Population-based survey of pain in the United States: differences among white, African American, and Hispanic subjects

Abstract

A cross-sectional telephone survey was conducted in nationally representative probability sample of non-Hispanic white subjects, non-Hispanic African American subjects, and Hispanic subjects of any race to explore relationships between chronic pain and race or ethnicity. Approximately one third in each group reported "frequent or persistent pain" for 3 months or longer during the past year, and approximately one third of the 454 white subjects, 447 African American subjects, and 434 Hispanic subjects in the final sample experienced "disabling pain" (defined as both high severity and high functional interference). White subjects had pain longer but with lesser intensity than the other groups, and pain-related life interference did not vary. Significantly fewer Hispanic subjects (68%) than white subjects (82%) or African American subjects (85%) had visited a physician for pain, and African American subjects (81%) were more likely than white subjects (75%) or Hispanic subjects (63%) to have used prescription medications. Disabling pain was positively associated with female sex (odds ratio [OR], 1.45), income of $25,000 or less (OR, 1.71), less than a high school education (OR, 1.72), and divorce (OR, 1.69) and was negatively associated with younger age (18-34 years; OR, 0.68), income between $25,000 and $74,999 (OR, 0.64) or $75,000 or more (OR, 0.37), being employed (OR, 0.48), suburban residence (OR, 0.64), and having a college (OR, 0.51) or graduate (OR, 0.32) degree. Multivariate logistic regression found that income of $25,000 or less (OR, 2.54), less than a high school education (OR, 1.59), and being unemployed (OR, 1.50) remained significant when other factors were controlled. Neither race nor ethnicity predicted disabling pain, but the minorities had more characteristics identified as predictors. The data suggest that race and ethnicity contribute to clinical diversity, but socioeconomic disadvantage is the more important predictor of disabling pain.

Perspective: Race and ethnicity influence the presentation and treatment of chronic pain. This study evaluated community-dwelling white, African American, and Hispanic subjects by using a sophisticated telephone survey methodology. Pain was highly prevalent across groups, and there were racial and ethnic differences in pain experience and treatment preferences. Race and ethnicity were not independently associated with severe pain, but both minorities were more likely to possess the socioeconomic and educational characteristics that were associated.