Social risks for disabling pain in older people: A prospective study of individual and area characteristics

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Abstract
Pain is common in adult life, and the extent to which pain interferes with daily activities rises with age. Little is known about the social factors associated with disabling pain. The objective was to determine the individual and neighbourhood social factors that predict pain that interferes with daily activities. This was a prospective cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 and over registered with six general practices were sent baseline and 3-year questionnaires. Individual predictors of the onset of pain interference were determined through multilevel modelling. Neighbourhood impact was examined using measures of deprivation taken from the UK Index of Multiple Deprivation 2004. 19% of the 3644 people without pain interference at baseline reported it at follow-up. Baseline social factors were weaker predictors than baseline age, multiple-site pain and anxiety or depression. However, perceived financial strain was a significant predictor (OR 1.5; 95% CI: 1.2, 1.8). Onset of pain interference varied by local area deprivation status. Those living in areas of high health deprivation had an increased risk of developing pain interference (OR 1.6; 95% CI: 1.1, 2.3). Whilst the onset of pain which disrupts daily life is influenced mainly by the characteristics of the pain and by the psychological factors, there are links with the social factors, particularly individual measures of perceived income adequacy. The onset of disabling pain is also influenced by the place where one lives. Policies to prevent disabling pain need to consider the contribution of neighbourhood deprivation and income inequalities to the extent of the problem.