Perceived discrimination in healthcare settings associated with pain severity
Purpose
Pain severity varies by age, sex, race, income, and discrimination, with marginalized groups experiencing higher severity due to systemic inequalities. This study analyzes data from 109,102 participants to assess the combined effects of age, race, income, and discrimination on mild, moderate, and severe pain outcomes
Background and significance
Pain is a significant public health issue that affects individuals differently across various demographic and socioeconomic factors, including age, sex, race, income, and experiences of discrimination. Understanding these disparities is essential for developing equitable healthcare policies and targeted clinical interventions. Prior research highlights that marginalized groups, particularly racial and ethnic minorities, often experience higher pain severity, which may be exacerbated by systemic discrimination and socioeconomic inequalities. However, research focusing on the combined effects of these factors remains limited.
Theoretical/Conceptual framework
The intersectionality framework (Crenshaw, 1989) explains how overlapping social identities such as race, gender, income, and age, create compounded disadvantages. In this study, the interaction between race, income, and discrimination was tested to identify unique vulnerabilities, worsening pain severity outcomes for marginalized groups through intersecting systemic inequalities.
Method
A multinomial logistic regression analysis was conducted to examine the associations between age, sex, race, income, and discrimination with pain severity (mild, moderate, severe) to estimate coefficients (β) for each predictor, with statistical significance set at p<.05. The sample included 109,102 participants from the All of US dataset
Results
Age was positively associated with pain severity: individuals aged 45-54 (β=1.322) and 55-64 (β=1.326) were significantly more likely to report moderate pain, while older groups reported elevated severe pain (β≈2.0,p<.001). Females were more likely to report moderate (β=0.297) and severe pain (β=0.330). Race effects showed that Blacks and Hispanics had higher moderate (β=0.168,0.131) and severe pain (β=0.535,0.508). Higher income significantly reduced pain severity, while discrimination consistently amplified moderate and severe pain, with strongest effects at higher discrimination levels (β>1.2,p<.001). Findings highlight disparities and the compounding role of discrimination in pain outcomes.
Conclusions
To address pain disparities, policies must target systemic discrimination, socioeconomic inequalities, and healthcare access. Anti-bias training, affordable care, age-sensitive geriatric programs, and gender-specific interventions are essential. Equity-focused metrics and longitudinal studies will monitor progress, particularly for marginalized and low-income groups, improving health outcomes and pain management.
Perceived discrimination in healthcare settings associated with pain severity
