Racial and Socioeconomic Disparities in Disabling Chronic Pain: Findings From the Health and Retirement Study

  • Mary R. Janevic
    Address reprint requests to Mary R. Janevic, PhD, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029.
    Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, Michigan

    Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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  • Sara J. McLaughlin
    Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, Ohio
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  • Alicia A. Heapy
    VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, Yale University School of Medicine, New Haven, Connecticut
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  • Casey Thacker
    Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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  • John D. Piette
    Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, Michigan

    Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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      • The National Pain Strategy calls for population research on high-impact chronic pain.
      • We examined sociodemographic disparities in such pain in the United States.
      • Approximately 8% of adults older than age 50 have high-impact chronic pain.
      • High-impact pain prevalence rose sharply with decreasing household wealth.
      • Black compared to white adults had greater pain-related disability across domains.


      The U.S. National Pain Strategy calls for increased population research on “high-impact chronic pain” (ie, longstanding pain that substantially limits participation in daily activities). Using data from the nationally-representative Health and Retirement Study (HRS), we investigated the prevalence of high-impact chronic pain in U.S. adults older than age 50 overall and within population subgroups. We also explored sociodemographic variation in pain-related disability within specific activity domains. Data are from a subsample of HRS respondents (n = 1,925) who were randomly selected for a supplementary pain module in 2010. Our outcome was operationalized as pain duration of ≥7 months and a disability rating of ≥7 (0–10 scale) in at least 1 domain: family/home, leisure, social activities, work, or basic activities. Overall, 8.2% (95% confidence interval = 6.7–10.1%) of adults older than age 50 met criteria for high-impact chronic pain. This proportion rose to 17.1% (95% confidence interval = 12.3–23.4%) among individuals in the lowest wealth quartile. Prevalence differences according to education, race/ethnicity, and age were not significant. Arthritis and depression were significantly associated with high-impact pain in multivariable analysis. Among adults with any chronic pain, African American and individuals in the lowest wealth quartile reported more pain-related disability across activity domains.


      High-impact chronic pain is unequally distributed among midlife and older U.S. adults. Efforts to reduce the burden of disabling chronic pain should prioritize socioeconomically vulnerable groups, who may have the least access to multimodal pain treatment to improve function.

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