Variability in Pain Prevalence Tied to Education Disparities

TOPLINE:

The prevalence of joint pain across US states tracks with levels of educational disparities, with individuals living in areas with the greatest inequalities facing the greatest pain risk.

METHODOLOGY:

Evidence suggests people with less education are more likely to experience joint pain, owing to behavioral risk factors such as smoking, limited access to healthcare resources, or delayed diagnosis and treatment.

Research on pain disparities relies heavily on individual-level data while neglecting overarching macrolevel factors such as state-level policies.

The study included individual-level data on 407,938 adults aged 25–80 years from the 2017 Behavioral Risk Factor Surveillance System (BRFSS), an annual health survey of US residents, with state-level data on six measures: the Supplemental Nutrition Assistance Program (SNAP); Earned Income Tax Credit (EITC), an antipoverty program; Medicaid Generosity Score (MGS); Gini index, an indicator of income inequality; social capital index, which considers factors such as social cohesion and civic engagement that may predict better health; and tobacco taxes, which indicate state policies restricting unhealthy behaviors.

The primary outcome was moderate or severe arthritis-attributable joint pain (scores of 6 or more on a 0–10 scale) as reported by respondents.

The investigators controlled for age, sex, and race/ethnicity, as well as a state’s proportion of immigrants (who tend to experience less pain).

TAKEAWAY:

The prevalence of joint pain varied substantially across states. It was lowest in Minnesota (6.9%), followed by Hawaii (7.5%) and Utah (7.7%). It was highest in West Virginia (23.1%), followed by Alabama (21.6%) and Arkansas (21.4%).

The average gap in pain prevalence between those with less than a high school (HS) education and those with at least a BA was 18.5% points but ranged from 8.8% in California to 31.1% in West Virginia.

At all educational levels, people in states with larger educational disparities tended to have a higher risk of joint pain; even individuals with college degrees are more likely to experience pain if they live in states with large educational gaps.

Individuals with <HS have over five times higher odds of joint pain than their peers with BA+ (odds ratio [OR], 5.381; 95% CI, 4.923 – 5.881).

Each standard deviation increase in SNAP was associated with a 7.5% decrease in odds of joint pain (OR = 0.925; 95% CI, 0.963 – 0.957), and a 1 standard deviation increase in SCI predicted a 18.1% decrease in joint pain (OR = 0.819; 95% CI, 0.748 – 0.896) (other state-level factors had no significant impact on joint pain).

IN PRACTICE:

The findings suggest state governments “could invest in policies to improve food security, increase social cohesion, and reduce income inequality to reduce pain prevalence and disparities” the authors write.

SOURCE:

The study was conducted by Rui Huang, Department of Sociology, University at Buffalo, Buffalo, New York, and colleagues. It was published online July 3, 2023, in Pain.

LIMITATIONS:

Researchers could not determine how much exposure respondents had to a given state context, which may have led to less precise estimates of state effects. The study lacked individual-level data on immigrant status, which could bias findings. Some state-level data do not exactly match the survey year of individual-level data from the BRFSS (2017), and state-level factors not considered likely also contribute to pain and pain disparities.

DISCLOSURES:

The study received support from the National Institute on Aging of the National Institutes of Health. The authors report no relevant conflicts of interest.

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