Low socio-economic status associated with high incidence of severe pain
MedWire News: Low socio-economic status is associated with an increased likelihood of self-reported pain, report UK researchers.
Over 40% of working-age individuals reporting severe pain are unable to work and are in receipt of state benefits.
"Apart from the direct impact upon the individual, this clearly has wider societal implications in terms of additional health and social care costs for affected people," say Craig Currie (Cardiff University, UK) and colleagues.
The findings are in line with a number of studies showing a direct relationship between increasing deprivation and a range of health conditions including cardiovascular disease, mental illness, arthritis, diabetes, respiratory illness, and many cancers.
Using data from the Health Survey for England (HSE) 2005, the researchers determined the association of severe pain with socio-economic characteristics in 9419 individuals. Pain was assessed using the EQ-5D and socio-economic status was classified by ability to work, social security benefits, the National Statistics Socioeconomic Classification (NS-SEC), and the Index of Multiple Deprivation (IMD).
Of the included individuals, 61.7% reported no pain, 33.7% reported moderate pain, and 4.6% reported severe pain. Compared with individuals experiencing no pain or moderate pain, those with severe pain were significantly older (aged 64.4 years vs 49.7 and 62.9 years) and reported a higher prevalence of morbidity (4.4-90.5% vs 2.3-54.6% and 0.5-12.0%).
Of the individuals with severe pain who were of working age, 43.6% reported being unable to work due to sickness or disability, with 41.0% claiming state benefits.
When the researchers assessed the level of socio-economic deprivation and how it affected pain status, they found that 7.6% of individuals living in areas within the highest quintile of deprivation reported severe pain compared with 3.0% of those living in the most affluent areas.
After adjusting for age, gender, and morbidity, the odds for severe pain were 1.65-fold higher for those living in the most versus the least deprived areas.
Similarly, a significantly greater proportion of individuals in the lowest household income quintile (annual income of £ 10,656 [US$ 16,388; € 13,229] or less) reported severe pain compared with those in the highest quintile (annual income of more than £ 39,436 [US$ 60,648; € 48,957]), at 7.0% versus 1.1% (odds ratio=2.58).
The researchers also found a clear increasing trend for severe pain according to occupation as measured by the NS-SEC, ranging from 1.4% of Class 1 (higher managerial and professional occupations) to 7.6% in Class 7 (routine occupations). For those in Class 8 (never worked and long-term unemployed) the proportion further increased to 9.8%.
"Regardless of the issues concerning the direction of causality, this study highlights the impact that severe pain may have," write the researchers in the European Journal of Pain.
By Ingrid Grasmo