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

      Purpose: Self-management programs providing education and supervised exercise are considered the mainstay in the treatment of hip and knee osteoarthritis (OA). Among many factors, socioeconomic status (SES) has been associated with the course of OA progression. However, it is unclear if the population who utilizes self-management programs reflects the general population with regard to SES. The purpose of this study was to explore SES among patients with hip or knee OA who have participated in a national self-management program compared to a matched general population sample in Sweden.
      Methods: We used data on 72 120 patients from the BOA register (Better management of patients with OsteoArthritis), a national quality register holding information on individuals registered for participation in a standardized self-management program for patients with hip or knee OA. Patients were enrolled to the program between 2008 and 2015. Patients were sex- and age-matched (1:3) to a general population sample (n=216 360) provided by Statistics Sweden. We undertook a cross-sectional analysis on educational attainment, cohabiting status, employment, type of occupation, and country of birth. Chi-square test was used to investigate proportional differences between Groups.
      Results: The BOA population had significantly higher (p<0.001) educational attainment (low 22.5%, medium 60.5%, high 17%), compared with in the general population (low 28.5%, medium 56%, high 15.5%). In the BOA population, 65% were cohabiting and 35% living alone (general population 60% and 40%, respectively) (p<0.001). Of those that was younger than the age of retirement in Sweden 79% of the BOA population were employed compared to 75.5% in the reverence population (p<.001). Of the population at work, the distribution of blue-collar workers was higher (51%) in the BOA population compared to the general population (44.5%). In the BOA population, 91% were born in Sweden, 7% in some other European country, and 2% outside of Europe. For the general population the distribution was 87%, 9.5% and 3.5% (p<0.001).
      Conclusions: Patients who enrolled in the national hip and knee self-management program in Sweden had higher SES than the general population. This indicates that the program may be insufficient to target and attract those with potentially the greatest needs.
      The results of this study will be used to modify the OA self-management program in order to achieve a more equal socioeconomic profile and decrease the disparities in the access of OA care. The results will also help to better interpret the result from future studies on the BOA population.