Trends in Disability and Limitations among U.S. Adults Age 18-44, 2000-2018.

Understanding disability trends is critical for health care and social policy. Although trends in disability and limitations have been studied extensively among older and middle-aged adults, little is known about trends in younger Americans, despite their importance for current and future population health. We present the first comprehensive evidence on disability trends among U.S. adults age 18-44. We analyze 20 measures of disability and limitations collected in the nationally representative National Health Interview Survey 2000-2018 (N=261,505). Robust Poisson models estimate age- and sex-adjusted trends and their covariates. Over one quarter (27.4%) reported at least one disability or limitation; the age-adjusted prevalence increased by 5% from 2000 to 2018. However, trends for specific disabilities and limitations varied tremendously. ADL and IADL limitations, cognitive, and social disabilities increased steeply (by 65-89% over the study period). Mobility limitations were generally unchanged or increased modestly. Hearing and 'other' limitations decreased significantly (25-48% decrease). The trends are only partly explained by education, health behaviors, chronic conditions, and other covariates. Disability trends research must not be limited to older adults. Researchers and policy makers interested in health care policy, planning, and caregiving should pay attention to disability trends among young adults in the United States.

US State Disparities in Life Expectancy, Disability-Free Life Expectancy, and Disabled Life Expectancy Among Adults Aged 25 to 89 Years.

Objectives. To estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and disabled life expectancy (DLE) by US state for women and men aged 25 to 89 years and examine the cross-state patterns.Methods. We used data from the 2013-2017 American Community Survey and the 2017 US Mortality Database to calculate state-specific TLE, DFLE, and DLE by gender for US adults and hypothetical worst- and best-case scenarios.Results. For men and women, DFLEs and DLEs varied widely by state. Among women, DFLE ranged from 45.8 years in West Virginia to 52.5 years in Hawaii, a 6.7-year gap. Men had a similar range. The gap in DLEs across states was 2.4 years for women and 1.6 years for men. The correlation among DFLE, DLE, and TLE was particularly strong in southern states. The South is doubly disadvantaged: residents have shorter lives and spend a greater proportion of those lives with disability.Conclusions. The stark variation in DFLE and DLE across states highlights the large health inequalities present today across the United States, which have significant implications for individuals' well-being and US states' financial costs and medical care burden.

Pain Trends Among American Adults, 2002-2018: Patterns, Disparities, and Correlates.

Determining long-term trends in chronic pain prevalence is critical for evaluating and shaping U.S. health policies, but little research has examined such trends. This study (1) provides estimates of pain trends among U.S. adults across major population groups; (2) tests whether sociodemographic disparities in pain have widened or narrowed over time; and (3) examines socioeconomic, behavioral, psychological, and medical correlates of pain trends. Regression and decomposition analyses of joint, low back, neck, facial/jaw pain, and headache/migraine using the 2002-2018 National Health Interview Survey for adults aged 25-84 (N = 441,707) assess the trends and their correlates. We find extensive escalation of pain prevalence in all population subgroups: overall, reports of pain in at least one site increased by 10%, representing an additional 10.5 million adults experiencing pain. Socioeconomic disparities in pain are widening over time, and psychological distress and health behaviors are among the salient correlates of the trends. This study thus comprehensively documents rising pain prevalence among Americans across the adult life span and highlights socioeconomic, behavioral, and psychological factors as important correlates of the trends. Chronic pain is an important dimension of population health, and demographic research should include it when studying health and health disparities.

COVID-19 Health Precautions: Identifying Demographic and Socio-Economic Disparities and Changes over Time.

The recent coronavirus disease 2019 (COVID-19) pandemic has required the adoption of precautionary health behaviours to reduce the risk of infection. This study examines adherence, as well as changes in adherence, to four key precautionary behaviours among Canadian adults: wearing face masks, social distancing, hand washing, and avoiding large crowds. Data are drawn from Series 3 and 4 of the nationally representative Canadian Perspectives Survey Series, administered by Statistics Canada in June and July 2020. We calculate overall adherence levels as well as changes over time. Logistic regression models estimate each behaviour as a function of demographic and socio-economic characteristics to identify adherence disparities across population segments. We find a nearly universal increase in precautionary behaviours from June to July in mask wearing (67.3 percent to 83.6 percent), social distancing (82.4 percent to 89.2 percent), and avoiding crowds (84.1 percent to 88.9 percent); no significant change occurred in the frequency of hand washing. We observe significant disparities in adherence to precautionary behaviours, especially for mask wearing, in June; female, older, immigrant, urban, and highly educated adults were significantly more likely to adhere to precautionary behaviours than male, younger, Canadian-born, rural, and low-educated adults. By July 2020, these disparities persisted or were slightly attenuated; women, however, had consistently higher adherence to all behaviours at both time points. These findings have substantial implications for policy and potential public health interventions.

La pandémie de COVID-19 (la maladie à coronavirus 2019) a exigé l'adoption de comportements préventifs en matière de santé afin de réduire les risques d'infection. La présente étude est consacrée à l'examen de l'adhésion, ainsi que de son évolution, à quatre comportements préventifs principaux chez les Canadiens adultes : le port de masques antiprojections, la distanciation physique, le lavage des mains et l'évitement des foules. Les données étudiées sont tirées des enquêtes 3 et 4 de la série d'enquêtes sur les perspectives canadiennes, réalisée par Statistique Canada en juin et juillet 2020. Nous calculons les niveaux globaux d'adhésion ainsi que l'évolution de cette adhésion dans le temps. Des modèles de régression logistique permettent d'estimer chaque comportement en fonction des caractéristiques démographiques et socio-économiques, et de cerner ainsi les disparités d'adhésion dans différents segments de population. Nous observons une augmentation quasi universelle des comportements préventifs de juin à juillet pour ce qui est du port du masque (67,3 pour cent à 83,6 pour cent), de la distanciation physique (82,4 pour cent à 89,2 pour cent) et de l'évitement des foules (84,1 pour cent à 88,9 pour cent) ; aucun changement significatif ne se manifeste dans la fréquence du lavage des mains. Nous observons également d'importantes disparités d'adhésion aux comportements préventifs, en particulier pour ce qui est du port du masque, en juin ; les femmes, les aînés, les immigrants, les citadins et les adultes très scolarisés sont sensiblement plus enclins à adhérer aux comportements préventifs que les hommes, les plus jeunes, les Canadiens de naissance, les résidents des régions rurales et les adultes peu scolarisés. En juillet 2020, ces disparités persistent ou s'atténuent légèrement ; les femmes, toutefois, affichent uniformément une plus grande adhésion à tous les comportements préventifs aux deux moments. Ces observations ont d'importantes conséquences pour la politique et les interventions potentielles en santé publique.

US State Policies, Politics, and Life Expectancy.

Policy Points Changes in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy. Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment. US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high-income countries. CONTEXT: Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well-being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in US life expectancy. METHODS: We merged annual data on life expectancy for US states from 1970 to 2014 with annual data on 18 state-level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014. FINDINGS: Results show that changes in life expectancy during 1970-2014 were associated with changes in state policies on a conservative-liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies. CONCLUSIONS: Understanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans' health and longevity.

Educational Disparities in Adult Mortality Across U.S. States: How Do They Differ, and Have They Changed Since the Mid-1980s?

Adult mortality varies greatly by educational attainment. Explanations have focused on actions and choices made by individuals, neglecting contextual factors such as economic and policy environments. This study takes an important step toward explaining educational disparities in U.S. adult mortality and their growth since the mid-1980s by examining them across U.S. states. We analyzed data on adults aged 45-89 in the 1985-2011 National Health Interview Survey Linked Mortality File (721,448 adults; 225,592 deaths). We compared educational disparities in mortality in the early twenty-first century (1999-2011) with those of the late twentieth century (1985-1998) for 36 large-sample states, accounting for demographic covariates and birth state. We found that disparities vary considerably by state: in the early twenty-first century, the greater risk of death associated with lacking a high school credential, compared with having completed at least one year of college, ranged from 40 % in Arizona to 104 % in Maryland. The size of the disparities varies across states primarily because mortality associated with low education varies. Between the two periods, higher-educated adult mortality declined to similar levels across most states, but lower-educated adult mortality decreased, increased, or changed little, depending on the state. Consequently, educational disparities in mortality grew over time in many, but not all, states, with growth most common in the South and Midwest. The findings provide new insights into the troubling trends and disparities in U.S. adult mortality.

The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach.

Adults with higher educational attainment live healthier and longer lives compared with their less educated peers. The disparities are large and widening. We posit that understanding the educational and macrolevel contexts in which this association occurs is key to reducing health disparities and improving population health. In this article, we briefly review and critically assess the current state of research on the relationship between education and health in the United States. We then outline three directions for further research: We extend the conceptualization of education beyond attainment and demonstrate the centrality of the schooling process to health; we highlight the dual role of education as a driver of opportunity but also as a reproducer of inequality; and we explain the central role of specific historical sociopolitical contexts in which the education-health association is embedded. Findings from this research agenda can inform policies and effective interventions to reduce health disparities and improve health for all Americans.

Disparities in Disability by Educational Attainment Across US States.

OBJECTIVES: To examine how disparities in adult disability by educational attainment vary across US states. METHODS: We used the nationally representative data of more than 6 million adults aged 45 to 89 years in the 2010-2014 American Community Survey. We defined disability as difficulty with activities of daily living. We categorized education as low (less than high school), mid (high school or some college), or high (bachelor's or higher). We estimated age-standardized disability prevalence by educational attainment and state. We assessed whether the variation in disability across states occurs primarily among low-educated adults and whether it reflects the socioeconomic resources of low-educated adults and their surrounding contexts. RESULTS: Disparities in disability by education vary markedly across states-from a 20 percentage point disparity in Massachusetts to a 12-point disparity in Wyoming. Disparities vary across states mainly because the prevalence of disability among low-educated adults varies across states. Personal and contextual socioeconomic resources of low-educated adults account for 29% of the variation. CONCLUSIONS: Efforts to reduce disparities in disability by education should consider state and local strategies that reduce poverty among low-educated adults and their surrounding contexts.

Employment and income losses among cancer survivors: Estimates from a national longitudinal survey of American families.

BACKGROUND: Cancer presents a substantial hardship for patients and their families in multiple domains beyond health and survival. Relatively little is known about the economic impact of cancer. The authors present estimates of the aggregate effects of a cancer diagnosis on employment and income in a prospective, nationally representative sample of US adults. METHODS: The authors used data from the 1990 through 2009 waves of the Panel Study of Income Dynamics, a nationally representative, prospective, population-based observational study with high-quality individual and family-level economic information. Age-adjusted, sex-stratified, individual fixed-effects regression models were used to derive estimates of the impact of cancer on employment, hours worked, individual income, and total family income. RESULTS: Significant effects of cancer on all 4 outcomes were observed. The probability of a cancer patient being employed dropped by almost 10 percentage points, and hours worked declined by up to 200 hours in the first year after diagnosis. Annual labor-market earnings dropped almost 40% within 2 years after diagnosis and remained low, whereas total family income declined by 20%, although it recovered within 4 years after the diagnosis. These economic impacts on survivors were driven by effects among men; the effects among women largely were not statistically significant. CONCLUSIONS: A cancer diagnosis has substantial effects on the economic well-being of affected adults and their families. With the increasing number of cancer survivors in the US population, there is a growing need for examining the long-term implications for economic well-being and ways to mitigate the economic hardship associated with cancer.

Accuracy of Telehealth-Administered Measures to Screen Language in Spanish-Speaking Preschoolers.

INTRODUCTION: There is a critical need for telehealth language screening measures for use with Spanish-speaking children because of the shortage of bilingual providers and the current lack of psychometrically sound measures that can be administered via telehealth. The purpose of the current study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking preschoolers from rural and underserved areas of the country. MATERIALS AND METHODS: This study applied a hybrid telehealth approach that implemented synchronous videoconferencing, videocasting, and traditional pen and paper measures. Screening measures included a processing efficiency measure (Spanish nonword repetition [NWR]), language sampling, and a developmental language questionnaire. Eighty-two mostly Spanish-speaking preschool-age children and their parents participated. Thirty-four children had language impairment (LI), and 48 had typical language development. RESULTS: Although many of the individual measures were significantly associated with standardized language scores (r=0.27-0.55), not one of the measures had classification values of 0.8 or higher, which is recommended when screening for LI. However, when NWR scores were combined with language sample or parent survey measures, promising classification accuracy values that approached or were higher than 0.8 were obtained. CONCLUSIONS: This research provides preliminary evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. A processing efficiency measure, NWR, combined with a parent survey or language sample measure can provide informative and accurate diagnostic information when screening Spanish-speaking preschool-age children for LI.

Does Pain Explain Trends in Disability? An Analysis of Middle-Aged and Older U.S. Adults, 2002-2018.

OBJECTIVES: This article investigates the role of pain in disability trends in the United States, within the context of recent unfavorable disability trends and the concurrent rise in pain. METHODS: We conducted a 2-part analysis using National Health Interview Survey data from 2002 to 2018 for U.S. adults aged 45-84. First, we assessed how changes in the prevalence of 5 site-specific types of pain (headaches/migraines, joint, low back, neck, and facial/jaw pain) associated with disability trends. Second, we used self-reported causes of disability and examined whether there has been a change in the proportion of individuals who attribute their disability to 1 of 5 chronic or acute painful conditions. RESULTS: The 5 site-specific types of pain, individually and collectively, were significantly associated with increases in disability. If site-specific chronic pain had not increased during the study period, the trend for functional limitations would have been 40% lower, and that for activity limitations would have shown a slight decline instead of an increase. Attributions of functional limitations to painful conditions increased by 23% during the 2002-2018 period, representing an additional 9.82 million Americans experiencing pain-attributable disability. Arthritis/rheumatism, back/neck problems, and other musculoskeletal/connective conditions were the primary sources of pain-related disability. DISCUSSION: Our research provides the first systematic, national examination of how pain is contributing to disability trends in the United States. The findings have implications for disability reduction policies and shed light on the far-reaching consequences of pain for overall population health.

Pain Lowers Subjective Survival Probabilities Among Middle-Aged and Older Adults.

OBJECTIVES: Pain is a leading cause of disability and a limiting factor in individuals' assessments of their own subjective health; however, its association with subjective longevity has yet to be explored. Subjective survival probabilities (SSPs), or one's own perceived chances of living to a given age, can influence individuals' behavior as they plan for their futures. This study assesses whether pain correlates to lower SSPs. METHODS: We use a repeated cross-section of the 2000-2018 waves of the Health and Retirement Study, a longitudinal and nationally representative survey of Americans aged 51 and older (N = 31,773). RESULTS: Fractional logit regressions indicate that, across all age groups, respondents with severe and/or interfering pain reported significantly lower SSPs than those with no pain (Marginal Effect [ME] = -0.03 to -0.06, p < .05). Controlling for all covariates, mild or moderate noninterfering pain was only associated with a significant reduction in SSPs among the youngest group reporting their chances of living to age 75 (ME = -0.02, p < .001). Descriptively and in the model results, respondents with mild or moderate noninterfering pain appeared to more closely resemble pain-free respondents than those with severe or interfering pain. DISCUSSION: These findings highlight the importance of pain on SSPs, and contribute to the growing evidence that pain interference is uniquely important in predicting meaningful health outcomes.

The geography of arthritis-attributable pain outcomes: a county-level spatial analysis.

ABSTRACT: Research on the geographic distribution of pain and arthritis outcomes, especially at the county level, is limited. This is a high-priority topic, however, given the heterogeneity of subnational and substate regions and the importance of county-level governments in shaping population health. Our study provides the most fine-grained picture to date of the geography of pain in the United States. Combining 2011 Behavioral Risk Factor Surveillance System data with county-level data from the Census and other sources, we examined arthritis and arthritis-attributable joint pain, severe joint pain, and activity limitations in US counties. We used small area estimation to estimate county-level prevalences and spatial analyses to visualize and model these outcomes. Models considering spatial structures show superiority over nonspatial models. Counties with higher prevalences of arthritis and arthritis-related outcomes are mostly clustered in the Deep South and Appalachia, while severe consequences of arthritis are particularly common in counties in the Southwest, Pacific Northwest, Georgia, Florida, and Maine. Net of arthritis, county-level percentages of racial/ethnic minority groups are negatively associated with joint pain prevalence, but positively associated with severe joint pain prevalence. Severe joint pain is also more common in counties with more female individuals, separated or divorced residents, more high school noncompleters, fewer chiropractors, and higher opioid prescribing rates. Activity limitations are more common in counties with higher percentages of uninsured people. Our findings show that different spatial processes shape the distribution of different arthritis-related pain outcomes, which may inform local policies and programs to reduce the risk of arthritis and its consequences.

Is the relationship between chronic pain and mortality causal? A propensity score analysis.

ABSTRACT: Chronic pain is a serious and prevalent condition that can affect many facets of life. However, uncertainty remains regarding the strength of the association between chronic pain and death and whether the association is causal. We investigate the pain-mortality relationship using data from 19,971 participants aged 51+ years in the 1998 wave of the U.S. Health and Retirement Study. Propensity score matching and inverse probability weighting are combined with Cox proportional hazards models to investigate whether exposure to chronic pain (moderate or severe) has a causal effect on mortality over a 20-year follow-up period. Hazard ratios (HRs) with 95% confidence intervals (CIs) are reported. Before adjusting for confounding, we find a strong association between chronic pain and mortality (HR: 1.32, 95% CI: 1.26-1.38). After adjusting for confounding by sociodemographic and health variables using a range of propensity score methods, the estimated increase in mortality hazard caused by pain is more modest (5%-9%) and the results are often also compatible with no causal effect (95% CIs for HRs narrowly contain 1.0). This attenuation highlights the role of confounders of the pain-mortality relationship as potentially modifiable upstream risk factors for mortality. Posing the depressive symptoms variable as a mediator rather than a confounder of the pain-mortality relationship resulted in stronger evidence of a modest causal effect of pain on mortality (eg, HR: 1.08, 95% CI: 1.01-1.15). Future work is required to model exposure-confounder feedback loops and investigate the potentially cumulative causal effect of chronic pain at multiple time points on mortality.

Trends in mortality risk by education level and cause of death among US White women from 1986 to 2006.

OBJECTIVES: To elucidate why the inverse association between education level and mortality risk (the gradient) has increased markedly among White women since the mid-1980s, we identified causes of death for which the gradient increased. METHODS: We used data from the 1986 to 2006 National Health Interview Survey Linked Mortality File on non-Hispanic White women aged 45 to 84 years (n = 230 692). We examined trends in the gradient by cause of death across 4 time periods and 4 education levels using age-standardized death rates. RESULTS: During 1986 to 2002, the growing gradient for all-cause mortality reflected increasing mortality among low-educated women and declining mortality among college-educated women; during 2003 to 2006 it mainly reflected declining mortality among college-educated women. The gradient increased for heart disease, lung cancer, chronic lower respiratory disease, cerebrovascular disease, diabetes, and Alzheimer's disease. Lung cancer and chronic lower respiratory disease explained 47% of the overall increase. CONCLUSIONS: Mortality disparities among White women widened across 1986 to 2006 partially because of causes of death for which smoking is a major risk factor. A comprehensive policy framework should address the social conditions that influence smoking among disadvantaged women.

Pain and Disability Transitions Among Older Americans: The Role of Education.

Previous literature has rarely examined the role of pain in the process of disablement. We investigate how pain associates with disability transitions among older adults, using educational attainment as a moderator. Data are from the National Health and Aging Trends Study, N = 6,357; 33,201 1 year transitions between 2010 to 2020. We estimate multinomial logistic models predicting incidence or onset of and recovery from functional limitation and disability. Results show pain significantly predicts functional limitation and disability onset 1 year after a baseline observation, and decreases odds of recovery from functional limitation or disability. Contrary to expectations, higher education does not buffer the association of pain in onset of disability, but supporting expectations, it facilitates recovery from functional limitation or disability among those with pain. The analysis implicates pain as having a key role in the disablement process and suggests that education may moderate this with respect to coping with and subsequently recovering from disability. PERSPECTIVE: This article is among the first examining how pain is placed in the disablement process by affecting onset of and recovery from disability. Both paths are affected by pain, but education moderates the association only with respect to the recovery process.

Educational Differences in Life Expectancies With and Without Pain.

OBJECTIVES: This study computes years and proportion of life that older adults living in the United States can expect to live pain-free and in different pain states, by age, sex, and level of education. The analysis addresses challenges related to dynamics and mortality selection when studying associations between education and pain in older populations. METHODS: Data are from National Health and Aging Trends Study, 2011-2020. The sample contains 10,180 respondents who are age 65 and older. Pain expectancy estimates are computed using the Interpolated Markov Chain software that applies probability transitions to multistate life tables. RESULTS: Those with higher educational levels expect not only a longer life but also a higher proportion of life without pain. For example, a 65-year-old female with less than high school education expects 18.1 years in total and 5.8 years, or 32% of life, without pain compared with 23.7 years in total with 10.7 years, or 45% of life without pain if she completed college. The education gradient in pain expectancies is more salient for females than males and narrows at the oldest ages. There is no educational disparity in the percent of life with nonlimiting pain. DISCUSSION: Education promotes longer life and more pain-free years, but the specific degree of improvement by education varies across demographic groups. More research is needed to explain associations between education and more and less severe and limiting aspects of pain.

Comparing trends in mid-life 'deaths of despair' in the USA, Canada and UK, 2001-2019: is the USA an anomaly?

OBJECTIVES: In recent years, 'deaths of despair' due to drugs, alcohol and suicide have contributed to rising mid-life mortality in the USA. We examine whether despair-related deaths and mid-life mortality trends are also changing in peer countries, the UK and Canada. DESIGN: Descriptive analysis of population mortality rates. SETTING: The USA, UK (and constituent nations England and Wales, Northern Ireland and Scotland) and Canada, 2001-2019. PARTICIPANTS: Full population aged 35-64 years. OUTCOME MEASURES: We compared all-cause and 'despair'-related mortality trends at mid-life across countries using publicly available mortality data, stratified by three age groups (35-44, 45-54 and 55-64 years) and by sex. We examined trends in all-cause mortality and mortality by causes categorised as (1) suicides, (2) alcohol-specific deaths and (3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period and cohort trends in these causes of death. RESULTS: The USA and Scotland both saw large relative increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in comparison. Alcohol-specific deaths showed less consistent trends that did not track other 'despair' causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries. CONCLUSIONS: In the UK, Scotland has suffered increases in drug-related mortality comparable with the USA, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortalities generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive 'deaths of despair' narrative.

Chronic pain among U.S. sexual minority adults who identify as gay, lesbian, bisexual, or "something else".

ABSTRACT: This study assesses chronic pain prevalence among sexual minority U.S. adults who self-identify as gay/lesbian, bisexual, or "something else," and examines the role of select covariates in the observed patterns. Analyses are based on 2013 to 2018 waves of the National Health Interview Survey, a leading cross-sectional survey representative of the U.S. population. General chronic pain and chronic pain in 3+ sites among adults aged 18 to 64 years (N = 134,266 and 95,675, respectively) are analyzed using robust Poisson regression and nonlinear decomposition; covariates include demographic, socioeconomic, healthcare, and psychological distress measures. We find large disparities for both pain outcomes. Americans who self-identify as bisexual or "something else" have the highest general chronic pain prevalence (23.7% and 27.0%, respectively), compared with 21.7% among gay/lesbian and 17.2% straight adults. For pain in 3+ sites, disparities are even larger: Age-adjusted prevalence is over twice as high among adults who self-identify as bisexual or "something else" and 50% higher among gay/lesbian, compared with straight adults. Psychological distress is the most salient correlate of the disparities, whereas socioeconomic status and healthcare variables explain only a modest proportion. Findings thus indicate that even in an era of meaningful social and political advances, sexual minority American adults have significantly more chronic pain than their straight counterparts. We call for data collection efforts to include information on perceived discrimination, prejudice, and stigma as potential key upstream factors that drive pain disparities among members of these minoritized groups.