Presentations

Abstract

Introduction: Arthritis, characterized by joint inflammation, is associated with chronic pain, and significant physical and social limitations. While previous studies have linked arthritis to Serious Psychological Distress (SPD) in the general U.S. adult population, the relationship within specific subgroups, particularly immigrants and racial/ethnic minorities, remains unexamined. Understanding this relationship is crucial, as these groups face unique social determinants that may exacerbate both arthritis and SPD, potentially leading to health disparities that require targeted interventions.

Methods: We analyzed nationally representative 2002-2018 National Health Interview Survey data on U.S. adults aged ≥ 18 years (n = 439, 996) to examine how immigration status and race/ethnicity interact with arthritis to influence the risk of SPD. We fitted multivariable logistic regression models to assess associations, included interaction terms to examine moderating effects, and adjusted for sociodemographic (sex, age, employment status) and health/behavioral factors (health insurance status, BMI, smoking status, drinking status, comorbidities, functional limitation, social limitation, marital status). For statistically significant interactions, we calculated predicted marginal probabilities.

Results: Immigrants (n= 79,156) had higher odds of experiencing SPD than non-immigrants (n=351,840);(p<0.05). Individuals with arthritis (n= 95,337) had higher odds of SPD than individuals without arthritis (n=335,659); (p<0.001). There were significant interactions between arthritis and immigration status as well as arthritis and race/ethnicity (p<0.05). Immigrants with arthritis were more likely to experience SPD compared to non-immigrants with arthritis as well as immigrants and non-immigrants without arthritis. NH Mixed individuals without arthritis had the highest likelihood of SPD among any racial/ethnic group, with or without arthritis, followed by Hispanic individuals with arthritis. A dose-response was observed between SPD and the number of functional and social limitations, with more limitations associated with higher SPD risk.

Conclusion: Immigrants and racial/ethnic minorities with arthritis experience disparities in poor health outcomes, particularly in relation to SPD. The observed relationship between SPD and functional/social limitations, which are also linked to arthritis, underscores the integration of physical and mental health. Our findings offer important insights into the relationship between arthritis and SPD among immigrants and racial/ethnic minorities; however, the findings should be interpreted with these limitations in mind. First, the reliance on self-reported data introduces the potential for reporting bias, which may affect the accuracy of the associations observed Second, the cross-sectional design of the study limits our ability to establish causality, as both the exposure (arthritis) and outcome (SPD) variables were assessed simultaneously, precluding the determination of a temporal sequence. To better understand these disparities and inform the development of targeted interventions, further research is necessary to investigate how common arthritic implications, such as functional and social limitations, may mediate the relationship between arthritis and SPD.