Intersectional Differences in Health Care Outcomes among Patients with Musculoskeletal Disorders in Germany

In all regions of the world, musculoskeletal disorders are a significant contributor to the burden of chronic illnesses. The effectiveness of treatments, such as rehabilitation, may vary intersectionally across demographic and other categories. The present study examines this intersectionality with respect to a lack of improvement in health conditions after rehabilitation of patients in Germany. Routine data from 298,617 patients aged 18-65 years residing in Germany who received rehabilitation because of arthropathies, dorsopathies, or soft tissue disorders during 2006-2016 were included in the analysis. Odds of the outcome were compared across demographic groups and across diagnostic sub-groups by means of multivariable logistic regression. Interaction terms were included to examine intersectional differences across these groups and over time. Women were more likely than men to have an impairment despite treatment (adjusted odds ratio [aOR] = 1.11; 95%-CI = 1.08, 1.13). In addition, patients in semi-skilled/unskilled employment were at higher odds of a poor outcome compared to patients in skilled positions (aOR = 1.13; 95%-CI = 1.10-1.17). Nationality also affected health care outcomes, with Turkish nationals and nationals from a Yugoslav successor state having higher odds of a poor outcome than Germans (aOR = 1.56; 95%-CI = 1.45-1.67 and aOR = 1.52; 95%-CI = 1.41-1.65, respectively). The findings highlight the importance of an intersectional perspective in health research and practice and can support the development of strategies and measures that aim to reduce disparities in health care.