1398 The Journal of Rheumatology 2014; 41:7; doi:10.3899/jrheum.131515 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2014. All rights reserved. The Association of Socioeconomic Status and Symptom Severity in Persons with Fibromyalgia Mary-Ann Fitzcharles, Emmanouil Rampakakis, Peter A. Ste-Marie, John S. Sampalis, and Yoram Shir ABSTRACT. Objective. Although persons with lower socioeconomic status (SES) generally have poorer health status for many medical conditions, the association of SES with symptom severity in fibromyalgia (FM) is unknown. The subjective symptoms of FM may be influenced by personal perceptions, and environ- mental and psychosocial factors. Therefore SES may influence symptom expression and severity. Methods. Data for this cross-sectional analysis were obtained from a real-life prospective cohort of 246 patients with FM categorized according to level of education: high school graduates or less (Group 1; n = 99), college graduates (Group 2; n = 84), and university graduates (Group 3; n = 63). The association between level of education, a well-validated measure of SES, and disease severity, functional status, and quality of life were examined. Results. Lower education was significantly associated with older age (p = 0.039), current unemployment (p < 0.001), and more severe disease, as measured by patient global assessment disease activity (p = 0.019), McGill Pain Questionnaire (p = 0.026), Pain Disability Index (p = 0.031), Pain Catastrophizing Scale (p = 0.015), Health Assessment Questionnaire (p = 0.001), and Fibromyalgia Impact Questionnaire (p = 0.002), but not pain level, anxiety, or depression. These associations remained significant even upon adjusting for age and sex differences. Conclusion. Patients with FM and lower SES, as assessed by education level, reported greater symptom severity and functional impairment, despite reporting similar levels of pain, depression, and anxiety. Although FM spans all socioeconomic groups, factors other than specific disease characteristics or mental status, appear to play an important role in patients’ perception of illness. (First Release June 15 2014; J Rheumatol 2014;41:1398–1404; doi:10.3899/jrheum.131515) Key Indexing Terms: SOCIOECONOMIC STATUS FIBROMYALGIA From the Division of Rheumatology, McGill University Health Centre, Montreal; JSS Medical Research, St-Laurent; Jewish General Hospital, McGill University, Montreal; and Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada. Dr. Fitzcharles has received consulting fees, speaking fees, and/or honoraria from Lilly, Janssen, Pfizer, and Purdue Pharma (less than $10,000 each) and has provided expert testimony regarding painful rheumatic conditions in court trials. Dr. Shir has received consulting fees, speaking fees, and/or honoraria from Astra-Zeneca, Janssen, Paladin, Pfizer, and Purdue Pharma. Dr. Sampalis and Dr. Rampakakis are employed at JSS Medical Research, a contract research organization. M.A. Fitzcharles, MB, ChB, Division of Rheumatology and Alan Edwards Pain Management Unit, McGill University Health Centre; E. Rampakakis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; P.A. Ste-Marie, BA, LL.B, Alan Edwards Pain Management Unit, McGill University Health Centre; J.S. Sampalis, PhD, JSS Medical Research, and Jewish General Hospital, McGill University; Y. Shir, MD, Alan Edwards Pain Management Unit, McGill University Health Centre. Address correspondence to Dr. M.A. Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles@muhc.mcgill.ca Accepted for publication March 20, 2014. symptoms contributing to impaired quality of life. Fatigue, sleep difficulties, and some degree of mood disorder is likely present to a variable degree in most patients. These specific symptoms, in addition to pain, have a direct effect on function. Considerable disability is reported for FM, with up to a third of persons with FM receiving disability pension 6,7 . Persons with poorer socioeconomic status (SES) have less favorable health outcomes for many diseases. This could be explained by such differences as access to medical care, health-related behaviors, poor health literacy, low adherence to management recommendations, and financial constraints. Among the best studied health conditions that could be affected by low SES are cancer, cardiac disease, diabetes, and rheumatic diseases such as systemic lupus erythematosus (SLE) 8 . In addition, musculoskeletal pain, including chronic widespread pain, is more prevalent in adults with poorer SES 9 . This relationship is partly explained by such factors as psychological distress, poor mental health, and adverse life events 9 . Beyond these more evident reasons for differences in health status, sociocultural factors may also play a role. However, it is not known whether the severity of symptoms in persons with FM may differ depending on SES. Fibromyalgia (FM) is a pain syndrome presenting mainly in women in the middle productive years of life, affecting about 2% of the population, with some studies reporting higher prevalence 1,2,3,4,5 . In addition to widespread body pain, patients experience a variety of other somatic www.jrheum.org Downloaded on December 3, 2021 from