Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic

Abstract

The coronavirus disease 19 (COVID-19) pandemic negatively affected children's health in the United States (US), with more severe disruption for marginalized groups. However, potential impact on pediatric chronic pain has not been assessed at the population level. This study aimed to (1) estimate differences in the US national prevalence of pediatric chronic pain during the first year of the COVID-19 pandemic (2020), relative to one year earlier (2019); (2) determine whether differences in prevalence varied across sociodemographic groups; and (3) explore changes in child, caregiver, and family factors associated with chronic pain prevalence. Using data of children 6 to 17 years from the National Survey of Children's Health 2019 and 2020 (n = 50,518), we compared weighted percentages of sample characteristics by year and conducted a series of directed-acyclic graph-informed survey-weighted Poisson regressions. The estimated national prevalence (95% CI) of pediatric chronic pain was 10.8% (9.9, 11.9%) in 2019, decreasing to 7.6% (6.9, 8.3%) in 2020. Contrary to hypotheses, the adjusted prevalence of chronic pain was 31% lower in 2020 than in 2019 (aPR = 0.69, 95% CI: 0.61, 0.79), adjusting for child age, sex, race or ethnicity, caregiver education, neighborhood park or playground, and census region. The 2019 to 2020 change in chronic pain prevalence was similar by age ( P = 0.34), sex ( P = 0.94), race or ethnicity ( P = 0.41), caregiver education ( P = 0.49), neighborhood park or playground ( P = 0.22), and census region ( P = 0.20). Exploratory analyses identified 3 potential contributors to the unexpected decrease in the national prevalence of pediatric chronic pain: lower prevalence of bullying, more frequent family meals, and higher family resilience.

Figure 1.

Social disruption of child, caregiver, and family factors in 2020 may have affected the prevalence of pediatric chronic pain in the United States, relative to the same period one year earlier.

Figure 2.

National prevalence of chronic pain among children 6–17 years of age in the United States by survey year – National Survey of Children’s Health (NSCH).

Figure 3.

Relative difference in national prevalence of pediatric chronic pain in the United States (2020 vs. 2019) – National Survey of Children’s Health (NSCH). aPR=Adjusted prevalence ratios; CI=Confidence intervals. a= Based on Poisson regression for the association between survey year (2020 vs. 2019) and pediatric chronic pain, adjusted for child age, sex, race/ethnicity, parent education, neighborhood park, and Census region categories. b= Based on six Poisson regression models built by adding multiplicative interaction term(s) between survey year and categories of each putative effect measure modifier to the overall model. P-values refer to the test of null hypotheses that the difference in prevalence of pediatric chronic pain from 2019 to 2020 is the same across all sociodemographic groups given covariates; that is, no effect measure modification (e.g., H₀: aPR_female=aPR_male).