Using heterogeneity in disease to understand the relationship between health and personality

The aim of this study was to compare the relationship between two health outcomes (pain and self-reported health) and personality while accounting for heterogeneity in arthritic disease. Traditionally health research has treated patients' disease experiences as homogeneous but stratified medicine suggests that doing so might over-generalise findings and miss important effects. We present a longitudinal analysis over 14 years, on a subsample of 443 arthritic respondents from the English Longitudinal Study of Ageing (ELSA). Using linear regressions, we modelled how the Big Five domains of personality (wave 5) moderated the relationship between past (at wave 1) and present health (at wave 7). Then, to model heterogeneity in arthritis experience we included assignment to 4 different sub-groups based on their experience of pain progression. The results showed that modelling heterogeneity led to the identification of specific stratified effects for personality (neuroticism, agreeableness, and extraversion) not observed when these data are treated as homogenous. Higher agreeableness was associated with worse pain for those in a sub-group reporting the greatest pain, and higher extraversion was protective against pain among those whose pain improved. The results highlight the importance of modelling heterogeneity of disease.