Association of chronic pain with incidence and progression of cardiometabolic multimorbidity in middle-aged and older populations: a multicohort study

Abstract

Introduction: Chronic pain is associated with single cardiometabolic diseases (CMDs). Less is known about the association of chronic pain with the co-occurrence of multiple CMDs, known as cardiometabolic multimorbidity (CMM).

Objectives: This study aims to examine the association between chronic pain and incidence of CMM and if it existed, to what extent chronic pain relates to the progression of specific CMD-related multimorbidity (MM).

Methods: We pooled individual-level data of 59,134 participants from 4 cohort studies across 18 countries between 2010 and 2020. Participants aged 45 years or older, free of CMDs (diabetes, heart diseases, and stroke), and with self-reported chronic pain status at baseline were included. Multinomial logistic regression was performed on the association of chronic pain with incident CMM and the progression of specific CMD-related MM.

Results: One-third (21,204) of participants reported chronic pain at baseline. After 8 to 9 years, 1344 (2.3%) developed CMM. Chronic pain was associated with the onset of each CMD (odds ratio [OR] range 1.12-1.37) and CMM combinations (OR range 1.57-2.09). It is also linked with the increased odds of more CMDs (1, 2, and 3) during the follow-up. For example, OR increased from 1.31 for individuals with one CMD, to 1.57 for those with 2 CMDs, to 2.09 for those with 3 CMDs. Chronic pain was also associated with developing all CMD-related MM (OR range 1.26-1.88). Compared with those with diabetes only, participants with chronic pain were more likely to progress to diabetes and heart diseases, as well as diabetes, heart diseases, and stroke.

Conclusion: Chronic pain is associated with incidence and progression of CMM, whose management should be considered in primary and secondary prevention of CMM among middle-aged and older populations.

Keywords: Cardiometabolic multimorbidity; Chronic pain; Middle-aged and older adults; Multicohort.

Figure 1.

The selection of participants from 4 cohort studies. CHARLS, the China Health and Retirement Longitudinal Study; ELSA, the English Longitudinal Study on Ageing; HRS, the US Health and Retirement Study; SHARE, the Survey of Health, Ageing and Retirement in Europe.

Figure 2.

Forest plots for the association between chronic pain and incident cardiometabolic diseases combinations. All models were adjusted for age, sex, country, body mass index (BMI), marital status, education levels, and income levels. Cases/% refers to the frequency and percentage of incident CMD among participants with/without baseline chronic pain. ^aCMM was defined as the coexistence of 2 or more types of CMDs (diabetes, heart diseases, or stroke) in this study. CMD, cardiometabolic disease; CMM, cardiometabolic multimorbidity; OR, odds ratio; CI, confidence interval.

Figure 3.

Forest plots for the associations of chronic pain with the progression of specific cardiometabolic diseases–related multimorbidity. The models were adjusted for age, sex, country, body mass index (BMI), marital status, education levels, and income levels. Cases/% refers to the frequency and percentage of incident CMD among participants with/without baseline chronic pain. CI, confidence interval; CMD, cardiometabolic disease; MM, multimorbidity; OR, odds ratio.

Figure 4.

Meta-analysis for the association between baseline chronic pain and (A) number of cardiometabolic diseases and (B) cardiometabolic multimorbidity according to cohort studies. All models were adjusted for age, sex, body mass index (BMI), marital status, education levels, and income levels in CHALRS, ELSA, and HRS cohort, and additionally adjusted for country in SHARE cohort including 15 countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Netherlands, Slovenia, Spain, Sweden and Switzerland). Cases/% refers to the frequency and percentage of incident CMD among participants with/without baseline chronic pain. ^aCMM was defined as the coexistence of 2 or more types of CMDs (diabetes, heart diseases, or stroke) in this study. CHARLS, the China Health and Retirement Longitudinal Study; CI, confidence interval; CMD, cardiometabolic disease; CMM, cardiometabolic multimorbidity; ELSA, the English Longitudinal Study on Ageing; HRS, the US Health and Retirement Study; OR, odds ratio; SHARE, the Survey of Health, Ageing and Retirement in Europe.