A new study co-authored by Western researcher Anna Zajacova shows that racial and ethnic disparities in pain prevalence in the U.S. are far larger than previously realized, with multiracial and Indigenous (Native American/Alaska Native) adults reporting the highest levels of pain.
She says this finding is significant because pain can be used as a barometer of mental and physical health of a population.
“We aren’t talking about one particular type of pain, we are looking at pain overall,” said Zajacova, sociology professor at Western. “And it turns out that when we ask people about their pain experience, it is a really good way to capture their well-being and is an important determinant of health care utilization.”
The research, published in the journal Pain, is based on data provided by nearly 274,000 participants, and indicates that Indigenous and multiracial Americans have by far the highest pain prevalence, while Asian Americans have the lowest pain prevalence, regardless of which specific pain measure is being assessed.
“The fact that people who identify as multiracial reported such high levels of pain is significant and we need to understand why,” Zajacova said. She notes that some of these factors could include psychosocial factors such as discrimination or social support. “These are big questions that can help inform clinicians and public health researchers to understand how the social context is influencing the health of certain groups.”
The researchers say pain can be influenced by overall health, health behaviours and physical fitness, as well as social stress, psychological and financial stress, and other “upstream social factors.”
The current research represents the first portrait of U.S. pain prevalence across six major racial and ethnic groups as defined by the U.S. Census Bureau. While earlier studies of pain disparities focused mostly on Black, white, and sometimes Hispanic adults, the current study also includes Indigenous people (defined as Native Americans by the U.S. Census Bureau), Asian Americans and the fast-growing multiracial category.
“This research identifies the groups that have the highest unmet need for pain prevention and management,” said study co-author Hanna Grol-Prokopczyk, associate professor of sociology at the College of Arts and Sciences at the University at Buffalo. “We also want to learn from the groups that are doing well in terms of pain in order to understand why they’re doing well. We want to identify protective factors, like good health practices, medical care and social support, and conduct further research to determine why these groups are not experiencing chronic pain as much as other groups.”
The Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey (NHIS), which the researchers used for their analysis, estimates that more than 50 million people reported pain on most days or every day. That’s slightly more than one out of every five American adults, with a cost to the economy greater than heart disease, cancer and diabetes combined.
Yet most research on pain prevalence has focused on comparisons between Black and white adults. More limited research attention has been given to Hispanic people, despite being the country’s largest non-white group representing about 21 per cent of the population. Even less research on pain prevalence has been devoted to Asian American and Native American adults, while pain among multiracial Americans, a population expected to double by 2050 to more than 20 million people, has never been systematically studied.
The current study uses NHIS data from 2010 — the first survey wave to include global pain questions — to 2018, the most recent year data were available at the time the paper was being written. A different group of participants was surveyed each year.
The researchers currently have studies in progress looking at similar data for Canada.