A Comparative Look at Pain Prevalence: Europe and U.S. Zachary Zimmer (Mount Saint Vincent University, Canada) Anna Zajacova (Western University, Canada) ADDAPT working group workshop, Pain, Pain Treatment, and Inequality: High-Priority Findings and Gaps in Pain Disparities Research, December 8, 2017, Potomac, MD.
Health Trends Pain Trends Evaluating population level health trends important. Consider population aging and increasing longevity. Much attention has been paid to some trends: e.g., mortality, disability. Comparatively little attention on pain trends. Few if any national studies (Grol-Prokopczyk, 2017; Zimmer & Zajacova, forthcoming). Few if any comparative studies.
Pain questions in HRS and AHEAD 1. Are you often troubled by pain? No Yes Three measures 2. How bad is the pain most of the time? Mild Moderate Severe 3. Does the pain limit your ability to do usual activities? No Yes Any pain (~ 30%) Mild/moderate + not limiting (~10%) Severe +/or limiting (~20%)
1992 93 94 95 96 97 98 99 2000 01 02 03 04 05 06 07 08 09 2010 11 12 13 14 Data structure for following trends Age 72+ 1995 2014 N s Males 21,437 Females 31,127 Age 62-71 1998 2014 Males 22,536 Females 25,749 1992 Age 55-61 2014 Males 31,319 Years Females 34,116 N = 166,284
1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 Trend - pain of any severity Prevalence 48 44 40 36 32 28 24 Male Female 55-61 62-71 72+ 20 16 Survey year
1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 Trend - mild non-limiting pain Prevalence 16 14 12 10 8 6 4 Male Female 55-61 62-71 72+ 2 0 Survey year
1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 Trend - severe and/or limiting pain Prevalence 33 30 27 24 21 18 15 Male Female 55-61 62-71 72+ 12 9 Survey year
Average annual percent change, weighted Males Females Any pain +2.4 +2.0 Mild non-limiting pain +2.6 +2.6 Severe and/or limiting pain +2.3 +1.7
Patterns remain after controlling for: Age Sex Race Marital status Education Wealth Six chronic conditions
Conclusion Dramatic increase in pain prevalence among adults 55 and older in the U.S. from 1992 to 2014.
Survey of Health, Aging and Retirement in Europe 26 countries in Europe + Israel. Age 50+. Six waves from 2004 to 2015. Each wave includes a refreshed sample. Representative of the population 50+.
Pain questions Wave 1 2004 Wave 2 2006 Wave 4 2011 Wave 5 2013 Wave 6 2015 For the past six months at least, have you been bothered by any of these health conditions? Pain in your back, knees, hips or any other joint? Yes No Are you troubled with pain? Yes No IF YES, how bad is it most of the time? Mild Moderate Severe?
Data structure Wave 1 2004 Wave 2 2006 Wave 4 2011 Wave 5 2013 Wave 6 2015 Austria Belgium Denmark France Germany Italy Netherlands Spain Sweden Switzerland Czech Poland Site specific pain Austria Belgium Czech Denmark Estonia France Germany General pain Israel Italy Luxembourg Slovenia Spain Sweden Switzerland
Sample sizes Country 2004 2006 2011 2013 2015 Austria 1,569 5,255 4,382 3,402 Belgium 3,810 5,324 5,640 5,823 Czech 2,750 5,539 5,643 4,858 Denmark 1,706 2,287 4,168 3,733 Estonia 5,752 5,638 France 3,122 5,851 4,506 3,948 Germany 2,997 1,621 5,752 4,412 Israel 2,599 2,035 Italy 2,553 3,595 4,750 5,313 Luxembourg 1,610 1,564 Netherlands 2,968 2,789 Poland 2,466 1,733 Slovenia 2,958 4,224 Spain 2,316 3,728 6,708 5,636 Sweden 3,049 1,969 4,556 3,906 Switzerland 997 3,788 3,051 2,806 Average N 2,525 3,623 4,434 4,092 Total N 193,155
Aggregated prevalence Males Females Site specific pain (2004, 06, 11) 48% 59% General pain (2013, 15) 37% 50% Mild/moderate 29% 37% Severe 8% 13%
Trends in site specific pain, 2004/6-2011 (showing percentages) 70 65 60 55 50 45 40 Males 70 65 60 55 50 45 40 Females 35 35 30 30 Prevalence in 2004/6 Prevalence in 2011 Change is significant at p<.05
Pooled and weighted average annual percent change Males Females +1.5 +1.4
Trends in general pain, 2013-2015 (showing percentages) 60 55 50 45 40 35 30 25 20 Males 65 Females 60 55 50 45 40 35 30 25 20 Prevalence in 2013 Prevalence in 2015 Change is significant at p<.05
Trends in mild/moderate pain, 2013 2015 (showing percentages) 50 45 40 35 30 Males 50 45 40 35 30 Females 25 20 15 25 20 15 Prevalence in 2013 Prevalence in 2015 Change is significant at p<.05
Trends in severe pain, 2013 2015 (showing percentages) Males Females 20 18 16 14 12 10 8 6 4 2 0 20 18 16 14 12 10 8 6 4 2 0 Prevalence in 2013 Prevalence in 2015 Change is significant at p<.05
Pooling and weighted average annual percent change Males Females Any pain -0.4-0.6 Mild/Moderate +1.4 +0.6 Severe -6.4-3.3
Multilevel logistic regression models showing odds ratios for trends and random effects Model 1 Model 2 Model 3 2004/6 to 2011 2013 to 2015 2013 to 2015 Site specific vs No pain Any general vs No pain Mild/Moderate vs No pain Severe vs No pain Time 2 (vs Time 1) ǂ 1.240 1.103 1.083 1.060 Random intercept (SE).102 (.019).130 (.037).079(.010) Random slope (SE).024 (.009).021 (.011).034(.003) P <.01.01 < P <.05 ǂ Controls for age, sex, married, education and six chronic conditions (arthritis, heart disease, diabetes, lung disease, cancer, stroke).
Conclusion - On balance, trends in pain prevalence in Europe, 2004/6 to 2011, resemble trends in the United States. - There is however substantial across country variation. - Trends from 2013 to 2015 are not clear.
Canadian Community Health Survey (CCHS) Nationally-representative repeated crosssectional survey 10 waves of data from 2001 to 2014. Pain question: Are you usually free of pain or discomfort? Age 45 to 80+ N=550,000 26% report pain or discomfort
2001 2003 2005 2007 2009 2010 2011 2012 2013 2014 2001 2003 2005 2007 2009 2010 2011 2012 2013 2014 Prevalence of any pain or discomfort, 2001-2014 32 30 Male Female Prevalence 28 26 24 22 20 18 Survey year
Is this a global phenomenon?
Thank you Email me at: zachary.zimmer@msv.uc for a copy of our forthcoming paper in Journals of Gerontology: Social Sciences. Zachary Zimmer acknowledges support of the Social Sciences and Humanities Research Council through the Canada Research Chairs program.
70 65 60 55 50 45 40 35 30 Percent of Males and Females With Specific Pain by Year and Country, 2004/06-2011 Austria Belgium Denmark France Czech Germany 2004/06 -- 2011 2004/06 -- 2011 2004/06 -- 2011 2004/06 -- 2011 2004/06 2011 2004/06 2011 70 65 Italy Netherlands Poland Spain Sweden Switzerland 60 55 50 45 40 35 30 2004/06 -- 2011 2004/06 -- 2011 2004/06 -- 2011 2004/06 -- 2011 2004/06 -- 2011 2004/06 -- 2011 Male Female Change significant at p<.05
Percent of Males and Females With Chronic Pain by Year and Country, 2013-2015 60 50 40 Austria Belgium Czech Denmark Estonia 30 20 60 50 40 France Germany Israel Italy Luxembourg 30 20 60 50 40 30 20 Slovenia Spain Sweden Switzerland Male Female Change significant at p<.05
Percent of Males and Females With Severe Chronic Pain by Year and Country, 2013-2015 25 20 Austria Belgium Czech Denmark Estonia 15 10 5 0 25 20 France Germany Israel Italy Luxembourg 15 10 5 0 25 20 15 10 5 0 Slovenia Spain Sweden Switzerland Male Female Change significant at p<.05
1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 Prevalence of pain of any severity by year, age and sex Prevalence 48 44 40 36 32 28 24 Male Female 55-61 62-71 72+ 20 16 Survey year
1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 1992 1994 1995/6 1998 2000 2002 2004 2006 2008 2010 2012 2014 Prevalence of pain of any severity by year, age and sex Prevalence 48 44 40 36 32 28 24 Male Female 55-61 62-71 72+ 20 16 Survey year
Aggregated prevalence, 1992-2014 Males Females Any pain 28.7 35.0 Mild/moderate non-limiting pain 11.0 10.7 Severe and/or limiting pain 17.7 24.3