Neighborhood Disadvantage Linked to Knee Pain via Reduced Sleep Efficiency

Neighborhood disadvantage indirectly affects knee pain severity through reduced sleep efficiency among individuals with or at risk of developing knee osteoarthritis (OA), according to study results published in Arthritis Care & Research.

Researchers in the United States performed a cross-sectional analysis of data from the Understanding Pain and Limitations in Osteoarthritic Disease 2 study to examine how neighborhood disadvantage influences pain severity in knee OA. They investigated the potential mediating roles of sleep efficiency and pain catastrophizing on this relationship. Eligible participants were aged between 45 and 85 years, reported having knee pain for at least 1 month, and identified as either non-Hispanic African American/Black or non-Hispanic Caucasian/White.

Neighborhood disadvantage was measured using the third iteration of the 2019 Area Deprivation Index (ADI), while sleep efficiency was objectively assessed using an actigraph worn on the wrist for a period of 5 to 15 days. Pain catastrophizing was evaluated using the Coping Strategies Questionnaire-Revised criteria. Knee pain severity was measured with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale.

A total of 140 participants (mean age, 58.22 years; 62.1% women) were included in the analysis, among whom 51.4% were non-Hispanic White and 48.6% were non-Hispanic Black. The average overall ADI score was 66.95, indicating moderate disadvantage, while the mean WOMAC pain score was 7.68. Participants were evenly distributed across the Kellgren Lawrence grading system, with 55.71% classified as grade 2 or higher.

Results of mediation analyses showed that individuals in areas with higher neighborhood disadvantage had significantly worse sleep efficiency (a1 = -0.08), which was associated with greater pain (b1 = -0.09). The indirect effect of neighborhood disadvantage on pain through sleep efficiency was significant (95% CI, 0.0003-0.0176).

However, sleep efficiency was not significantly related to pain catastrophizing, nor did catastrophizing mediate the relationship between neighborhood disadvantage and pain. Additionally, neighborhood disadvantage did not directly or indirectly predict pain through catastrophizing, with both direct and total effects being nonsignificant.

Study results are limited by the inability to guarantee causality or determine the sequence of events due to the cross-sectional nature of the analysis.

“[T]here is substantial literature showing that safe neighborhoods are associated with better sleep health, perhaps due to decreased anxiety, worry, and reduced nighttime physiological arousal,” the study authors noted. “Future studies should assess perceived social cohesion and safety within neighborhoods directly to examine these associations, and we speculate that social connectedness may be able to buffer against neighborhood disadvantage.”

This article originally appeared on Rheumatology Advisor