Embodied inequities: an intersectional examination of the roles of gender, sexual orientation, and social support in chronic pain inequities in the United States.

Abstract

Background: Chronic pain inequities follow a social power-driven gradient of health, whereby those with less social advantage experience chronic pain more often. Feeling socially supported may reduce the burden of chronic pain.

Purpose: To take an intersectional approach to understand inequities in chronic pain in the United States, by testing whether living at different intersections of sexual orientation and gender shape chronic pain through differences in experiences of social and emotional support.

Methods: We compared chronic pain frequency and availability of social support at intersections of sexual orientation and gender in the 2021 National Health Interview Study using an analytic intercategorical intersectional approach using a 3-way decomposition approach to mediation.

Results: Pairwise comparisons highlighted inequities in chronic pain among sexual minority women (i.e., women who identified as "something else," gay/lesbian, or bisexual) and bisexual men compared to all other identities (i.e., straight and questioning men and women, and men who identified as "something else"). Inequities were most salient for bisexual men and women, especially bisexual women. A theoretical intervention to increase available social support to that of straight women, who reported the greatest availability of social support, would decrease chronic pain frequency for all sexual minority people except for gay/lesbian women. Inequities, while attenuated, would persist among bisexual men and women after a theoretical intervention.

Conclusions: Social position shapes chronic pain inequities in sexual minority people in the United States through differences in available social and emotional support. Results highlight bisexual men as an understudied group in chronic pain research.