Intersecting Social Identities and Health in Arthritis: A Latent Class Analysis of the Canadian Longitudinal Study on...

Social determinants of health (SDOH), such as race, education, and income, tend to be considered individually, without recognizing the interaction between factors. Our objective was to understand how SDOH interact to inform outcomes for Canadians living with arthritis.

We conducted a cross-sectional study using data from the Canadian Longitudinal Study on Aging and guided by the Campbell and Cochrane Equity Methods Group's PROGRESS-Plus (place of residence; race, culture, ethnicity, language; occupation; gender, sex; religion; education; socioeconomic status; and social capital; plus: personal characteristics associated with discrimination, features of relationships, and time-dependent relationships) framework on SDOH. We used latent class analysis to identify distinct groups of people living with arthritis based on SDOH characterizations. We then conducted logistic regression to evaluate associations between group membership and (1) general health, (2) mental health, (3) satisfaction with life, (4) pain or discomfort, (5) limitations in activity, and (6) mood disorders.

Of 9,811 respondents in the Canadian Longitudinal Study on Aging, 2,505 reported that they are living with arthritis. Participants with arthritis were primarily living in urban centers (sample weighted 85%), female (54%), identified as women (54%), White (94%), Catholic or Christian (70%), making above $100,000 Canadian dollars (58%), married (80%), and between 45 and 54 years (61%). Through latent class analysis, we developed a five-class model. With respect to social capital, having more social support availability tended to be predictive of class membership. Within all five classes, those who had a higher income, were married, and had high levels of social support consistently had better outcomes overall.

The interaction between SDOH, particularly social support, income, and marital status, is associated with health outcomes for people living with arthritis. To improve delivery of equitable and high-quality care, an appropriate consideration of unmet social needs is required, as well as considering health outcomes through the lens of intersectionality for people living with arthritis in Canada.