Welfare policies, joint pain prevalence and educational gaps in 50 U.S. states from 2011 to 2021: A fixed effects analysis

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Pain Pub Date : 2025-09-02 DOI:10.1016/j.jpain.2025.105539

Rui Huang , Yuhang Li , Feinuo Sun

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Abstract

Research on geographic disparities in pain and arthritis-related outcomes is still in its infancy, with little attention to the developing trends over time and the role of state welfare policies in shaping pain disparities. This study examines 1) spatiotemporal trends of moderate/severe arthritis-related joint pain prevalence across 50 U.S. states, 2) educational disparities therein, and 3) the impact of welfare policies— i.e., Supplemental Nutrition Assistance Program, Earned Income Tax Credit, minimum wage, unemployment insurance, and Medicaid generosity. This study compiles 6-wave biennial state-level panel data using data from the Behavioral Risk Factor Surveillance System (BRFSS). Logistic regressions are conducted to estimate trends of joint pain prevalence, prevalence for different educational groups (i.e., less than high school, high school or some college, bachelor’s degree or above), and educational disparities. Incorporating policy data from the State Policy & Politics Database (SPPD) and the Kaiser Family Foundation’s database (KFF), fixed effects regressions were used, with state- and year-fixed effects, to assess the impact of welfare policies. Results show that joint pain prevalence has risen in most states, with educational disparities in pain widening in over half, though both trends vary substantially across states. Colorado and North Dakota exhibit considerably sharper increases in both pain prevalence and educational inequalities. Generous Medicaid programs are associated with decreased joint pain prevalence for general population and the least-educated, and marginally linked to smaller educational inequalities therein. This study underscores the importance of state welfare policies in addressing pain disparities and calls for targeted interventions to support less-educated populations.

Perspectives

This article uses state-level panel data on arthritis-related pain and welfare policies to underscore the importance of studying macro-level policy determinants of pain and associated disparities.

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福利政策、关节疼痛患病率和教育差距：2011 - 2021年美国50个州的固定效应分析

关于疼痛和关节炎相关结果的地理差异的研究仍处于起步阶段，很少关注随着时间的推移发展趋势以及国家福利政策在形成疼痛差异中的作用。本研究考察了1)美国50个州中/重度关节炎相关关节疼痛患病率的时空趋势，2)其中的教育差异，以及3)福利政策的影响，即补充营养援助计划，劳动收入信贷，最低工资，失业保险和医疗补助慷慨。本研究利用行为风险因素监测系统（BRFSS）的数据汇编了两年一次的6波国家级面板数据。通过Logistic回归来估计关节疼痛患病率的趋势、不同教育群体（即高中以下、高中或某些大学、学士学位或以上）的患病率以及教育差异。结合来自州政策与政治数据库（SPPD）和凯撒家庭基金会数据库（KFF）的政策数据，使用固定效应回归，并结合州和年度固定效应，来评估福利政策的影响。结果显示，关节疼痛的患病率在大多数州都有所上升，在疼痛方面的教育差异扩大了一半以上，尽管这两种趋势在各州之间差异很大。科罗拉多州和北达科他州在疼痛患病率和教育不平等方面都表现出明显的增长。慷慨的医疗补助计划与普通人群和受教育程度最低的人群中关节疼痛患病率的降低有关，并且与其中较小的教育不平等有轻微的联系。这项研究强调了国家福利政策在解决疼痛差异方面的重要性，并呼吁采取有针对性的干预措施来支持受教育程度较低的人群。视角：本文利用国家层面的面板数据和国家福利政策数据来强调研究疼痛和相关差异的宏观政策决定因素的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pain 医学-临床神经学

CiteScore

6.30

自引率

7.50%

发文量

441

审稿时长

42 days

期刊介绍： The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.