WITHDRAWN: Discrimination and Pain Among Racially Diverse Community Dwelling Midlife and Older Adults in the United States

Background: Pain contributes to high burden on systems of healthcare, decreases quality of life and constitutes an important public health problem. Discrimination affects the lives and health of socially disadvantaged groups. Yet, limited research examines the relationship of discrimination and pain among racially diverse older adults. Guided by the Biopsychosocial Model of Pain and Minority Stress Framework, we posit that discrimination impacts pain outcomes and that these effects vary across racial groups. Hence, we examined the main and interactive effects of discrimination and race on the presence, intensity and number of pain locations among Black, Hispanic and White community dwelling midlife and older adults in the US.

Methods: Using data from Wave 3 (2015) of the National Social Life, Health, and Aging Project (NSHAP), we investigated the relationship between discrimination and pain among 2,745 Black, Hispanic and White adults 50 years and over. We assessed discrimination across a variety of domains and pain presence (previous 4-weeks), intensity and locations via reliable and validated measures (i.e., Everyday Discrimination Scale, Pain Map; Verbal Descriptor Scale). We used linear and logistic regression analyses to explore main and interactive effects of discrimination and race on pain outcomes. Our final models, considered relevant demographic, physical and mental health, and social factors.

Results: Participant mean age was 67.2 years (SD= 10), 55% were female, 12% were widowed, and 30% had a high school education or less. During the previous year, 70% reported at least one form of discrimination. However, Blacks (43%) and Hispanics (29%) most frequently cited discrimination based on ancestry, race or skin color while Whites (38%) cited ageism. Blacks also reported significantly more frequent discrimination than Hispanics and Whites. Pain prevalence was 71%. Mean intensity was 2.9 (SD: .98; Range 1-6) indicating a moderate level. Mean number of pain locations was 2.5 (SD: 1.8; Range: 1-12), with back and leg pain most common. Adjusted analyses revealed that discrimination was positively associated with pain presence (OR: 1.084, CI: 1.043, 1.127) and more pain locations (β=.052, p<.001). Compared to Whites, Blacks were less likely to report the presence of pain (OR: .678; CI:.507, .908) and fewer pain locations (β = -.298, p=.025) while Hispanics reported more intense pain (β =.222, p=.012). Significant interactive effects indicated that experiences of discrimination among Hispanics were associated with higher pain intensity (β =.097, p=.003) and number of pain locations (β =.123, p=.016). We found no other significant interactive effects.

Conclusions and Implications: Findings demonstrate that discrimination is an important factor across multiple domains of pain and that the effects vary as a function of race. Future work should examine how individual and interacting types of discrimination (e.g., sexual orientation, gender) impact important pain outcomes across diverse older adults. Qualitative research is also needed to understand how discrimination shapes subjective experiences of pain (e.g., choosing to report pain, mistrust, immigrant stress etc.) among older Blacks and Hispanics. Finally, social workers and other health professionals should collaborate in the implementation of pain interventions that acknowledge and address discrimination among diverse older adults.