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Academic Editor

PLOS ONE

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This analysis used data or information from the Harmonized HRS, ELSA, SHARE, KLoSA, CHARLS, and MHAS datasets, and Codebooks developed by the Gateway to Global Aging Data, supported by the National Institute on Aging (grant numbers R01 AG030153, RC2 AG036619, and 1R03AG043052). For more information, please refer to https://g2aging.org. HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. Funding for ELSA is provided by the National Institute of Aging (grants 2RO1AG7644–01A1 and 2RO1AG017644) and a consortium of UK Government departments coordinated by the Office for National Statistics. 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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1:  Socioeconomic status, depression, and incident arthritis in adults aged 50 years and over: prospective evidence from 21 countries.

The main objective of the study is clearly presented, proposing a methodological approach that addresses an existent gap in the arthritis literature, investigating the effect of depression and/or socioeconomic status (SES) on incident arthritis

Introduction

The introduction highlights the importance of examining relationship between depression and SES in the incidence of arthritis, emphasizing the need to integrate these factors into the research in order to design strategies aimed at reducing the burden of this disease.

It is true that there Is a limited number of papers that refers to depression and SES as risk factor to incident arthritis but it is well known that at least depression has a bidirectional causal relationship with arthritis (i.e Brain Behav. 2024 Jun;14(6):e3551. Consequently authors should to elaborate more about depression or/and SES can be seen as a cause of incident arthritis.

Methods and Materials

This is a secondary analysis of six longitudinal aging studies. I think is more appropriate to refer to the six studies instead of the 21 countries.

The description of independent variables is clear enough but, please explain further if changes over time in these two variables were taken into account.

I consider adequate and pertinent the use of the various statistical methods and tests applied in the data analysis, particularly given that they were applied separately in every dataset by country(s), which allows to obtain more accurate and representative estimates tailored to each sample. In addition, it is relevant that the analysis was conducted both with and without missing data, enabling the assessment of how and to what extent the missing data may have influenced the results.

The specific ethical approvals for each cohort should be mentioned in this section. In the case of MHAS for example, the web page indicates what information is needed to include.

Results

The results are conclusive and present the values obtained from the applied tests and statistical models, both crude and adjusted, aimed at evaluating the extent to which various risk factors influence the development of arthritis in adults aged 50 years and older. The findings demonstrate that the study’s main objective addresses clearly and effectively explored. Specifically, depression is associated with an increased risk of developing arthritis. Therefore, significant associations are identified between several socioeconomic indicators and the incidence of the disease among participants in the longitudinal cohorts. In other words, individuals with an unfavourable socioeconomic status, low education attainment and depressive symptoms, tend to have higher risk of developing the disease. In contrast, participants with more favourable socioeconomic conditions, exhibited a lower risk, regardless of whether they reported symptoms of depression.

Discussion

The interpretation of the results is precise and valid, in the terms of the perspective of the study.

However, some issues should be considered in order to strengthen this section.

One limitation is the follow up. The variables relationship and the incidence could change if the follow up would be longer.

I also consider it essential to revisit this study from a class-based perspective. Although, the study identifies SES as a relevant variable, it does not delve into the multiple dimensions that a lower socioeconomic status entails in relation to individuals’ quality of life, nor how these conditions may contribute to an increased risk of developing arthritis.

The study adopts an approach that, while focusing on SES and depression, also centres on the level of education, under the assumption that lower educational attainment is associated with reduced knowledge of the disease and its symptoms, potentially leading to delays in diagnosis and appropriation treatment of arthritis. Moreover, it is important to emphasize that the lack of information about the disease is not exclusive to individuals with low levels of education; other fundamental aspects —such as economic access to medical services for treating chronic degenerative conditions, as well as issues related to time and distance— are also influenced by SES.

Another important aspect to highlight is that, although the data analysis by country helps to o avoid statistical bias, the proposed strategies and health policies are presented from a generalized perspective. This represents another limitation of the study, as solutions do not necessarily have to be, and often cannot be, homogenous.

Therefore, I argue that a more integral (holistic) approach that includes these diverse dimensions is essential for a truly effective approximation of the comprehension of arthritis in adults aged 50+.

Reviewer #2:  This study is written well, easy to understand and with academic language. Nice tables, graphs, figures. I do not have revision suggestions. The impact of this study across multiple populations is helpful because we practice medicine in a global environment. And additionally similar to the recent obesity study across populations then this multi-national study helps us to better understand that many health issues are shared issues thus we can begin trying to solve the globally instead of continuing to focus only on single populations. This study can be used to justify the inclusion of international participants in studies about arthritis and social determinants of health.

Methods are well described and Results indicate that the Methods were followed.

Results were presented in an understandable logical manner.

Discussion included the linkage to similar Results in other studies. Discussion included the limitations of the self reported data and self reported physician diagnosis.

Further work on identifying covariates and confounders was included.

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Reviewer #1: No

Reviewer #2: Yes:  Jeananne Elkins MPH, DPT, PhD

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Socioeconomic status, depression, and incident arthritis in adults aged 50 years and over: prospective evidence from six longitudinal aging studies

PONE-D-25-22108R1

Dear Dr. Hu,

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Kind regards,

Modupe Akintomide

Academic Editor

PLOS ONE