Reyes-Gibby Cielito C, Aday Lu Ann, Todd Knox H, Cleeland Charles S, Anderson Karen O
Department of Epidemiology, UT MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
J Pain. 2007 Jan;8(1):75-84. doi: 10.1016/j.jpain.2006.06.002. Epub 2006 Sep 1.
Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle- to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (> or =51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28%, and 17% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99% CI, 1.09-2.17), psychological distress (OR, 1.99; 99% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity.
This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care.
美国医疗保健中的种族和民族差异依然存在。尽管疼痛是疾病最常见且使人丧失能力的症状之一,但仅有少数研究评估了种族和民族多样化的中老年社区样本中的疼痛差异,因此限制了研究结果在更广泛人群中的普遍性。利用2000年健康与退休研究的数据,我们评估了美国一个年龄在51岁及以上的非西班牙裔白人(n = 11,021)、非西班牙裔黑人(n = 1,804)和西班牙裔(n = 952)社区样本中疼痛的患病率及影响。对疼痛、疼痛严重程度、因疼痛导致的活动受限、合并症以及社会人口统计学变量进行了评估。结果显示,疼痛患病率为28%,17%的样本报告因疼痛导致活动受限。与非西班牙裔白人相比,非西班牙裔黑人(优势比[OR],1.78;99%置信区间[CI],1.33 - 2.37)和西班牙裔(OR,1.80;99% CI,1.26 - 2.56)患重度疼痛的风险更高。对有疼痛的受访者(n = 3,811)的分析表明,患有慢性病(2种合并症,OR,1.5;99% CI,1.09 - 2.17)、心理困扰(OR,1.99;99% CI,1.54 - 2.43)、是医疗补助接受者(OR,1.63;99% CI,1.17 - 2.25)以及教育水平较低(OR,1.45;99% CI,1.14 - 1.85)是重度疼痛的显著预测因素,并有助于解释疼痛严重程度方面的种族/民族差异。
这项研究使用了一个种族和民族多样化的大型社区样本,提供了实证证据,表明美国老年社区成年人疼痛严重程度的种族/民族差异可由慢性病、社会经济状况和医疗服务可及性方面的不同脆弱性来解释。