Education and self-care activities among persons with rheumatoid arthritis

Associations between low formal education and increased morbidity and mortality have been well established among persons with rheumatoid arthritis (RA) and other conditions. This study attempted to identify a partial explanation for the association between low education and poor outcomes among persons with RA by examining self-care activities performed by persons with different levels of education. Persons with 13+ yr of education were significantly more likely to perform specific self-care activities (e.g., using a heated pool, tub, shower, OR=2.59; using relaxation methods, OR=3.00; using stress control methods, OR=2.41; avoiding certain foods, OR=1.74). The association between education and performance of self-care activities was not linear. When significant differences were noted, 13 yr of education was usually the point at which performance was significantly different than among lower education groups; individuals with 12 yr of education often exhibited lower frequencies of particular behaviors than did individuals with 9–11 yr of education. The association between higher education and performance of more self-care activities may shed light on previously described associations between education and morbidity. However, low education should not be viewed as the cause of increased morbidity and mortality, but as a proxy for a constellation of factors responsible for poor health outcomes.