreasing or steady over time, while there was a declining tendency in relative inequalities for all outcomes. The overall conclusion of the thesis is that there are socioeconomic inequalities in fracture-related mortality and OA-related outcomes in favour of people with higher SES. The associations need to be investigated in more detail in order to be able to reduce the observed differences.
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