Li Chihua, Liu Chunyu, Ye Chenfei, Lian Zi, Lu Peiyi
Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China.
Faculty of Health Sciences, University of Macau, Macao SAR, China.
Pain. 2025 Feb 1;166(2):388-397. doi: 10.1097/j.pain.0000000000003349. Epub 2024 Aug 26.
Using cross-sectional data from the United States, England, China, and India, we examined the relationship between education and frequent pain, alongside the modification role of gender in this relationship. We further examined patterns of 3 pain dimensions among participants who reported frequent pain, including pain severity, interference with daily activities, and medication use (these pain dimension questions were not administered in all countries). Our analytical sample included 92,204 participants aged 50 years and above. We found a high prevalence of frequent pain across the 4 countries ranging from 28% to 41%. Probit models showed that higher education was associated with lower risk of pain (United States: -0.26, 95% CI: -0.33, -0.19; England: -0.32, 95% CI: -0.39, -0.25; China: -0.33, 95% CI -0.41, -0.26; India: -0.18, 95% CI -0.21, -0.15). Notably, in China and India, the negative association between higher education and frequent pain was less pronounced among women compared with men, which was not observed in the United States or England. Further analysis showed that individuals with higher education experiencing frequent pain reported less severity, fewer daily activity interferences, and less medication use compared with those with lower education. In the United States, these associations were stronger among women. Our findings highlight the prevalent pain among middle-aged and older adults in these 4 countries and emphasize the potentially protective role of higher education on frequent pain, with nuanced gender differences across different settings. This underscores the need for tailored strategies considering educational and gender differences to improve pain management and awareness.
利用来自美国、英国、中国和印度的横断面数据，我们研究了教育与频繁疼痛之间的关系，以及性别在这种关系中的调节作用。我们进一步研究了报告频繁疼痛的参与者中三种疼痛维度的模式，包括疼痛严重程度、对日常活动的干扰以及药物使用情况（并非所有国家都设置了这些疼痛维度问题）。我们的分析样本包括92204名50岁及以上的参与者。我们发现这四个国家频繁疼痛的患病率很高，在28%至41%之间。概率模型显示，受教育程度较高与疼痛风险较低相关（美国：-0.26，95%置信区间：-0.33，-0.19；英国：-0.32，95%置信区间：-0.39，-0.25；中国：-0.33，95%置信区间-0.41，-0.26；印度：-0.18，95%置信区间-0.21，-0.15）。值得注意的是，在中国和印度，与男性相比，女性中高等教育与频繁疼痛之间的负相关不太明显，而在美国和英国未观察到这种情况。进一步分析表明，与受教育程度较低的人相比，经历频繁疼痛的受教育程度较高的人报告的疼痛严重程度较低、对日常活动的干扰较少且药物使用较少。在美国，这些关联在女性中更强。我们的研究结果突出了这四个国家中老年人普遍存在的疼痛问题，并强调了高等教育对频繁疼痛的潜在保护作用，不同环境下存在细微的性别差异。这凸显了需要考虑教育和性别差异制定针对性策略，以改善疼痛管理和提高疼痛意识。
