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Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program
OBJECTIVE: To investigate whether adults with potential multiple social disadvantage have poorer outcomes following attendance in an osteoarthritis (OA) management program (OAMP), and if so, what might determine this result. METHODS: Among consecutive knee OA attendees of the Good Life With Osteoart...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wiley Periodicals, Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087615/ https://www.ncbi.nlm.nih.gov/pubmed/35900880 http://dx.doi.org/10.1002/acr.24987 |
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author | Peat, George Yu, Dahai Grønne, Dorte T. Marshall, Michelle Skou, Soren T. Roos, Ewa M. |
author_facet | Peat, George Yu, Dahai Grønne, Dorte T. Marshall, Michelle Skou, Soren T. Roos, Ewa M. |
author_sort | Peat, George |
collection | PubMed |
description | OBJECTIVE: To investigate whether adults with potential multiple social disadvantage have poorer outcomes following attendance in an osteoarthritis (OA) management program (OAMP), and if so, what might determine this result. METHODS: Among consecutive knee OA attendees of the Good Life With Osteoarthritis in Denmark (GLA:D) OAMP in Denmark we defined a group with potential “intersectional disadvantage” based on self‐reported educational attainment, country of birth, and citizenship. Outcomes of this group were compared with GLA:D participants who were native Danish citizens with higher educational attainment. Outcomes were pain intensity, Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale score, and the EuroQol 5‐domain instrument in 5 levels (EQ‐5D‐5L) score at 3 and 12 months. After data preprocessing, we used entropy balancing to sequentially control for differences between the groups in baseline covariates. Mean between‐group differences in outcomes were estimated by weighted linear regression. RESULTS: Of 18,448 eligible participants, 250 (1.4%) were nonnative/foreign citizens with lower education. After balancing for differences in baseline score and in administrative and demographic characteristics, they had poorer outcomes than higher‐educated native Danish citizens on pain intensity and EQ‐5D‐5L score at both follow‐up points (e.g., between‐group mean differences in pain visual analog scale [0–100] at 3 and 12 months: 3.4 [95% confidence interval (95% CI) –0.5, 7.3] and 6.2 [95% CI 1.7, 10.7], respectively). Differences in KOOS quality of life subscale score, were smaller or absent. Balancing for differences on baseline score, comorbidity, self‐efficacy, and depression had the greatest effect on reducing observed outcome inequalities. CONCLUSION: Outcome inequalities widened following OAMP attendance, particularly at longer‐term follow‐up, but the magnitude of differences was generally modest and inconsistent across outcome measures. Tailoring content to reduce outcome inequalities may be indicated, but improving access appears the greater priority. |
format | Online Article Text |
id | pubmed-10087615 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Wiley Periodicals, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100876152023-04-12 Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program Peat, George Yu, Dahai Grønne, Dorte T. Marshall, Michelle Skou, Soren T. Roos, Ewa M. Arthritis Care Res (Hoboken) Theme Issue Articles: Health Disparities And Health Equity In The Rheumatic Diseases OBJECTIVE: To investigate whether adults with potential multiple social disadvantage have poorer outcomes following attendance in an osteoarthritis (OA) management program (OAMP), and if so, what might determine this result. METHODS: Among consecutive knee OA attendees of the Good Life With Osteoarthritis in Denmark (GLA:D) OAMP in Denmark we defined a group with potential “intersectional disadvantage” based on self‐reported educational attainment, country of birth, and citizenship. Outcomes of this group were compared with GLA:D participants who were native Danish citizens with higher educational attainment. Outcomes were pain intensity, Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale score, and the EuroQol 5‐domain instrument in 5 levels (EQ‐5D‐5L) score at 3 and 12 months. After data preprocessing, we used entropy balancing to sequentially control for differences between the groups in baseline covariates. Mean between‐group differences in outcomes were estimated by weighted linear regression. RESULTS: Of 18,448 eligible participants, 250 (1.4%) were nonnative/foreign citizens with lower education. After balancing for differences in baseline score and in administrative and demographic characteristics, they had poorer outcomes than higher‐educated native Danish citizens on pain intensity and EQ‐5D‐5L score at both follow‐up points (e.g., between‐group mean differences in pain visual analog scale [0–100] at 3 and 12 months: 3.4 [95% confidence interval (95% CI) –0.5, 7.3] and 6.2 [95% CI 1.7, 10.7], respectively). Differences in KOOS quality of life subscale score, were smaller or absent. Balancing for differences on baseline score, comorbidity, self‐efficacy, and depression had the greatest effect on reducing observed outcome inequalities. CONCLUSION: Outcome inequalities widened following OAMP attendance, particularly at longer‐term follow‐up, but the magnitude of differences was generally modest and inconsistent across outcome measures. Tailoring content to reduce outcome inequalities may be indicated, but improving access appears the greater priority. Wiley Periodicals, Inc. 2022-09-10 2023-01 /pmc/articles/PMC10087615/ /pubmed/35900880 http://dx.doi.org/10.1002/acr.24987 Text en © 2022 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Theme Issue Articles: Health Disparities And Health Equity In The Rheumatic Diseases Peat, George Yu, Dahai Grønne, Dorte T. Marshall, Michelle Skou, Soren T. Roos, Ewa M. Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program |
title | Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program |
title_full | Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program |
title_fullStr | Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program |
title_full_unstemmed | Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program |
title_short | Do Patients With Intersectional Disadvantage Have Poorer Outcomes From Osteoarthritis Management Programs? A Tapered Balancing Study of Patient Outcomes From the Good Life With Osteoarthritis in Denmark Program |
title_sort | do patients with intersectional disadvantage have poorer outcomes from osteoarthritis management programs? a tapered balancing study of patient outcomes from the good life with osteoarthritis in denmark program |
topic | Theme Issue Articles: Health Disparities And Health Equity In The Rheumatic Diseases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087615/ https://www.ncbi.nlm.nih.gov/pubmed/35900880 http://dx.doi.org/10.1002/acr.24987 |
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