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Title: Socioeconomic status and social relationships in persons with spinal cord injury from 22 countries : does the countries’ socioeconomic development moderate associations?
Authors: Fekete, C
Reinhardt, JD 
Arora, M
Engkasan, JP
Gross-Hemmi, M
Kyriakides, A
Le Fort, M
Tough, H
Issue Date: 2021
Source: PLoS one, 2021, v. 16, no. 8, e0255448
Abstract: Background Social relationships are powerful determinants of health and inequalities in social relationships across socioeconomic status (SES) groups may contribute to social inequalities in health. This study investigates inequalities in social relationships in an international sample of persons with spinal cord injury and explores whether social gradients in relationships are moderated by the countries’ socioeconomic development (SED).
Methods Data from 12,330 participants of the International SCI Community Survey (InSCI) performed in 22 countries were used. We regressed social relationships (belongingness, relationship satisfaction, social interactions) on individual SES (education, income, employment, financial hardship, subjective status) and countries’ SED (Human Development Index) using multi-level models (main effects). To test potential moderation of the SED, interaction terms between individual SES and countries’ SED were entered into multi-level models.
Results Paid work, absence of financial hardship and higher subjective status were related to higher belongingness (OR, 95% CI: 1.50, 1.34–1.67; 1.76, 1.53–2.03; 1.16, 1.12–1.19, respectively), higher relationship satisfaction (OR, 95% CI: 1.28, 1.15–1.42; 1.97, 1.72–2.27; 1.20, 1.17–1.24, respectively) and fewer problems with social interactions (Coeff, 95% CI: 0.96, 0.82–1.10; 1.93, 1.74–2.12; 0.26, 0.22–0.29, respectively), whereas associations with education and income were less consistent. Main effects for countries’ SED showed that persons from lower SED countries reported somewhat higher relationship satisfaction (OR, 95% CI: 0.97, 0.94–0.99) and less problems with social interactions (Coeff, 95% CI: -0.04, -0.09- -0.003). Results from moderation analysis revealed that having paid work was more important for relationships in lower SED countries, while education and subjective status were more important for relationships in higher SED countries (interaction terms p<0.05).
Conclusion Social relationships in persons with spinal cord injury are patterned according to individual SES and the countries’ SED and larger socioeconomic structures partly moderate associations between individual SES and social relationships.
Publisher: Public Library of Science
Journal: PLoS one 
EISSN: 1932-6203
DOI: 10.1371/journal.pone.0255448
Rights: © 2021 Fekete et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The following publication Fekete C, Reinhardt JD, Arora M, Patrick Engkasan J, Gross-Hemmi M, Kyriakides A, et al. (2021) Socioeconomic status and social relationships in persons with spinal cord injury from 22 countries: Does the countries’ socioeconomic development moderate associations? PLoS ONE 16(8): e0255448 is available at https://doi.org/10.1371/journal.pone.0255448
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