Development of chronic pain and high-impact chronic pain across the US rural–urban continuum, 2019–2020

Purpose

Rural health disadvantages are well documented in previous literature; however, research on rural–urban disparities in chronic pain outcomes is scarce. This paper fills this gap by examining pain prevalences and longitudinal transitions across the rural–urban continuum (i.e., large central metro, large fringe metro, medium and small metro, and nonmetropolitan).

Methods

Based on the 2019–2020 National Health Interview Survey Longitudinal Cohort (NHIS-LC) data, we examined the disparities in pain prevalences and transitions among different pain statuses, including no pain, nonchronic pain, chronic pain, and high-impact chronic pain (HICP), across the rural–urban continuum and by age, sex, race/ethnicity, and region. A test for linear trend was conducted to examine the significance of linear changes across the rural–urban continuum.

Findings

The findings reveal significant linear increases in the prevalence of chronic pain and HICP, as well as transitions from no pain to nonchronic pain and from nonchronic pain to more severe pain conditions, along the continuum from metropolitan to nonmetropolitan areas. Subgroup analyses indicate that rural–urban gaps are most pronounced among middle-aged (45–64) groups and non-Hispanic Whites.

Conclusions

This longitudinal analysis provides new evidence on rural–urban health disparities by focusing on pain, highlighting the urgent need to enhance health care services in remote and rural areas for effective pain prevention and management.