Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs

PLoS One. 2014 May 21;9(5):e97134. doi: 10.1371/journal.pone.0097134. eCollection 2014.


Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education.

Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS).

Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men.

Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Pain / physiopathology
  • Chronic Pain / rehabilitation
  • Chronic Pain / therapy*
  • Educational Status*
  • Female
  • Healthcare Disparities / ethics*
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Pain Management / methods
  • Patient Selection / ethics*
  • Primary Health Care / ethics*
  • Primary Health Care / statistics & numerical data
  • Severity of Illness Index
  • Sex Factors
  • Sweden

Grants and funding

This work was supported by the Swedish Research Council (grant no: 344-2009-5839). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.