High-Impact Chronic Pain Incidence Among U.S. Adults: A Brief Report Focused on Socioeconomic Factors

Introduction: Epidemiologic studies of contributors to high-impact chronic pain incidence are needed to inform population health, pain prevention, and management. Focused on indicators of socioeconomic position, the authors aimed to determine the association of socioeconomic position with high-impact chronic pain incidence among U.S. adults. Methods: This nationally representative cohort study (2019-2020) included adults (aged ≥18 years) without baseline high-impact chronic pain in survey-weighted analyses (N=9,534). The primary outcome was incident high-impact chronic pain. Exposures were baseline indicators of socioeconomic position, namely, educational attainment, family income, work status, living arrangement, omission of medical care due to cost, and food insecurity. Results were stratified by baseline pain: no chronic pain and low-impact chronic pain. Results: The overall 1-year high-impact chronic pain cumulative incidence was 4.3% (95% CI=3.7, 4.8); it was higher among those with baseline low-impact chronic pain (14.2%; 95% CI=11.8%, 16.6%) than among those without chronic pain (2.6%; 95% CI=2.1, 3.1). After directed acyclic graph-informed adjustment, adults with lower socioeconomic position were generally approximately twice as likely to experience incident high-impact chronic pain as their more privileged counterparts. Conclusions: U.S. adults with lower socioeconomic position had generally higher risk of high-impact chronic pain incidence. Multilevel solutions to socioeconomic disparities and enhanced pain care for all may be considered to improve pain burden and population health.