Social determinants associated with unhealthy lifestyles in adults over 60 years of age with chronic musculoskeletal pain

Abstract

Introduction

Chronic musculoskeletal pain in older adults is associated with unhealthy lifestyles, possibly influenced by social determinants of health (SDH).

Objective

To identify the association between SDH and unhealthy lifestyles in older adults with chronic musculoskeletal pain.

Material and methods

A cross-sectional study was conducted. A structured survey was administered to assess SDH (gender, educational level, income, availability of green spaces, rurality, multimorbidity, and cohabitation) and lifestyles (physical activity: IPAQ; sleep quality: abbreviated PSQI; perceived stress: PSS-4; adherence to the Mediterranean diet: MedDiet Score). Mann–Whitney U tests and multivariate logistic regression models were applied.

Results

One hundred people were included (mean age 69.0 ± 9.8; 83% women). Forty percent were physically inactive, 71% had poor sleep quality, 36% had high perceived stress, and 76% had low adherence to the Mediterranean diet. Female sex was associated with poorer sleep quality (p = 0.023), absence of green areas with less weekly walking time (p = 0.042), multimorbidity with higher perceived stress (p = 0.039), and low educational level with lower adherence to the Mediterranean diet (p = 0.022). These findings were maintained in logistic regression models adjusted for age, body mass index, and pain intensity.

Conclusions

Being female, having lower educational attainment, living without access to green areas, and presenting multimorbidity were associated with poorer sleep, decreased dietary adherence, lower physical activity, and higher stress, respectively. These findings correspond to associations observed in a cross-sectional design and do not allow causal relationships to be established.

Resumen

Introducción

El dolor musculoesquelético crónico en personas mayores se asocia con estilos de vida poco saludables, posiblemente influenciados por determinantes sociales de la salud (DSS).

Objetivo

Identificar la asociación entre DSS y estilos de vida poco saludables en personas mayores con dolor musculoesquelético crónico.

Material y métodos

Se realizó un estudio transversal. Se aplicó una encuesta estructurada que evaluó DSS (sexo, nivel educativo, ingreso económico, disponibilidad de áreas verdes, ruralidad, multimorbilidad y convivencia) y estilos de vida (actividad física: IPAQ; calidad del sueño: PSQI abreviado; estrés percibido: PSS-4; adherencia a dieta mediterránea: MedDiet Score). Se aplicaron pruebas U de Mann–Whitney y modelos de regresión logística multivariada.

Resultados

Se incluyeron 100 personas (edad promedio 69.0 ± 9.8; 83% mujeres). El 40% presentó inactividad física, 71% mala calidad del sueño, 36% alto estrés percibido y 76% baja adherencia a la dieta mediterránea. El sexo femenino se asoció con peor calidad del sueño (p = 0,023), la ausencia de áreas verdes con menor tiempo semanal de caminata (p = 0,042), la multimorbilidad con mayor estrés percibido (p = 0,039) y el bajo nivel educacional con una menor adherencia a dieta mediterránea (p = 0,022). Estos hallazgos se mantuvieron en modelos de regresión logística ajustados por edad, índice de masa corporal e intensidad del dolor.

Conclusiones

Ser mujer, tener menor nivel educacional, vivir sin acceso a áreas verdes y presentar multimorbilidad se relacionaron con peores indicadores de sueño, adherencia dietaria, actividad física y estrés, respectivamente. Estos hallazgos corresponden a asociaciones observadas en un diseño transversal y no permiten establecer relaciones causales.