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Sociodemographic disparities in chronic pain, based on 12-year longitudinal data

Grol-Prokopczyk, Hanna

doi: 10.1097/j.pain.0000000000000762
Research Paper

Abstract: Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n = 19,776) to describe long-term pain disparities among older (age 51+) American adults. It also investigates whether pain severity, reporting heterogeneity, survey nonresponse, and/or mortality selection might bias estimates of social disparities in pain. In the process, the article clarifies whether 2 unexpected patterns observed cross-sectionally—plateauing of pain above age 60, and lower pain among racial/ethnic minorities—are genuine or artefactual. Findings show high prevalence of chronic pain: 27.3% at baseline, increasing to 36.6% thereafter. Multivariate latent growth curve models reveal extremely large disparities in pain by sex, education, and wealth, which manifest primarily as differences in intercept. Net of these variables, there is no racial/ethnic minority disadvantage in pain scores, and indeed a black advantage vis-à-vis whites. Pain levels are predictive of subsequent death, even a decade in the future. No evidence of pain-related survey attrition is found, but surveys not accounting for pain severity and reporting heterogeneity are likely to underestimate socioeconomic disparities in pain. The lack of minority disadvantage (net of socioeconomic status) appears genuine. However, the age-related plateauing of pain observed cross-sectionally is not replicated longitudinally, and seems partially attributable to mortality selection, as well as to rising pain levels by birth cohort.

Socioeconomic disparities in chronic pain are estimated using 12-year longitudinal data. Key sources of measurement bias, including mortality selection and reporting heterogeneity, are identified.

Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY, USA

Corresponding author. Address: Department of Sociology, University at Buffalo, State University of New York, 430 Park Hall, Buffalo, NY 14260, USA. Tel.: (716) 645-8480; fax: (716) 645-3934. E-mail address: hgrol@buffalo.edu (H. Grol-Prokopczyk).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received February 15, 2016

Received in revised form October 26, 2016

Accepted November 07, 2016

© 2017 International Association for the Study of Pain
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