Are persistent physical symptoms associated with low socioeconomic status: a meta-epidemiologic study?

Problem

Persistent (“medically unexplained”) physical symptoms reduce quality of life. Risk factors for these disorders include early live adversity. However, there has been no systematic study of the relationship between socioeconomic factors and the prevalence of persistent physical symptoms or related functional symptom syndromes. Reflecting the “deep-end” approach to the most deprived sections of the population, we were particularly interested in comparing the most deprived 10-20% with the remainder of the population.

Approach

We carried out a meta-epidemiologic study in which we systematically identified studies describing one or more of the following: multiple “medically unexplained” symptoms (including somatoform disorders); chronic widespread musculoskeletal pain (including fibromyalgia); fatigue (including chronic fatigue syndrome); functional GI disorders (including IBS); chronic pelvic / genitourinary pain; and functional neurological disorders.We searched Medline and Embase from 1980 to the present for papers including one or more of the symptoms / syndromes along with terms relating to epidemiology or socioeconomic status. Data extraction is complete for multiple symptoms and for other symptoms /syndromes since 2017. Full data extraction and analysis will be completed by May 2020.We are conducting meta-analysis of the results of case-control studies with meta regression to examine the influence of study variables.

Findings

To date, we have identified 9420 titles with 1126 abstracts identified for full text searching. So far, we have extracted data from 25 studies with case and control data from 426 full text papers.To date the pooled odds ratio for the prevalence of multiple symptoms in the most deprived sector of the population is 1.7 (95%CI 1.5 to 1.9) and for prevalence of fibromyalgia is 1.6 (1.1 to 2.5).We will report full study findings across all symptoms/ syndromes in July.

Consequences

This is the first study to systematically show that at least some persistent physical symptoms and functional syndromes have an adverse socioeconomic gradient. Symptom disorders contribute to the excess burden of ill-health in poorer people. As this demographic group may be least likely to engage with programmes such as IAPT symptom management programmes, interventions are needed to enable people living in, or close to, poverty to live well despite persistent physical symptoms.