Is financial hardship associated with reduced health in disability? The case of spinal cord injury in Switzerland

Christine Fekete; Johannes Siegrist; Jan D Reinhardt; Martin W G Brinkhof; SwiSCI Study Group

doi:10.1371/journal.pone.0090130

Is financial hardship associated with reduced health in disability? The case of spinal cord injury in Switzerland

PLoS One. 2014 Feb 28;9(2):e90130. doi: 10.1371/journal.pone.0090130. eCollection 2014.

Authors

Christine Fekete¹, Johannes Siegrist², Jan D Reinhardt³, Martin W G Brinkhof⁴; SwiSCI Study Group

Collaborators

SwiSCI Study Group:
Abdul Al-Khodairy, Olivier Deriaz, Michael Baumberger, Hans Peter Gmünder, Armin Curt, Martin Schubert, Hansjörg Lüthi, Margret Hund-Georgiadis, Thomas Troger, Urs Styger, Max Moor, Hardy Landolt, Rita Schaumann-Von Stosch, Mirjam Brach, Gerold Stucki, Martin Brinkhof, Christine Thyrian

Affiliations

¹ Swiss Paraplegic Research, Nottwil, Switzerland.
² Senior Professorship for Work Stress Research, Faculty of Medicine, University of Duesseldorf, Life Science Center, Duesseldorf, Germany.
³ Swiss Paraplegic Research, Nottwil, Switzerland ; Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, Sichuan Province, China.
⁴ Swiss Paraplegic Research, Nottwil, Switzerland ; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.

Abstract

Objective: To investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland.

Methods: Observational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions.

Results: Financial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18-5.21), comorbidities (OR 2.88, 95% CI 1.83-4.53) and pain (OR 3.32, 95% CI 2.21-4.99), whereas mental health (OR 0.23, 95% CI 0.15-0.36), participation (OR 0.30, 95% CI 0.21-0.43) and quality of life (OR 0.22, 95% CI 0.15-0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00-1.07) and higher quality of life (OR 1.06, 95% CI 1.02-1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship.

Conclusions: Suffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Disabled Persons / psychology*
Educational Status
Female
Humans
Income*
Male
Mental Health
Middle Aged
Pain / complications
Pain / physiopathology
Pain / psychology*
Quality of Life / psychology*
Regression Analysis
Socioeconomic Factors
Spinal Cord Injuries / complications
Spinal Cord Injuries / physiopathology
Spinal Cord Injuries / psychology*
Switzerland

Grants and funding

This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), supported by the Swiss Paraplegic Foundation. JS was additionally supported by the grant agreement HEALTH-F3-2011-278350 (DRIVERS) of the European Commission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.