Skip to main content

Advertisement

Log in

At the Intersection of Ethnicity/Race and Poverty: Knee Pain and Physical Function

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Knee osteoarthritis (OA) disproportionately affects racial and ethnic minorities. Non-Hispanic Blacks (NHB) report a higher prevalence and severity of knee OA symptoms than their non-Hispanic White (NHW) counterparts. The role of poverty in explaining this disparity remains unclear.

Objective

The overall aim of this cross-sectional study was to determine whether ethnic/racial differences in knee pain and physical function varied according to poverty status.

Design

NHB and NHW adults with or at risk of knee OA self-reported sociodemographic information, and completed the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and the Short Physical Performance Battery (SPPB). Annual income was adjusted for number of household occupants to determine poverty status (i.e., living above versus below poverty line).

Results

Findings revealed 120 individuals living above the poverty line (49% NHB, 77% NHW) and 71 individuals living below the poverty line (51% NHB, 23% NHW). Adjusted multivariable models revealed significant ethnic/race by poverty status interactions for knee pain (p = 0.036) and physical function (p = 0.032) on the WOMAC, as well as physical function on the SPPB (p = 0.042). Post hoc contrasts generally revealed that NHW adults living above the poverty line experienced the least severe knee pain and best physical function, while NHB adults living below the poverty line experienced the most severe knee pain and poorest physical function.

Conclusions

Results of the present study add to the literature by emphasizing the importance of considering poverty and/or other indicators of socioeconomic status in studies examining ethnic/racial disparities in pain and physical function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Barbour KE, Helmick CG, Boring M, Brady TJ. Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013–2015. MMWR Morb Mortal Wkly Rep. 2017;66(9):246–53. https://doi.org/10.15585/mmwr.mm6609e1.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F, National Arthritis Data Workgroup Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58(1):26–35. doi:https://doi.org/10.1002/art.23176.

    Article  Google Scholar 

  3. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008;58(1):15–25. https://doi.org/10.1002/art.23177.

    Article  PubMed  Google Scholar 

  4. Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, et al. Understanding the pain experience in hip and knee osteoarthritis—an OARSI/OMERACT initiative. Osteoarthr Cartil. 2008;16(4):415–22. https://doi.org/10.1016/j.joca.2007.12.017.

    Article  CAS  PubMed  Google Scholar 

  5. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006;33(11):2271–9.

    PubMed  Google Scholar 

  6. Dunlop DD, Manheim LM, Song J, Chang RW. Arthritis prevalence and activity limitations in older adults. Arthritis Rheum. 2001;44(1):212–21. https://doi.org/10.1002/1529-0131(200101)44:1<212::AID-ANR28>3.0.CO;2-Q.

    Article  CAS  PubMed  Google Scholar 

  7. Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007;34(1):172–80.

    PubMed  Google Scholar 

  8. Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol. 1988;128(1):179–89.

    Article  CAS  Google Scholar 

  9. Jordan JM, Linder GF, Renner JB, Fryer JG. The impact of arthritis in rural populations. Arthritis Care Res. 1995;8(4):242–50.

    Article  CAS  Google Scholar 

  10. Tepper S, Hochberg MC. Factors associated with hip osteoarthritis: data from the First National Health and Nutrition Examination Survey (NHANES-I). Am J Epidemiol. 1993;137(10):1081–8.

    Article  CAS  Google Scholar 

  11. Allen KD. Racial and ethnic disparities in osteoarthritis phenotypes. Curr Opin Rheumatol. 2010;22(5):528–32. https://doi.org/10.1097/BOR.0b013e32833b1b6f.

    Article  PubMed  Google Scholar 

  12. Vina ER, Ran D, Ashbeck EL, Kwoh CK. Natural history of pain and disability among African-Americans and Whites with or at risk for knee osteoarthritis: a longitudinal study. Osteoarthr Cartil. 2018;26(4):471–9. https://doi.org/10.1016/j.joca.2018.01.020.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Allen KD, Helmick CG, Schwartz TA, DeVellis RF, Renner JB, Jordan JM. Racial differences in self-reported pain and function among individuals with radiographic hip and knee osteoarthritis: the Johnston County Osteoarthritis Project. Osteoarthr Cartil. 2009;17(9):1132–6. https://doi.org/10.1016/j.joca.2009.03.003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Allen KD, Oddone EZ, Coffman CJ, Keefe FJ, Lindquist JH, Bosworth HB. Racial differences in osteoarthritis pain and function: potential explanatory factors. Osteoarthr Cartil. 2010;18(2):160–7. https://doi.org/10.1016/j.joca.2009.09.010.

    Article  CAS  PubMed  Google Scholar 

  15. Cruz-Almeida Y, Sibille KT, Goodin BR, Petrov ME, Bartley EJ, Riley JL 3rd, et al. Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis Rheum. 2014;66(7):1800–10. https://doi.org/10.1002/art.38620.

    Article  Google Scholar 

  16. Golightly YM, Dominick KL. Racial variations in self-reported osteoarthritis symptom severity among veterans. Aging Clin Exp Res. 2005;17(4):264–9.

    Article  Google Scholar 

  17. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag. 2012;2(3):219–30. https://doi.org/10.2217/pmt.12.7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Meghani SH, Chittams J. Controlling for socioeconomic status in pain disparities research: all-else-equal analysis when “all else” is not equal. Pain Med. 2015;16(12):2222–5. https://doi.org/10.1111/pme.12829.

    Article  PubMed  Google Scholar 

  19. Ang DC, Ibrahim SA, Burant CJ, Kwoh CK. Is there a difference in the perception of symptoms between African Americans and Whites with osteoarthritis? J Rheumatol. 2003;30(6):1305–10.

    PubMed  Google Scholar 

  20. Fuentes M, Hart-Johnson T, Green CR. The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults. J Natl Med Assoc. 2007;99(10):1160–9.

    PubMed  PubMed Central  Google Scholar 

  21. Macartney S, Bishaw A, Fontenot K. Poverty rates for selected detailed race and Hispanic groups by state and place: 2007–2011. US Department of Commerce, Economics, and Statistics Administration. 2013;US Census Bureau.

  22. Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Thompson KA, Bulls HW, Sibille KT, Bartley EJ, Glover TL, Terry EL, et al. Optimism and psychological resilience are beneficially associated with measures of clinical and experimental pain in adults with or at risk for knee osteoarthritis. Clin J Pain. 2018;34(12):1164–72. https://doi.org/10.1097/AJP.0000000000000642.

    Article  PubMed  Google Scholar 

  24. Thompson K, Bulls H, Terry E, Sibille K, Bradley L, Goodin B, et al. At the intersection of race and socioeconomic disadvantage: painful and disabling knee osteoarthritis. J Pain. 2018;19(3):S107–S8. https://doi.org/10.1016/j.jpain.2017.12.256.

    Article  Google Scholar 

  25. U.S. Federal Poverty Guidelines. US Department of Health and Human Services. 2017.

  26. Daly MC, Duncan GJ, McDonough P, Williams DR. Optimal indicators of socioeconomic status for health research. Am J Public Health. 2002;92(7):1151–7.

    Article  Google Scholar 

  27. Poleshuck EL, Green CR. Socioeconomic disadvantage and pain. Pain. 2008;136(3):235–8. https://doi.org/10.1016/j.pain.2008.04.003.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Corbett DB, Simon CB, Manini TM, George SZ, Riley JL 3rd, Fillingim RB. Movement-evoked pain: transforming the way we understand and measure pain. Pain. 2018;160:757–61. https://doi.org/10.1097/j.pain.0000000000001431.

    Article  Google Scholar 

  29. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.

    Article  CAS  Google Scholar 

  30. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.

    CAS  PubMed  Google Scholar 

  31. Roux CH, Saraux A, Mazieres B, Pouchot J, Morvan J, Fautrel B, et al. Screening for hip and knee osteoarthritis in the general population: predictive value of a questionnaire and prevalence estimates. Ann Rheum Dis. 2008;67(10):1406–11. https://doi.org/10.1136/ard.2007.075952.

    Article  CAS  PubMed  Google Scholar 

  32. Kraus VB, Blanco FJ, Englund M, Karsdal MA, Lohmander LS. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthr Cartil. 2015;23(8):1233–41. https://doi.org/10.1016/j.joca.2015.03.036.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039–49.

    Article  CAS  Google Scholar 

  34. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502.

    Article  CAS  Google Scholar 

  35. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–70.

    Article  CAS  Google Scholar 

  36. Robinson ME, Riley JL 3rd, Myers CD, Sadler IJ, Kvaal SA, Geisser ME, et al. The Coping Strategies Questionnaire: a large sample, item level factor analysis. Clin J Pain. 1997;13(1):43–9.

    Article  CAS  Google Scholar 

  37. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66.

    Article  Google Scholar 

  38. Edwards MH, van der Pas S, Denkinger MD, Parsons C, Jameson KA, Schaap L, et al. Relationships between physical performance and knee and hip osteoarthritis: findings from the European Project on Osteoarthritis (EPOSA). Age Ageing. 2014;43(6):806–13. https://doi.org/10.1093/ageing/afu068.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Little TD, Jorgensen TD, Lang KM, Moore EW. On the joys of missing data. J Pediatr Psychol. 2014;39(2):151–62. https://doi.org/10.1093/jpepsy/jst048.

    Article  PubMed  Google Scholar 

  40. Myers TA. Goodbye, listwise deletion: presenting hot deck imputation as an easy and effective tool for handling missing data. Commun Methods Meas. 2011;5(4):297–310.

    Article  Google Scholar 

  41. Andridge RR, Little RJ. A review of hot deck imputation for survey non-response. Int Stat Rev. 2010;78(1):40–64. https://doi.org/10.1111/j.1751-5823.2010.00103.x.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cruz-Almeida Y, Cardoso J, Riley JL 3rd, Goodin B, King CD, Petrov M, et al. Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis. Exp Gerontol. 2017;98:186–91. https://doi.org/10.1016/j.exger.2017.08.026.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Duncan R, Peat G, Thomas E, Hay E, McCall I, Croft P. Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be? Ann Rheum Dis. 2007;66(1):86–91.

    Article  CAS  Google Scholar 

  44. Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, et al. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ. 2009;339:b2844.

    Article  Google Scholar 

  45. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008;9(1):116.

    Article  Google Scholar 

  46. Finan PH, Buenaver LF, Bounds SC, Hussain S, Park RJ, Haque UJ, et al. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum. 2013;65(2):363–72.

    Article  Google Scholar 

  47. Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, et al. The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthr Cartil. 2006;14(10):1033–40.

    Article  CAS  Google Scholar 

  48. Zhang Y, Nevitt M, Niu J, Lewis C, Torner J, Guermazi A, et al. Fluctuation of knee pain and changes in bone marrow lesions, effusions, and synovitis on magnetic resonance imaging. Arthritis Rheum. 2011;63(3):691–9.

    Article  Google Scholar 

  49. Janevic MR, McLaughlin SJ, Heapy AA, Thacker C, Piette JD. Racial and socioeconomic disparities in disabling chronic pain: findings from the health and retirement study. J Pain. 2017;18(12):1459–67. https://doi.org/10.1016/j.jpain.2017.07.005.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Callahan LF, Cleveland RJ, Shreffler J, Schwartz TA, Schoster B, Randolph R, et al. Associations of educational attainment, occupation and community poverty with knee osteoarthritis in the Johnston County (North Carolina) osteoarthritis project. Arthritis Res Ther. 2011;13(5):R169. https://doi.org/10.1186/ar3492.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Cleveland RJ, Luong ML, Knight JB, Schoster B, Renner JB, Jordan JM, et al. Independent associations of socioeconomic factors with disability and pain in adults with knee osteoarthritis. BMC Musculoskelet Disord. 2013;14:297. https://doi.org/10.1186/1471-2474-14-297.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Feldman CH, Dong Y, Katz JN, Donnell-Fink LA, Losina E. Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty. BMC Musculoskelet Disord. 2015;16:18. https://doi.org/10.1186/s12891-015-0475-8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Dixon T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis. 2004;63(7):825–30. https://doi.org/10.1136/ard.2003.012724.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Loignon C, Hudon C, Goulet E, Boyer S, De Laat M, Fournier N, et al. Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project. Int J Equity Health. 2015;14:4. https://doi.org/10.1186/s12939-015-0135-5.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Lubetkin EI, Jia H. Burden of disease associated with lower levels of income among US adults aged 65 and older. BMJ Open. 2017;7(1):e013720. https://doi.org/10.1136/bmjopen-2016-013720.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Pampel FC, Krueger PM, Denney JT. Socioeconomic disparities in health behaviors. Annu Rev Sociol. 2010;36:349–70. https://doi.org/10.1146/annurev.soc.012809.102529.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Sapolsky R. Sick of poverty. Sci Am. 2005;293(6):92–9.

    Article  Google Scholar 

  58. Lantz PM, House JS, Mero RP, Williams DR. Stress, life events, and socioeconomic disparities in health: results from the Americans’ Changing Lives Study. J Health Soc Behav. 2005;46(3):274–88. https://doi.org/10.1177/002214650504600305.

    Article  PubMed  Google Scholar 

  59. Thoits PA. Stress and health: major findings and policy implications. J Health Soc Behav. 2010;51(Suppl):S41–53. https://doi.org/10.1177/0022146510383499.

    Article  PubMed  Google Scholar 

  60. Assari S. Unequal gain of equal resources across racial groups. Int J Health Policy Manag. 2018;7(1):1–9.

    Article  Google Scholar 

  61. Creamer P, Lethbridge-Cejku M, Hochberg MC. Factors associated with functional impairment in symptomatic knee osteoarthritis. Rheumatology (Oxford). 2000;39(5):490–6.

    Article  CAS  Google Scholar 

  62. Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol. 2011;7(4):216–24. https://doi.org/10.1038/nrrheum.2011.2.

    Article  CAS  PubMed  Google Scholar 

  63. Sibille KT, Langaee T, Burkley B, Gong Y, Glover TL, King C, et al. Chronic pain, perceived stress, and cellular aging: an exploratory study. Mol Pain. 2012;8:12. https://doi.org/10.1186/1744-8069-8-12.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80–94.

    Article  Google Scholar 

  65. Yudell M, Roberts D, DeSalle R, Tishkoff S. Science and society. Taking race out of human genetics. Science. 2016;351(6273):564–5. https://doi.org/10.1126/science.aac4951.

    Article  CAS  PubMed  Google Scholar 

  66. Chokshi DA. Income, poverty, and health inequality. JAMA. 2018;319(13):1312–3. https://doi.org/10.1001/jama.2018.2521.

    Article  PubMed  Google Scholar 

Download references

Funding

Financial support was provided by NIH/NIA Grants R37AG033906-14 (R.B.F) and R01AG054370 (K.T.S); UF CTSA Grant UL1TR001427 and UAB CTSA Grant UL1TR001417 from the NIH Center for Advancing Translational Sciences; NIH Training Grants TL1TR001418 provided to the University of Alabama at Birmingham (K.A.T.); University of Florida McKnight Brain Institute Career Enhancement Award and NIH/NINDS Grant K22NS102334 (E.L.T.), and NIH/NIA Grant R00AG052642 (E.J.B).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Burel R. Goodin.

Ethics declarations

All procedures were reviewed and approved by the Institutional Review Boards at the University of Florida and University of Alabama at Birmingham.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study with human participants were in accordance with the ethical standards of the University of Florida and the University of Alabama at Birmingham, and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thompson, K.A., Terry, E.L., Sibille, K.T. et al. At the Intersection of Ethnicity/Race and Poverty: Knee Pain and Physical Function. J. Racial and Ethnic Health Disparities 6, 1131–1143 (2019). https://doi.org/10.1007/s40615-019-00615-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-019-00615-7

Keywords

Navigation