Role of Allostatic Load in Sociodemographic Patterns of Pain Prevalence in the U.S. Population

  • Gary D. Slade
    Address reprint requests to Gary D. Slade, BDSc, DDPH, PhD, Old Dental Building, Room 2100, UNC School of Dentistry, CB #7450, Chapel Hill, NC 27599-7450.
    Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Anne E. Sanders
    Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Kunthel By
    Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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      Persistent stressors associated with sociodemographic disadvantage exert a physiologic toll, labeled “allostatic load,” that contributes to disparities in some health conditions. We investigated the contribution of allostatic load to pain prevalence in U.S. adults. Interviews with 14,184 adults in the 1999–2004 National Health and Nutrition Examination Survey asked about severe headache, pain that lasted >24 hours, and widespread pain. Ten biomarkers of allostatic load were quantified from blood (glycated hemoglobin), serum (C-reactive protein, homocysteine, cholesterol, triglycerides), urine (creatinine, albumin), and physical measurements (body mass index, systolic and diastolic blood pressure). Log-binomial regression models estimated prevalence ratios (PRs) and 95% confidence intervals (95% CIs). Prevalence ranged from 3.4% for widespread pain to 26.9% for pain >24 hours. After adjustment for demographic characteristics, low income was associated with greater prevalence of pain >24 hours (PR = 1.65, 95% CI = 1.49, 1.83), severe headache (PR = 2.05, 95% CI = 1.68, 2.50), and widespread pain (PR = 3.67, 95% CI = 2.56, 5.27). Racial/ethnic minorities had lower prevalence of all 3 pain conditions than non-Hispanic whites. While greater allostatic load was associated with elevated prevalence of pain, allostatic load did not meaningfully attenuate PRs associated with income or race/ethnicity. We conclude that greater pain prevalence among low-income groups is not explained by greater allostatic load.


      In U.S. adults, pain occurs more frequently in lower-income groups, although the relationship is not attributable to their experience of greater allostatic load. While allostatic load contributes to population variation in pain, other etiologic mechanisms contributing to pain are needed to account for income disparities in pain.

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