The Socioeconomic Status Gradient in Pain: A Cross-Country Analysis

Chronic pain has an important impact on peoples’ lives and is a fundamental dimension of wellbeing. Pain is the most common reason people seek medical attention and take medications. It also complicates the treatment of other ailments and limits one’s ability to work and function in society. At the individual level, it is associated with a series of negative outcomes including depression, job loss, and reduced quality of life. At the societal level, it imposes considerable costs on the health care system and the economy.

Taking into account both the direct costs of medical treatment, and the indirect costs associated to the loss in productivity, IOM (2011) estimated that chronic pain costs the US society at least $560 - 635 billion every year.

In this paper, I exploit newly available data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS) to study the prevalence of chronic pain among older adults 50-64 in 14 European countries and the US. and investigate the extent to which chronic pain is associated with socioeconomic status.

In the preliminary analysis conducted so far, I find that pain is part of life for one out of three Europeans, with wide variations across countries. In every country, more women are bothered by pain than men, with perhaps surprising differences in the gender gap across countries.

That markers of socioeconomic status, such as education and income, are associated to health outcomes is by now quite well established. The association between SES and pain, however, has only been recently receiving attention among researchers, and so far the focus has been mostly on education. SHARE and HRS allow me to go beyond education and consider additional dimensions of SES. I first document the existence of dramatic differences in the prevalence of pain by educational attainments in Europe as well as in the US: In every country, individuals with basic or no education are much more likely to be troubled by pain than those that have completed secondary education, and these two categories are more likely to report pain than those who have higher educational attainments. Next, I show that the reporting of pain shows a strong gradient also according to income quintiles, across all the countries in the sample. Arguably more importantly, I find that that there is more country-level variation in the lowest income quintile as well as in the lowest education group, suggesting that country-specific characteristics matter the most for people in the bottom of the income distribution.

What can explain this strong association between pain and SES and the observed disparities? A possible explanation is that people with lower SES are more likely to have worked in manual jobs, or to suffer from poor health. In the multivariate analysis, I control for such differences using controls for occupation and industry and for several dimensions of health status. I estimate probit regressions for the prevalence of pain and ordered probits for the intensity of pain.