At the Intersection of Ethnicity/Race and Poverty: Knee Pain and Physical Function

J Racial Ethn Health Disparities. 2019 Dec;6(6):1131-1143. doi: 10.1007/s40615-019-00615-7. Epub 2019 Jul 10.


Background: Knee osteoarthritis (OA) disproportionately affects racial and ethnic minorities. Non-Hispanic Blacks (NHB) report a higher prevalence and severity of knee OA symptoms than their non-Hispanic White (NHW) counterparts. The role of poverty in explaining this disparity remains unclear.

Objective: The overall aim of this cross-sectional study was to determine whether ethnic/racial differences in knee pain and physical function varied according to poverty status.

Design: NHB and NHW adults with or at risk of knee OA self-reported sociodemographic information, and completed the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and the Short Physical Performance Battery (SPPB). Annual income was adjusted for number of household occupants to determine poverty status (i.e., living above versus below poverty line).

Results: Findings revealed 120 individuals living above the poverty line (49% NHB, 77% NHW) and 71 individuals living below the poverty line (51% NHB, 23% NHW). Adjusted multivariable models revealed significant ethnic/race by poverty status interactions for knee pain (p = 0.036) and physical function (p = 0.032) on the WOMAC, as well as physical function on the SPPB (p = 0.042). Post hoc contrasts generally revealed that NHW adults living above the poverty line experienced the least severe knee pain and best physical function, while NHB adults living below the poverty line experienced the most severe knee pain and poorest physical function.

Conclusions: Results of the present study add to the literature by emphasizing the importance of considering poverty and/or other indicators of socioeconomic status in studies examining ethnic/racial disparities in pain and physical function.

Keywords: Ethnicity/race; Knee pain; Osteoarthritis; Physical function; Poverty.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthralgia / ethnology*
  • Arthralgia / physiopathology
  • Black or African American / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / ethnology*
  • Osteoarthritis, Knee / physiopathology
  • Physical Functional Performance*
  • Poverty / statistics & numerical data*
  • White People / statistics & numerical data*