MSK Health inequalities resource page

Building back inclusively: Radical approaches to tackling the elective backlog

NHS Confederation (September 2021)

Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic. This briefing recommends radical, whole-system changes to tackle the elective backlog inclusively.

THE IMPACT OF DEPRIVATION ON PATIENTS AWAITING PLANNED CARE

Kunal Kulkarni, Rohi Shah, Jitendra Mangwani, Joseph Dias Bone Jt Open. 2022;3(10):777-785. doi:10.1302/2633-1462.310.BJO-2022-0037.R1

The most deprived patients experience poorer physical and mental health, with this most adversely impacted by lengthy orthopaedic waiting list delays. Interventions to address inequalities should focus on prioritizing the most deprived.

INEQUALITIES AND INEQUITIES IN THE TYPES OF CHRONIC PAIN SERVICES AVAILABLE IN AREAS OF DIFFERING DEPRIVATION ACROSS ENGLAND

Shrujal Jain EMAIL logo , Varsha Jadwani , Sana Spogmy and Jackie Walumbe (2023) Scandinavian Journal of Pain, vol. 23, no. 1, 2023, pp. 168-174. https://doi.org/10.1515/sjpain-2022-0015

 There was no significant difference in the overall number of types of chronic pain services provided by NHS Trusts serving areas of differing deprivation, but deprived areas were being disadvantaged with regards to specific services. These areas were significantly less likely to have occupational therapy, return-to-work programmes, and hand therapy services. Areas with fewer types of professionals in their pain multidisciplinary team were also significantly more deprived than those with more types.

THE IMPACT OF FRAILTY AND DEPRIVATION ON THE LIKELIHOOD OF RECEIVING PRIMARY TOTAL HIP AND KNEE ARTHROPLASTY AMONG PEOPLE WITH HIP AND KNEE OSTEOARTHRITIS

Cook, M.J., Lunt, M., Ashcroft, D.M., Board, T. and O’Neill, T.O., (2023) The Journal of Frailty & Aging

Compared to those in neighbourhoods in the least deprived quintile of IMD, those in neighbourhoods in the fourth and fifth quintile of IMD were less likely to receive THA, with similar results for TKA. Higher levels of frailty at OA diagnosis were associated also with reduced likelihood of receiving THA and TKA. The association, however, between deprivation and likelihood of receiving THA and TKA could not be explained by increased levels of frailty among those living in the most deprived areas.

THE ASSOCIATION OF SOCIO-ECONOMIC AND PSYCHOLOGICAL FACTORS WITH LIMITATIONS IN DAY-TO-DAY ACTIVITY OVER 7 YEARS IN NEWLY DIAGNOSED OSTEOARTHRITIS PATIENTS

Kouraki, A., Bast, T., Ferguson, E. and Valdes, A.M., (2022) Scientific Reports, 12(1), p.943.

Study found that high social deprivation before diagnosis predicts greater limitations in activities of daily living after diagnosis, with this effect partly mediated by impaired cognitive ability. Also that higher educational attainment before diagnosis may protect against limitations in activities of daily living after diagnosis via better cognitive ability and lower anxiety. Therefore, improving cognitive ability and managing anxiety may mitigate the associations of social deprivation and low educational attainment with limitations in activities of daily living.

ASSOCIATION BETWEEN SOCIAL DEPRIVATION AND DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

Dey, M., Busby, A., Elwell, H., Lempp, H., Pratt, A., Young, A., Isaacs, J. and Nikiphorou, E., (2022) RMD Open, 8(1), p.e002058.

There are complex relationships underpinning the association between low socioeconomic status and worse disease outcomes in rheumatoid arthritis. An increased understanding of the multifactorial relationship between socioeconomic status and rheumatoid arthritis disease activity will facilitate a more holistic, and ultimately more effective, approach to patient care.

SOCIOECONOMIC DISADVANTAGE IS ASSOCIATED WITH PROBABLE SARCOPENIA IN COMMUNITY-DWELLING OLDER ADULTS: FINDINGS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING

Swan, L., Warters, A. and O’Sullivan, M., (2022). The Journal of Frailty & Aging, 11(4), pp.398–406.

Disadvantaged Socioeconomic position was associated with an increased likelihood of probable sarcopenia when controlled for other known risk factors. The findings suggest a need and opportunity for sarcopenia prevention and treatment strategies to address socioeconomic disadvantage in policies and practice.

INFLUENCE OF SOCIAL SUPPORT, FINANCIAL STATUS, AND LIFESTYLE ON THE DISPARITY BETWEEN INFLAMMATION AND DISABILITY IN RHEUMATOID ARTHRITIS

Gwinnutt, J.M., Norton, S., Hyrich, K.L., Lunt, M., Combe, B., Rincheval, N., Ruyssen-Witrand, A., Fautrel, B., McWilliams, D.F., Walsh, D.A., Nikiphorou, E., Kiely, P.D.W., Young, A., Chipping, J.R., MacGregor, A. and Verstappen, S.M.M. (2022) . Arthritis Care & Research, 4 August 2022

Less social support, worse financial situation, less exercise, and less education were associated with excess disability group membership; smoking, alcohol consumption, and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Conclusion: Greater emphasis is needed on the economic and social contexts of individuals with RA at presentation; these factors might influence disability over the following decade.

Equity of access to NHS-funded hip replacements in England and Wales: Trends from 2006 to 2016

Steven Wyatt, Rowena Bailey, Patrick Moore, Matthew Revell (2022) The Lancet Regional Health – Europe,
Volume 21, 2022, 100475

With respect to hip-replacement surgery in England and Wales, policy ambitions to reduce healthcare inequities have not been realised. More potent policy interventions may be required to address inequities in the supply of hip-replacements.

Socioeconomically-deprived patients suffer hip fractures at a younger age and require more hospital admissions, but early mortality risk is unchanged: The IMPACT Deprivation Study

Kay, R. S., Hall, A. J., Duckworth, A. D., & Clement, N. D. (2022) Musculoskeletal Care, 1– 9. https://doi.org/10.1002/msc.1711

Deprivation showed no linear correlation with early mortality risk but it was associated with an earlier age at presentation. More deprived patients were more likely to require further acute hospital admissions.

What effect have NHS commissioners’ policies for body mass index had on access to knee replacement surgery in England?: An interrupted time series analysis from the National Joint Registry

McLaughlin J, Kipping R, Owen-Smith A, McLeod H, Hawley S, Wilkinson JM, et al. (2022) PLoS ONE 17(6): e0270274. https://doi.org/10.1371/journal.pone.0270274

Body mass index policy introduction was associated with decreases in the rates of knee replacement surgery across localities that introduced policies. This affected all patient groups, not just obese patients at whom the policies were targeted. Data from this study show rates decreased most in more deprived groups.

The effect of social deprivation on hip fracture incidence in England has not changed over 14 years: an analysis of the English Hospital Episodes Statistics (2001–2015)

Bhimjiyani, A., Neuburger, J., Jones, T., Ben-Shlomo, Y. and Gregson, C.L., (2018).
Osteoporosis International, 29(1), pp.115–124.

Deprivation is a stronger relative predictor of hip fracture incidence in men than in women. Despite public health efforts to prevent hip fractures, the health inequality gap for hip fracture incidence has not narrowed for men, and marginally widened among women.

The impact of socioeconomic status on the link between osteoarthritis and the onset of common comorbidities.

University, K., Wilkie, R., Kaur, K. and Hayward, R.A., (2019).
Clinical and Experimental Rheumatology, 37(1), pp.44–48.

Consulters for osteoarthritis were more likely to develop physical and psychological comorbidities than those without osteoarthritis. Analyses indicated that mechanisms to comorbidity differ by socio-economic strata and a need for different approaches to prevent comorbidity for consulters with OA from different levels of deprivation.

Socioeconomic inequalities in the provision of osteoarthritis care – results from a national self-management program.

Gustafsson, K., Kvist, J., Eriksson, M., Dahlberg, L. and Rolfson, O., (2019).
Osteoarthritis and Cartilage, 27, p.S498.

Patients who enrolled in the national hip and knee self-management program in Sweden had higher socioeconomic status than the general population. This indicates that the program may be insufficient to target and attract those with potentially the greatest needs.

The impact of socio-economic status in rheumatoid arthritis.

Verstappen, S.M.M., (2017).
Rheumatology, 56(7), pp.1051–1052.

People with low socioeconomic status (SES) could have delayed presentation to clinical practice, limited access to health care and limited prescription of more expensive drugs in some countries, which is dependent on health care insurance plans. In countries where access to health-care facilities is not influenced by SES, there is especially an association between SES and self-reported patient-reported outcomes, such as the HAQ, but to a lesser extent with disease activity indices.

SOCIO-ECONOMIC INEQUALITIES IN FRAGILITY FRACTURE OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROGNOSTIC OBSERVATIONAL STUDIES

Valentin G, Pedersen SE, Christensen R, Friis K, Nielsen CP, Bhimjiyani A, Gregson CL, Langdahl BL. (2020)
Osteoporosis International 2020 Jan;31(1):31-42

The study found a consistently increased risk of post-hip fracture mortality with low Socio-economic status (SES) across SES measures and across countries with different political structures and different health and social care infrastructures.

The National Early Inflammatory Arthritis Audit (NEIAA) Short report on ethnicity

Healthcare Quality Improvement Partnership and British Society for Rheumatology, 2022.

This report presents data describing the association between ethnicity, experience of care as described by the quality standard for rheumatoid arthritis and clinician and patient-reported outcomes. The report provides recommendations and encourages providers and commissioners to consider how these can be delivered locally for the benefit of patients and the healthcare system.

WORSE OUTCOMES LINKED TO ETHNICITY FOR EARLY INFLAMMATORY ARTHRITIS IN ENGLAND AND WALES: A NATIONAL COHORT STUDY

Maryam A Adas, Sam Norton, Sathiyaa Balachandran, Edward Alveyn, Mark D Russell, Thomas Esterine, Paul Amlani-Hatcher, Sarah Oyebanjo, Heidi Lempp, Joanna Ledingham, Kanta Kumar, James B Galloway, Shirish Dubey (2023) Rheumatology, Volume 62, Issue 1, January 2023, Pages 169–180

 Some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment.

STRUCTURAL BARRIERS AND RACIAL DISPARITIES IN ORTHOPAEDIC SURGICAL PROCEDURES

Hosein-Woodley, R., Hirani, R. and Hirani, A., (2023) The Journal of Arthroplasty, 38(2), p.e3.

Letter: Although drastic structural changes pertaining to factors that widen the disparities for minority patients in orthopaedics need to be addressed, there are practical solutions that can be implemented right now. Decision aids can be an effective intervention considering that one of the factors decreasing TJA utilization among Black patients could be related to cultural attitudes toward surgery.

RACIAL AND ETHNIC DIFFERENCES IN A BIOCHEMICAL MARKER OF RHEUMATOID ARTHRITIS DISEASE ACTIVITY

Baker, R., Mantilla, B., Graf, J., Katz, P.P., Goglin, S., Barton, J.L., Liew, J.W. and Wysham, K.D., (2023) ACR Open Rheumatology, 5(3), pp.142–148.

US study found significantly higher disease activity measured by the MBDA and DAS28-ESR in Latinx participants compared with White participants. We also found significantly higher disease activity in Asian participants compared with White participants with the DAS28-ESR. Our findings, although limited by the small number of White participants in the referent group, suggest that RA disease activity measures may be influenced by external factors that have differential impacts by racial and ethnic group.

Musculoskeletal conditions and Black, Asian and minority ethnic people: addressing health inequalities.

Race Equality Foundation.

This report found that black and minority ethnic people are more likely to have some conditions, such as lupus and sickle cell disease, and have poorer experience of services. It includes some examples and suggestions of better practice, such as targeted and supported lifestyle interventions, better communication and a reduced dependence on medication.

Ethnic minority musculoskeletal health

Adebajo, A., Shikoh, S., Kumar, K. and Walker, D., (2017).
Rheumatology (Oxford, England), 57

As well as the social determinants of health that affect the general population, ethnic minority health is complicated by additional factors, including cultural beliefs and behaviours, education, language barriers, genetic phenotype and poor take-up of health education. Ethnic populations are distinct, and those with musculoskeletal conditions require targeted educational strategies.

Disparities in Outcomes for Blacks versus Whites Undergoing Total Hip Arthroplasty: A Systematic Literature Review

Mehta, B.Y., Bass, A.R., Goto, R., Russell, L.A., Parks, M.L., Figgie, M.P. and Goodman, S.M., (2018).
The Journal of Rheumatology, 45(5), pp.717–722.

All studies noted more pain and worse function for blacks; although differences were statistically significant, they were not clinically significant. When measured, there are small differences in THA outcomes between blacks and whites, but most studies do not analyse/collect race. Future studies should address the effect of race and socioeconomic factors on healthcare disparities.

Racial Disparity in the Perioperative Care for Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective Propensity-Matched Cohort Study

Elsharydah, A., Embabi, A.S., Minhajuddin, A. and Joshi, G.P., (2018).
Journal of racial and ethnic health disparities, 5(3), pp.632–637.

There is no significant difference in the type of anaesthesia received for total joint arthroplasty between African-American and white patients; however, there is a disparity in the postoperative outcomes in favour of the white patient group.

Sex and Gender Interactions in the Lives of Patients with Spondyloarthritis in Spain: A Quantitative-qualitative Study

Blasco-Blasco, M., Ruiz-Cantero, M.T., Juárez-Herrera Y Cairo, L.A., Jovaní, V. and Pascual, E., (2017)
The Journal of Rheumatology, 44(10), pp.1429–1435.

This study highlights the vital complexity in which patients with SpA are immersed, especially for women in a country where a mix of new and traditional gender roles coexist. Awareness of its existence is crucial when professionals strive to provide healthcare focused on their well-being in addition to medical therapy.

Disparities in the Treatment of the LGBTQ Population in Chronic Pain Management

Abd-Elsayed A, Heyer AM, Schatman ME. (2021)
Journal of Pain Research, 2021;14:3623-3625.

Within the LGBTQ population, unique challenges and social stress are linked with high levels of depressive disorders. These mental health challenges produce a population with high levels of chronic pain, worse outcomes, and unique challenges in treating them.

THE IMPACT OF HEALTH LITERACY: ASSOCIATIONS WITH DISEASE ACTIVITY AND MEDICATION PRESCRIPTION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Gorter, A., Bakker, M.M., ten Klooster, P.M., Boonen, A. and Vonkeman, H.E., (2023) Rheumatology, p.kead094. Rheumatology (Oxford). 2023 Feb 24:kead094.

 Significant differences in longitudinal disease activity and medication prescription were observed between groups with different health literacy levels. These results stress the importance of insight into the role of health literacy in treatment and outcomes in patients with rheumatoid arthritis.

THE IMPACT OF EDUCATION INEQUALITY ON RHEUMATOID ARTHRITIS RISK IS MEDIATED BY SMOKING AND BODY MASS INDEX: MENDELIAN RANDOMIZATION STUDY

Zhao, S.S., Holmes, M.V., Zheng, J., Sanderson, E. and Carter, A.R., (2022) Rheumatology, 61(5), pp.2167–2175.

Higher educational attainment has a protective effect on RA risk. Interventions to reduce smoking and excess adiposity at a population level may reduce this risk, but a large proportion of education’s effect on RA remains unexplained.

The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

Mackey, L.M., Blake, C., Casey, M.-B., Power, C., K., Victory, R., Hearty, C. and Fullen, B.M., (2019).
Physiotherapy. 2019 Sep;105(3):346-353

Inadequate health literacy was associated with older age, being unemployed or retired, less education, lower income, increased comorbidities, being less likely to utilise allied health services, poorer disease-related knowledge, and poorer beliefs about pain. Inadequate health literacy is prevalent in chronic pain patients and may impact on the development of certain characteristics necessary for effective self-management.

Educational inequalities in mortality associated with rheumatoid arthritis and other musculoskeletal disorders in Sweden

Kiadaliri, A.A., Petersson, I.F. and Englund, M., (2019).
BMC musculoskeletal disorders, 20(1), p.83.

This study found substantial educational inequality in mortality from MSK disorders. Further research is needed to investigate underlying pathways driving these inequalities.

DIGITAL EXCLUSION AS A POTENTIAL CAUSE OF INEQUALITIES IN ACCESS TO CARE: A SURVEY IN PEOPLE WITH INFLAMMATORY RHEUMATIC DISEASES

Hider, S., Muller, S., Gray, L., Manning, F., Brooks, M., Heining, D., Menon, A., Packham, J., Raghuvanshi, S., Roddy, E., Ryan, S., Scott, I. and Paskins, Z., (2022). Rheumatology Advances in Practice, 7(1), p.rkac109.

This survey showed that limited health and digital literacy, lack of digital access and low reported internet use were common, especially in older people with RA. People with limited health literacy or limited digital access reported lower confidence and satisfaction with remote consultations. Digital implementation roll-out needs to take account of people requiring extra support to enable them to access care digitally or risks exacerbating health inequalities.

Musculoskeletal health: trends, risk factors and disparities in England, November 2022

Office for Health Improvement and Disparities (November 2022)

National level data presenting trends and disparities in the prevalence of long term musculoskeletal conditions and their risk factors.

HARNESSING PEOPLE’S LIVED EXPERIENCE TO STRENGTHEN HEALTH SYSTEMS AND SUPPORT EQUITABLE MUSCULOSKELETAL HEALTH CARE

Belton, J.L., Slater, H., Ravindran, T.K.S. and Briggs, A.M., Journal of Orthopaedic & Sports Physical Therapy, pp.1–36.

Lived experience perspectives are not systematically integrated in initiatives to strengthen health systems. However, such integration is critical to creating equitable and person-centered health systems that provide care and support healthy populations. Cocreation principles and frameworks can guide processes to strengthen health systems, which must include historically marginalized groups and consider social and environmental contexts as they relate to health.

SOCIO-DEMOGRAPHIC DETERMINANTS IN THE EVOLUTION OF PAIN IN INFLAMMATORY RHEUMATIC DISEASES: RESULTS FROM ESPOIR AND DESIR COHORTS

Kumaradev, S., Roux, C., Sellam, J., Perrot, S., Pham, T., Dugravot, A. and Molto, A., (2022). Rheumatology (Oxford, England), 61(4), pp.1496–1509.

Being older, female, non-Caucasian and having lower education was found to be associated with worse pain in early and/or long-standing IRDs, despite universally accessible health-care. Early identification of at-risk populations and implementation of multidisciplinary strategies may reduce patient-reported health outcome disparities.

Chronic pain in adults 2017: health survey for England, London

Public Health England. Public Health England ed, (2020).

This report explores the responses to questions on chronic pain in the 2017 Health Survey for England. It sets out the overall prevalence of chronic pain amongst the general population as well as identifying differences between sub-groups. It finishes with an analysis of the use of specialist pain services.

Chronic pain in England: unseen, unequal and unfair

Ellis, B., Ly, M., Steinberger, S. and Chown, A., (2021).
Versus Arthritis

This report builds on the findings from the Health Survey for England 2017, providing an update on how chronic pain affects us as a nation and what we collectively need to do about the unseen, unfair and unequal burden of chronic pain.

EASING THE PAIN: REHABILITATION, RECOVERY AND REDUCING HEALTH INEQUITY

Rachel Newton & Natasha Owusu
The Chartered Society of Physiotherapy, September 2022

Lack of access to high-quality rehabilitation worsens health inequities faced by marginalised communities. The report, based on a literature review, outlines how people in marginalised groups and communities, such as those from ethnic minorities, are not only more likely to live shorter lives but spend a greater proportion of their lives struggling with health difficulties and disabilities.

Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: Variation by age, sex, geographic location and ethnicity.

van der Velde, R.Y., Wyers, C.E., Teesselink, E., Geusens, P.P.M.M., van den Bergh, J.P.W., de Vries, F., Cooper, C., Harvey, N.C. and van Staa, T.P., (2017)
Bone, 94, pp.50–55.

A retrospective observational study in the UK between 1990 and 2012 in subjects 50 years or older, stratified by age, sex, geographic region and ethnicity. There were marked differences in anti-osteoporosis treatment rates by ethnicity and geographic location within the UK.

We need to develop our approach to socially constructed concepts including socioeconomic factors, power, ethnicity and racism in pain care and research.

MacGregor, C. and Walumbe, J., (2021).
Pain and Rehabilitation – the Journal of Physiotherapy Pain Association, 2021(51), pp.1–4.

Guest editorial.

Pain in persons who are marginalized by social conditions

Craig, K. D., Holmes, C., Hudspith, M., Moor, G., Moosa-Mitha, M., Varcoe, C., & Wallace, B. (2020).
Pain, 161(2), 261–265.

This study addresses the challenges of providing access to pain management for people who have been socially and economically marginalized (People who are indigenous, recent immigrants or refugees, of colour, LGBTQ2S, less well educated, living with mental health or substance-use challenges, or have experienced violence and trauma, among others).

The Influence of Race, Sex, and Social Disadvantage on Self-reported Health in Patients Presenting with Chronic Musculoskeletal Pain.

Cheng, A.L., Bradley, E.C., Brady, B.K., Calfee, R.P., Klesges, L.M., Colditz, G.A. and Prather, H., (2022).
American journal of physical medicine & rehabilitation, 101(3), pp.211–216.

Black race was associated with greater anxiety than white race and female sex was associated with worse physical function than male sex. Compared with race and sex, social disadvantage is more consistently associated with worse physical and behavioural health in patients with chronic musculoskeletal pain.

CUMULATIVE SOCIAL DISADVANTAGE ASSOCIATED WITH CHILDHOOD ARTHRITIS: A CROSS-SECTIONAL ANALYSIS OF THE NATIONAL SURVEY OF CHILDREN’S HEALTH

Soulsby, W.D., Lawson, E. and Pantell, M.S., (2023) Arthritis care & research, 75(1), pp.3–8.

In this nationally representative sample, accumulated social disadvantage, measured via a cumulative social disadvantage score based on income level, guardian education, insurance status, and ACE exposure, was associated with an arthritis diagnosis and moderate-to-severe arthritis severity.

RELATIONSHIP BETWEEN ETHNICITY AND MULTIDISCIPLINARY INTERVENTION FOR YOUNG PEOPLE WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Bouraoui, A., Glanville, J., Ismail, S., Fisher, C., Mavrommatis, S., Leandro, M., Gupta, J., Meyer, S., Shakeshaft, P., Crissell, T. and Sen, D., (2022) Future Healthc J, 9(3), pp.317–320.

Comparison between Black, Asian and minority ethnic (BAME) and White ethnic groups revealed significant differences in terms of referral for pain optimisation, social support, and adherence and non-clinic attendance. Our findings reveal the importance of quality data for early identification and support of vulnerable young people, particularly those from BAME communities.

ASSOCIATION BETWEEN IMPLEMENTATION OF A COORDINATED CARE PATHWAY IN IDIOPATHIC SCOLIOSIS PATIENTS AND A REDUCTION IN PERIOPERATIVE OUTCOME DISPARITIES

Dela Merced, P., Vazquez Colon, C., Mirzada, A., Oke, A., Gal, Z., Cheng, J., Oetgen, M.M., Martin, B., Pestieau, S.R. and Cronin, J.A., (2022). Paediatric anaesthesia, 32(4), pp.556–562.

The study supports the hypothesis that use of a coordinated care pathway is associated with a reduction in racial and ethnic disparities in length of stay and pain scores in paediatric patients undergoing posterior spinal fusion.

Continuing specialist care into adulthood in young people with juvenile idiopathic arthritis: a retrospective cohort study using electronic health records in England

Costello RE, Kearsley-Fleet L, McDonagh JE, Hyrich K, Humphreys JH (2022) Rheumatology (Oxford). 2022 Sep 22:keac497. doi: 10.1093/rheumatology/keac497

Older age at diagnosis, female gender, less deprivation and a childhood diagnosis of uveitis were associated with continuing specialist care beyond age 18. 

The paediatric global musculoskeletal task force – ‘towards better MSK health for all’.

Foster, H.E., Scott, C., Tiderius, C.J. and Dobbs, M.B., (2020).
Pediatric rheumatology online journal, 18(1), p.60.

It is important that MSK morbidity in both children and adults is included in strategic planning. Vast inequity exists and there are many children and young people who live in areas of the world with high burden of health care challenges, compounded by paucity of specialist care and limited access to treatments.

Sociocultural Considerations in Juvenile Arthritis: A Review.

Lewis, K.A., Brown, S.A., Tiziani, S. and Carrasco, R., (2017). Journal of pediatric nursing, 37, pp.13–21.

Five categories of health determinants were found to influence outcomes: biology, individual behaviors, social environment, physical environment, and health services. Disparities continue to exist for racial and ethnic minority children with JA and those of low socioeconomic status.

THE ASSOCIATION BETWEEN LOW SOCIOECONOMIC STATUS WITH HIGH PHYSICAL LIMITATIONS AND LOW ILLNESS SELF-PERCEPTION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS: RESULTS FROM THE CHILDHOOD ARTHRITIS PROSPECTIVE STUDY

Verstappen SM, Cobb J, Foster HE, Fu B, Baildam E, Wedderburn LR, Davidson JE, Ioannou J, Chieng A, Hyrich KL, Thomson W.

Arthritis Care Res (Hoboken). 2015 Mar;67(3):382-9. doi: 10.1002/acr.22466. PMID: 25187470; PMCID: PMC4737227.

Patients from a low-SES background report more problems with daily activities and have a lower perception of the consequences of the disease than patients from a high-SES background, warranting special attention from a multidisciplinary team.

Longitudinal assessment of racial disparities in juvenile idiopathic arthritis disease activity in a treat-to-target intervention.

Chang, J.C., Xiao, R., Burnham, J.M. and Weiss, P.F., (2020).
Pediatric rheumatology online journal, 18(1), p.88.

Despite similar rates of improvement over time by race, disparities in JIA outcomes persisted throughout implementation of a treat to target with clinical decision support (CDS) approach. More consistent CDS use may have a greater benefit among black children and needs to be explored further.

Healthcare disparities in adolescent idiopathic scoliosis: the impact of socioeconomic factors on Cobb angle.

Russell, T., Dharia, A., Folsom, R., Kaki, M., Shumbusho, E., Fajardo, R.J., Shah, K., Shillingford-Cole, V. and Hogue, G.D., (2020).
Spine deformity, 8(4), pp.605–611.

Female patients had significantly greater Cobb angle measurements compared with male patients. Patients with government-supported insurance had significantly higher Cobb angles than privately insured patients but were both classified within the ‘mild’ range clinically and are likely not clinically significant. There was no correlation between income level and Cobb angle. Referral delay and Cobb angle severity did not vary by age, income, or insurance. A ?(2) analysis showed no association between Cobb angle and race.

DELIVERING EQUITABLE MSK HEALTHCARE: FROM PREVENTION TO HIGHLY SPECIALISED CARE: ARMA LECTURE 2022

Lecture only

Full event including discussion and Q&A (Note that there were some sound issues with this recording so you may need to adjust sound levels as you listen.)

Delivered by Liz Lingard Delivery Partner, System Improvement, NHS England (North East & Yorkshire) The profile of health inequalities is currently high, including the focus in the NHS on the Core 20+ approach. However, MSK gets a low profile in this work. What drives inequalities in MSK health? What can be done to address this?

Health Inequalities – unfair and avoidable

Connect Health, March 2022

This webinar looked at who is most at risk, what we can do to improve health inequalities, health literacy, segmentation and coproducing interventions with patients and the voluntary sector.

Women and Axial Spondyloarthritis: diagnosis and management

ARMA, October 2020

Men with Axial SpA are more likely than women to experience changes to the bones and fusion, and thus they can be picked up using x-ray. Women are more likely than men to experience inflammation rather than fusion, which is visible on MRI but not on x-ray. What are the implications for diagnosis and management?

BAME communities and Equity of Pain Care

ARMA conference 2020

See second presentation by Dr Asim Suleman, GP in Bradford, GPwER Pain Management