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. 2007 Oct;99(10):1160–1169.

The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults.

Molly Fuentes 1, Tamera Hart-Johnson 1, Carmen R Green 1
PMCID: PMC2574394  PMID: 17987920

Abstract

The association among race, neighborhood socioeconomic status (SES), and chronic pain has not been well examined in older people. Clinical data was obtained from older adults (>50 years old) presenting to a tertiary care pain center. The relative roles of race and neighborhood SES on the chronic pain experienced in older black and white adults were assessed. Older blacks experienced more affective pain, pain-related disability and mood disorder symptoms than older whites. Confirmatory factor analysis confirmed previously hypothesized factors for the McGill Pain Questionnaire pain dimensions and the Pain Disability Index. Exploratory and confirmatory factor analyses also identified factors in the Brief Symptom Inventory and neighborhood SES. Structural equation modeling showed black race was associated with lower neighborhood SES and also with increased affective pain, obligatory disability and mood disorders mediationally through neighborhood SES. It was indirectly associated with increased sensory and miscellaneous pain, and voluntary disability through low neighborhood SES. Racial interaction examination showed that neighborhood SES had the same relationship to outcomes by race. We found increasing neighborhood SES is associated with decreasing negative chronic pain outcomes for older blacks and whites. Our data provide evidence that both race and neighborhood SES are important factors to consider when examining the chronic pain experience among older Americans.

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Selected References

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  1. Aggarwal V. R., Macfarlane T. V., Macfarlane G. J. Why is pain more common amongst people living in areas of low socio-economic status? A population-based cross-sectional study. Br Dent J. 2003 Apr 12;194(7):383–380. doi: 10.1038/sj.bdj.4810004. [DOI] [PubMed] [Google Scholar]
  2. Andersson H. I., Ejlertsson G., Leden I., Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993 Sep;9(3):174–182. doi: 10.1097/00002508-199309000-00004. [DOI] [PubMed] [Google Scholar]
  3. Antonucci Toni C., Ajrouch Kristine J., Janevic Mary R. The effect of social relations with children on the education-health link in men and women aged 40 and over. Soc Sci Med. 2003 Mar;56(5):949–960. doi: 10.1016/s0277-9536(02)00099-0. [DOI] [PubMed] [Google Scholar]
  4. Baker David W., Cameron Kenzie A., Feinglass Joseph, Georgas Patricia, Foster Shawn, Pierce Deborah, Thompson Jason A., Hasnain-Wynia Romana. Patients' attitudes toward health care providers collecting information about their race and ethnicity. J Gen Intern Med. 2005 Oct;20(10):895–900. doi: 10.1111/j.1525-1497.2005.0195.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Baron R. M., Kenny D. A. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986 Dec;51(6):1173–1182. doi: 10.1037//0022-3514.51.6.1173. [DOI] [PubMed] [Google Scholar]
  6. Bird Joanne. Selection of pain measurement tools. Nurs Stand. 2003 Dec 10;18(13):33–39. doi: 10.7748/ns2003.12.18.13.33.c3515. [DOI] [PubMed] [Google Scholar]
  7. Cassisi Jeffrey E., Umeda Masataka, Deisinger Julie A., Sheffer Christine, Lofland Kenneth R., Jackson Cheryl. Patterns of pain descriptor usage in African Americans and European Americans with chronic pain. Cultur Divers Ethnic Minor Psychol. 2004 Feb;10(1):81–89. doi: 10.1037/1099-9809.10.1.81. [DOI] [PubMed] [Google Scholar]
  8. Chen Ying-Yeh, Kawachi Ichiro, Subramanian S. V., Acevedo-Garcia Dolores, Lee Yue-Joe. Can social factors explain sex differences in insomnia? Findings from a national survey in Taiwan. J Epidemiol Community Health. 2005 Jun;59(6):488–494. doi: 10.1136/jech.2004.020511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cherkas L. F., Aviv A., Valdes A. M., Hunkin J. L., Gardner J. P., Surdulescu G. L., Kimura M., Spector T. D. The effects of social status on biological aging as measured by white-blood-cell telomere length. Aging Cell. 2006 Oct;5(5):361–365. doi: 10.1111/j.1474-9726.2006.00222.x. [DOI] [PubMed] [Google Scholar]
  10. Cooper R. S., Kennelly J. F., Durazo-Arvizu R., Oh H. J., Kaplan G., Lynch J. Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas. Public Health Rep. 2001 Sep-Oct;116(5):464–473. doi: 10.1093/phr/116.5.464. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Diez Roux A. V., Merkin S. S., Arnett D., Chambless L., Massing M., Nieto F. J., Sorlie P., Szklo M., Tyroler H. A., Watson R. L. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001 Jul 12;345(2):99–106. doi: 10.1056/NEJM200107123450205. [DOI] [PubMed] [Google Scholar]
  12. Edwards R. R., Doleys D. M., Fillingim R. B., Lowery D. Ethnic differences in pain tolerance: clinical implications in a chronic pain population. Psychosom Med. 2001 Mar-Apr;63(2):316–323. doi: 10.1097/00006842-200103000-00018. [DOI] [PubMed] [Google Scholar]
  13. Edwards Robert R., Moric Mario, Husfeldt Brenda, Buvanendran Asokumar, Ivankovich Olga. Ethnic similarities and differences in the chronic pain experience: a comparison of african american, Hispanic, and white patients. Pain Med. 2005 Jan-Feb;6(1):88–98. doi: 10.1111/j.1526-4637.2005.05007.x. [DOI] [PubMed] [Google Scholar]
  14. Epel Elissa S., Lin Jue, Wilhelm Frank H., Wolkowitz Owen M., Cawthon Richard, Adler Nancy E., Dolbier Christyn, Mendes Wendy B., Blackburn Elizabeth H. Cell aging in relation to stress arousal and cardiovascular disease risk factors. Psychoneuroendocrinology. 2005 Nov 17;31(3):277–287. doi: 10.1016/j.psyneuen.2005.08.011. [DOI] [PubMed] [Google Scholar]
  15. Farmer Melissa M., Ferraro Kenneth F. Are racial disparities in health conditional on socioeconomic status? Soc Sci Med. 2005 Jan;60(1):191–204. doi: 10.1016/j.socscimed.2004.04.026. [DOI] [PubMed] [Google Scholar]
  16. Geisser M. E., Roth R. S., Theisen M. E., Robinson M. E., Riley J. L., 3rd Negative affect, self-report of depressive symptoms, and clinical depression: relation to the experience of chronic pain. Clin J Pain. 2000 Jun;16(2):110–120. doi: 10.1097/00002508-200006000-00004. [DOI] [PubMed] [Google Scholar]
  17. Gerstle D. S., All A. C., Wallace D. C. Quality of life and chronic nonmalignant pain. Pain Manag Nurs. 2001 Sep;2(3):98–109. doi: 10.1053/jpmn.2001.24716. [DOI] [PubMed] [Google Scholar]
  18. Green Carmen R., Ndao-Brumblay S. Khady, Nagrant Andrew M., Baker Tamara A., Rothman Edward. Race, age, and gender influences among clusters of African American and white patients with chronic pain. J Pain. 2004 Apr;5(3):171–182. doi: 10.1016/j.jpain.2004.02.227. [DOI] [PubMed] [Google Scholar]
  19. Green Carmen R., Ndao-Brumblay S. Khady, West Brady, Washington Tamika. Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan. J Pain. 2005 Oct;6(10):689–699. doi: 10.1016/j.jpain.2005.06.002. [DOI] [PubMed] [Google Scholar]
  20. Green Carmen Reneé, Baker Tamara A., Smith Edna M., Sato Yuka. The effect of race in older adults presenting for chronic pain management: a comparative study of black and white Americans. J Pain. 2003 Mar;4(2):82–90. doi: 10.1054/jpai.2003.8. [DOI] [PubMed] [Google Scholar]
  21. Henderson Claire, Diez Roux Ana V., Jacobs David R., Jr, Kiefe Catarina I., West Delia, Williams David R. Neighbourhood characteristics, individual level socioeconomic factors, and depressive symptoms in young adults: the CARDIA study. J Epidemiol Community Health. 2005 Apr;59(4):322–328. doi: 10.1136/jech.2003.018846. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kawachi Ichiro, Daniels Norman, Robinson Dean E. Health disparities by race and class: why both matter. Health Aff (Millwood) 2005 Mar-Apr;24(2):343–352. doi: 10.1377/hlthaff.24.2.343. [DOI] [PubMed] [Google Scholar]
  23. Kelley-Moore Jessica A., Ferraro Kenneth F. The black/white disability gap: persistent inequality in later life? J Gerontol B Psychol Sci Soc Sci. 2004 Jan;59(1):S34–S43. doi: 10.1093/geronb/59.1.s34. [DOI] [PubMed] [Google Scholar]
  24. Kerns R. D., Turk D. C., Rudy T. E. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain. 1985 Dec;23(4):345–356. doi: 10.1016/0304-3959(85)90004-1. [DOI] [PubMed] [Google Scholar]
  25. Kessler R. C., Neighbors H. W. A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav. 1986 Jun;27(2):107–115. [PubMed] [Google Scholar]
  26. Kirby James B., Kaneda Toshiko. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav. 2005 Mar;46(1):15–31. doi: 10.1177/002214650504600103. [DOI] [PubMed] [Google Scholar]
  27. Krieger Nancy, Chen Jarvis T., Waterman Pamela D., Rehkopf David H., Subramanian S. V. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health. 2005 Feb;95(2):312–323. doi: 10.2105/AJPH.2003.032482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. McCracken L. M., Matthews A. K., Tang T. S., Cuba S. L. A comparison of blacks and whites seeking treatment for chronic pain. Clin J Pain. 2001 Sep;17(3):249–255. doi: 10.1097/00002508-200109000-00011. [DOI] [PubMed] [Google Scholar]
  29. Morrison R. S., Wallenstein S., Natale D. K., Senzel R. S., Huang L. L. "We don't carry that"--failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000 Apr 6;342(14):1023–1026. doi: 10.1056/NEJM200004063421406. [DOI] [PubMed] [Google Scholar]
  30. Patel Kushang V., Eschbach Karl, Rudkin Laura L., Peek M. Kristen, Markides Kyriakos S. Neighborhood context and self-rated health in older Mexican Americans. Ann Epidemiol. 2003 Oct;13(9):620–628. doi: 10.1016/S1047-2797(03)00060-7. [DOI] [PubMed] [Google Scholar]
  31. Portenoy Russell K., Ugarte Carlos, Fuller Ivonne, Haas Gregory. Population-based survey of pain in the United States: differences among white, African American, and Hispanic subjects. J Pain. 2004 Aug;5(6):317–328. doi: 10.1016/j.jpain.2004.05.005. [DOI] [PubMed] [Google Scholar]
  32. Robert Stephanie A., Reither Eric N. A multilevel analysis of race, community disadvantage, and body mass index among adults in the US. Soc Sci Med. 2004 Dec;59(12):2421–2434. doi: 10.1016/j.socscimed.2004.03.034. [DOI] [PubMed] [Google Scholar]
  33. Ruehlman Linda S., Karoly Paul, Newton Craig. Comparing the experiential and psychosocial dimensions of chronic pain in african americans and Caucasians: findings from a national community sample. Pain Med. 2005 Jan-Feb;6(1):49–60. doi: 10.1111/j.1526-4637.2005.05002.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Saastamoinen Peppiina, Leino-Arjas Päivi, Laaksonen Mikko, Lahelma Eero. Socio-economic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees. Pain. 2005 Apr;114(3):364–371. doi: 10.1016/j.pain.2004.12.033. [DOI] [PubMed] [Google Scholar]
  35. Schneider Eric C., Zaslavsky Alan M., Epstein Arnold M. Racial disparities in the quality of care for enrollees in medicare managed care. JAMA. 2002 Mar 13;287(10):1288–1294. doi: 10.1001/jama.287.10.1288. [DOI] [PubMed] [Google Scholar]
  36. Schoenbaum M., Waidmann T. Race, socioeconomic status, and health: accounting for race differences in health. J Gerontol B Psychol Sci Soc Sci. 1997 May;52(Spec No):61–73. doi: 10.1093/geronb/52b.special_issue.61. [DOI] [PubMed] [Google Scholar]
  37. Shrout P. E., Fleiss J. L. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979 Mar;86(2):420–428. doi: 10.1037//0033-2909.86.2.420. [DOI] [PubMed] [Google Scholar]
  38. Smith G. D. Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States. Am J Public Health. 2000 Nov;90(11):1694–1698. doi: 10.2105/ajph.90.11.1694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Soobader M., LeClere F. B., Hadden W., Maury B. Using aggregate geographic data to proxy individual socioeconomic status: does size matter? Am J Public Health. 2001 Apr;91(4):632–636. doi: 10.2105/ajph.91.4.632. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Tait Raymond C., Chibnall John T. Factor structure of the pain disability index in workers compensation claimants with low back injuries. Arch Phys Med Rehabil. 2005 Jun;86(6):1141–1146. doi: 10.1016/j.apmr.2004.11.030. [DOI] [PubMed] [Google Scholar]
  41. Tello Juan Eduardo, Jones Julia, Bonizzato Paola, Mazzi Mariangela, Amaddeo Francesco, Tansella Michele. A census-based socio-economic status (SES) index as a tool to examine the relationship between mental health services use and deprivation. Soc Sci Med. 2005 Nov;61(10):2096–2105. doi: 10.1016/j.socscimed.2005.04.018. [DOI] [PubMed] [Google Scholar]
  42. Williams D. R., Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001 Sep-Oct;116(5):404–416. doi: 10.1093/phr/116.5.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Williams D. R., Jackson J. S. Race/ethnicity and the 2000 census: recommendations for African American and other black populations in the United States. Am J Public Health. 2000 Nov;90(11):1728–1730. doi: 10.2105/ajph.90.11.1728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Williams D. R. Missed opportunities in monitoring socioeconomic status. Public Health Rep. 1997 Nov-Dec;112(6):492–494. [PMC free article] [PubMed] [Google Scholar]
  45. Williams D. R. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896:173–188. doi: 10.1111/j.1749-6632.1999.tb08114.x. [DOI] [PubMed] [Google Scholar]
  46. Williams David R., Jackson Pamela Braboy. Social sources of racial disparities in health. Health Aff (Millwood) 2005 Mar-Apr;24(2):325–334. doi: 10.1377/hlthaff.24.2.325. [DOI] [PubMed] [Google Scholar]
  47. Williams David R., Neighbors Harold W., Jackson James S. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003 Feb;93(2):200–208. doi: 10.2105/ajph.93.2.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Yabroff K. Robin, Gordis Leon. Assessment of a national health interview survey-based method of measuring community socioeconomic status. Ann Epidemiol. 2003 Nov;13(10):721–726. doi: 10.1016/s1047-2797(03)00057-7. [DOI] [PubMed] [Google Scholar]

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