Differences in Pain Among U.S. Subpopulations Based on Race and Hispanic Ancestry

A new analysis of data from the National Health Interview Survey (NHIS) found that pain in U.S. adult Hispanics varies across Hispanic subpopulations. Although many Hispanic subpopulations exhibited lower prevalence of pain than White non-Hispanics, the pain prevalence for other Hispanic subpopulations was equivalent to or greater than that for White non-Hispanics. This analysis was conducted by the National Center for Complementary and Integrative Health (NCCIH) and was recently published in The Journal of Pain.

Data for this analysis came from 144,434 adults who completed questionnaires in the 2010–2017 NHIS—a nationally representative, annual survey in which Americans are interviewed about their health- and illness-related experiences. The questionnaires asked about pain status within the past 3 or 6 months, and the analysis used the following three pain measures:

• Category 3–4 pain: The two most severe pain categories on a 0 to 4 pain scale in which 0 is no pain and 4 is chronic, very severe pain.
• Chronic pain: Defined as pain on most days or every day in the past 6 months.
• High-impact chronic pain: Defined as chronic pain that limited life or work activities on most days or every day during the past 6 months.

Examining the pain status in groups based on both race and Hispanic ancestry showed relationships that have not been seen before in analyses of similar surveys. Findings from the analysis include:

• Among Hispanic participants, there was little variation in pain prevalence by race (e.g., no difference between individuals of Mexican ancestry who identified themselves as White or Black); however, there were large variations across ancestry subpopulations.
• Participants of Puerto Rican ancestry reported more chronic, severe, and debilitating pain than other groups.
• Compared to White Puerto Rican participants, White participants with Central/South American or Mexican ancestry were less likely to report Category 3–4 pain and high-impact chronic pain, and those of Cuban ancestry were less likely to report high-impact chronic pain. For example, White participants with Mexican ancestry were 32 percent less likely to report Category 3–4 pain and 50 percent less likely to report high-impact chronic pain than White Puerto Rican participants.
• Although no differences were seen between White Puerto Rican and White non-Hispanic participants for Category 3–4 pain, White non-Hispanic participants were 40 percent less likely to report high-impact chronic pain.
• Asian non-Hispanic and Black non-Hispanic participants were significantly less likely to report Category 3–4 pain and high-impact chronic pain than White Puerto Rican participants. For instance, Black non-Hispanic participants were 26 percent less likely to report Category 3–4 pain and 42 percent less likely to report high-impact chronic pain than White Puerto Rican participants.
• A large range in prevalence was seen for each of the three pain measures. The highest pain prevalence (seen in Black Puerto Ricans for Category 3–4 pain and in American Indian/Alaska Native non-Hispanics for chronic pain and high-impact chronic pain) was at least three times the lowest pain prevalence (seen in Asian non-Hispanics for all three pain measures).

The author noted that the data add to a growing literature documenting large differences in health status among Hispanic subpopulations and provide a basis for further epidemiologic research on pain. Research is needed on Hispanic cultural values that might modify pain reports, as well as on whether Hispanic subpopulations with severe, chronic, and/or debilitating pain are receiving appropriate pain management.