To examine the associations between socioeconomic position (SEP) and the incidence of serious hand infections—pyogenic flexor tenosynovitis (PFT) and septic arthritis (SA)—as well as risks of opioid overuse following diagnosis using nation-level data.

In a registry-based nationwide retrospective cohort study, (1) associations between SEP and incidence of PFT/SA; (2) SEP and infection-type effects on opioid overuse in the general population and (3) SEP and clinical predictors of opioid overuse among individuals diagnosed with PFT/SA were examined.

Using linked Swedish national registers (2010–2015), (1) a multinomial regression to assess SEP and infection risk (n=5 697 865); (2) logistic regression on opioid overuse (≥2 dispensations within 3 months) related to SEP and infection status and (3) a restricted analysis among diagnosed individuals (n=3701) to isolate clinical determinants of opioid overuse was conducted.

Among the study population, 0.04% had PFT and 0.02% had SA. In the general population, 0.31% received two or more opioid prescriptions, compared with 4.5% of those with PFT and 6.8% of those with SA. Male sex, older age, being native, low occupational qualification, comorbidity and—specifically for SA—low income were associated with higher infection risk. Both infections independently predicted opioid overuse (adjusted OR for PFT: 13.23 (95% CI 10.92 to 16.02); adjusted OR for SA: 15.16 (11.99 to 19.17)). Additional predictors of overuse included low SEP, female sex, older age, native birth, living alone and comorbidity. Infected individuals with SA were more likely to overuse opioids than those with PFT, but SEP had limited predictive power within this subgroup.

Despite universal healthcare, socioeconomic disparities exist in hand infection incidence and opioid prescribing. PFT and SA increase the risk of opioid overuse, but SE inequalities, except comorbidity, are less relevant among individuals. Targeted, equitable pain management strategies that reduce unnecessary opioid exposure while ensuring adequate care are needed.