Chronic pain prevalence and trends in urban, suburban, and rural areas amongAmerican adults aged 55+, 1998–2022

Rural-urban health disparities in the United States are large and persistent, yet most surveillance efforts focus on mortality and disability. Monitoring rural-urban trends in pain, a major but overlooked indicator of population health, remains understudied. Given changes in demographics and resources of urban, suburban, and rural areas since the turn of the 21st century, which may have altered place-based differences in pain prevalence. Using nationally representative data from the Health and Retirement Study of 35,230 adults aged 55 and older (n = 206,600 person-wave observations), we estimated pain prevalence and trends across urban, suburban, and rural areas from 1998 to 2022. We assessed variation by age, sex/gender, race and ethnicity, and census region. Over 24 years, pain prevalence increased by 70 % (Prevalence Ratio [PR] = 1.70, 95 % Confidence Interval [CI]: 1.64, 1.75) and was consistently highest in rural areas and lowest in urban areas. However, pain prevalence rose most sharply in suburbs as compared to both rural and urban areas (suburban and time interaction vs. rural areas: PR = 1.08, 95 % CI: 1.00, 1.17). Suburban pain prevalence was similar to urban levels in 1998 but converged with that of rural levels by 2022. Stratified analyses revealed broadly similar patterns across demographic and regional groups, with particularly rapid increases among suburban populations in the South. These findings highlight nationwide increases in chronic pain, with suburban areas emerging as new “hotspots” alongside rural areas. Given that pain is a leading cause of disability and functional decline, monitoring place-based trends is essential for addressing this growing public health concern.