Social Determinants of Chronic Pain in the United States

Abstract

Social aspects of the biopsychosocial framework of pain have been under theorized and under researched. We proposed a theory-driven conceptual framework to expose multilevel intersectional systems of inequity and pathways through which they may shape pain over the life course and across generations. Using directed acyclic graph-informed regression in a nationally representative sample of US adults, we estimated large relative inequities in high-impact chronic pain (HICP) and number of site-specific pains, especially by family income and education. Inequities in low-impact chronic pain and site-specific pains were smaller. In intersectional decomposition analysis, adults in nearly all doubly marginalized positions of race/ethnicity and socioeconomic position (SEP) were estimated to have higher absolute HICP burden than non-Hispanic White adults with high SEP, and lower absolute HICP burden than expected based on the sum of SEP and race/ethnicity disparities alone. Enhanced conceptualization, measurement, and analytic strategies for social determinants of pain may contribute to research and policy strategies towards population health equity.