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The Unequal Effect of Income on Risk of Overweight/Obesity of Whites and Blacks with Knee Osteoarthritis: the Osteoarthritis Initiative

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Abstract

Background

Although the protective effect of socioeconomic status (SES) against risk of overweight/obesity is well established, such effects may not be equal across diverse racial and ethnic groups, as suggested by the marginalization-related diminished returns (MDR) theory.

Aims

Built on the MDR theory, this study explored racial variation in the protective effect of income against overweight/obesity of Whites and Blacks with knee osteoarthritis (OA).

Methods

This cross-sectional study used baseline data of the OA Initiative, a national study of knee OA in the USA. This analysis included 4664 adults with knee OA, which was composed of 3790 White and 874 Black individuals. Annual income was the independent variable. Overweight/obesity status (body mass index more than 25 kg/m2) was the dependent variable. Race was the moderator. Logistic regressions were used for data analysis.

Results

Overall, higher income was associated with lower odds of being overweight/obese. Race and income showed a statistically significant interaction on overweight/obesity status, indicating smaller protective effect of income for Blacks compared with Whites with knee OA. Race-stratified regression models revealed an inverse association between income and overweight/obesity for White but not Black patients.

Conclusions

While higher income protects Whites with knee OA against overweight/obesity, this effect is absent for Blacks with knee OA. Clinicians should not assume that the needs of high-income Whites and Blacks with knee OA are similar, as high-income Blacks may have greater unmet needs than high-income Whites. Racially tailored programs may help reduce the health disparities between Whites and Blacks with knee OA. The results are important given that elimination of racial disparities in obesity is a step toward eliminating racial gap in the burden of knee OA. This is particularly important given that overweight/obesity is not only a prognostic factor for OA but also a risk factor for cardiometabolic diseases and premature mortality.

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Acknowledgments

The authors thank Mohammed Saqib, University of Michigan, for his contribution to the draft of this paper.

Funding

SA and MB are supported by the NIH awards 54MD008149, R25 MD007610, U54MD007598, and U54 TR001627. SA is also supported by the NIH grant S21MD000103.

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Authors and Affiliations

  1. Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, 90059, USA

    Shervin Assari & Mohsen Bazargan

  2. Department of Family Medicine, UCLA, Los Angeles, CA, USA

    Mohsen Bazargan

  3. Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA

    Majid Chalian

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  1. Shervin Assari
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SA: conceptual design, analysis, manuscript draft. MC and MB: interpretation of the findings, revision.

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Correspondence to Shervin Assari.

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Ethical Approval

The University of California, San Francisco (UCSF) institutional review board (IRB) approved the OAI study protocol. (Approval Number: 10-00532 Approval Date: 2/24/2017). Informed consent was obtained from all participants. All participants received a financial incentive for their participation. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (including the name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Assari, S., Bazargan, M. & Chalian, M. The Unequal Effect of Income on Risk of Overweight/Obesity of Whites and Blacks with Knee Osteoarthritis: the Osteoarthritis Initiative. J. Racial and Ethnic Health Disparities 7, 776–784 (2020). https://doi.org/10.1007/s40615-020-00719-5

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