Arthritis may increase risk of poverty, especially for women

An arthritis diagnosis increases the risk of falling into poverty, according to an Australian study.

Arthritis is a very debilitating disease and likely impacts labor force participation, either forcing people to retire early due to the pain or physical restriction of arthritis, reducing the hours they can work or changing to a lower-paid job, said lead author Emily Callander, a research fellow at the University of Sydney.

"For those who are already in retirement it may be that the costs of treatment or costs of accessing aids or career services have required them to draw down some of their assets, which would lower the income they derive from their assets," Callander told Reuters Health by email.

The researchers studied more than 4,000 Australian adults between 2007 and 2012.

At the start of the study, the participants were not in poverty and did not have arthritis. By 2009, 300 of the participants had developed arthritis, half of whom were men. Over the study, 18 percent of women and 16 percent of men fell into poverty based on income, and the proportion in poverty increased with age.

Women who developed arthritis were 51 percent more likely to fall into income poverty than nonarthritic women. For men, arthritis increased the risk by 22 percent.

Women were also more likely to fall into poverty by a definition encompassing income, health and education attainment, or "multidimensional poverty," according to the results in Arthritis and Rheumatology.

"It is known that people with lower incomes are more likely to develop arthritis, but this is the first study to show the inverse relationship - that arthritis could also lead to income poverty," Callander said.

Women are more likely than men to have severe arthritis, which may make it harder for them to work, but that dimension was not included in this study, she noted.

"In our analysis we did take into consideration other factors, such as age, being married or in a de facto relationship as opposed to being single, being a home owner as opposed to renting or having a mortgage, and whether the person lived in a major city, an inner regional area or a rural area," she said. "However, even after considering all these other factors, being diagnosed with arthritis still leads to an increased risk of poverty."

But the study did not account for other health issues, including obesity, which increases the risk for arthritis and is more common among people with lower socioeconomic status, said Dr. Gillian Hawker, chair of Medicine at the University of Toronto, who was not involved in the research.

"Poverty is associated with poor diet and less opportunity for physical activity which increases the risk for obesity and in turn for osteoarthritis," Hawker told Reuters Health by email.

We should first address the common risk factors, particularly obesity, and ensure that all people with arthritis have access to surgical and non-surgical treatment, she said.

Preventing arthritis would reduce the health burden as well as the economic burden, but as the population ages in many countries, arthritis will continue to become more common, so it will also be important to help those with the condition remain in the workforce, Callander said.

"We know, for example, that workplace modifications may help people remain in employment, so encouraging employees and employers to look at these options would be a great start," she said.

"One of the most important considerations should be that any arthritis interventions - be it treatment or prevention - should be equally effective in both low and high income patients, this will ensure that our health interventions do not widen inequality gaps," she said. "Furthermore, when treating arthritis patients, health professionals should be aware of this greater risk of income poverty, and consider a patient's ability to pay for any out of pocket costs when determining considering treatment options and devising treatment plans."