Rural-urban disparities in the prevalence of chronic pain in adults: Associations with demographic and socioeconomic characteristics

Purpose

To explore rural-urban differences in chronic pain prevalence among adults in the United States.

Methods

This cross-sectional study analyzed pooled data from the 2019-2021 and 2023 National Health Interview Survey. We used chi-square tests and logistic regression to determine how rurality of residence was associated with chronic pain prevalence among adults aged 18 and older before and after adjustment for demographic and socioeconomic variables. STROBE reporting guidelines were applied.

Findings

Unadjusted prevalence of chronic pain was 29% for rural adults and 21% for their urban counterparts (P <.0001). After control for covariates, rural-urban differences decreased but remained statistically significant. Adjusted odds of chronic pain were 9% higher in rural than in urban populations (P <.01). Adjusted chronic pain prevalence was 23% for rural and 22% for urban adults (P <.01). Multivariable analyses suggested that rural-urban prevalence differences were related to risk factors that were more common in rural populations, including older age, current or past married status, lower income, lower education levels, and non-Hispanic White race and ethnicity.

Conclusions

The substantial rural-urban disparity in chronic pain prevalence is partly associated with demographic and socioeconomic risk factors correlated with rurality. Persisting rural-urban differences in adjusted chronic pain prevalence may also be correlated with barriers limiting rural residents’ access to guideline-concordant pain management. Innovations in delivery systems and payment policies may help to reduce these barriers.