Is Financial Hardship Associated with Reduced Health in Disability? The Case of Spinal Cord Injury in Switzerland

OBJECTIVE To investigate socioeconomic inequalities in a comprehensive set of health indicators among persons with spinal cord injury in a wealthy country, Switzerland. METHODS Observational cross-sectional data from 1549 participants of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), aged over 16 years, and living in Switzerland were analyzed. Socioeconomic circumstances were operationalized by years of formal education, net equivalent household income and financial hardship. Health indicators including secondary conditions, comorbidities, pain, mental health, participation and quality of life were used as outcomes. Associations between socioeconomic circumstances and health indicators were evaluated using ordinal regressions. RESULTS Financial hardship was consistently associated with more secondary conditions (OR 3.37, 95% CI 2.18-5.21), comorbidities (OR 2.88, 95% CI 1.83-4.53) and pain (OR 3.32, 95% CI 2.21-4.99), whereas mental health (OR 0.23, 95% CI 0.15-0.36), participation (OR 0.30, 95% CI 0.21-0.43) and quality of life (OR 0.22, 95% CI 0.15-0.33) were reduced. Persons with higher education reported better mental health (OR 1.04, 95% CI 1.00-1.07) and higher quality of life (OR 1.06, 95% CI 1.02-1.09); other health indicators were not associated with education. Household income was not related to any of the studied health indicators when models were controlled for financial hardship. CONCLUSIONS Suffering from financial hardship goes along with significant reductions in physical health, functioning and quality of life, even in a wealthy country with comprehensive social and health policies.