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Race-related differences in acute pain complaints among inner-city women: the role of socioeconomic status

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Abstract

Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants’ baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women’s pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women.

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Acknowledgements

This study was funded by the National Institute of Drug Abuse (NIDA; R01DA039522).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA

    Teresa A. Lillis, John Burns, Frances Aranda, Helen J. Burgess, Linzy M. Pinkerton & Stevan E. Hobfoll

  2. Center on Mental Health Services Research and Policy, University of Illinois Chicago, 1601 W. Taylor St., MCE 912, Chicago, IL, 60612, USA

    Frances Aranda

  3. Department of Psychiatry, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA

    Helen J. Burgess

  4. Department of Emergency Medicine, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA

    Yanina A. Purim-Shem-Tov

  5. Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave. South, Nashville, TN, 37212, USA

    Stephen Bruehl

  6. Mid-Atlantic MIRECC, VA Medical Center, Durham VA Health Care System, 508 Fulton St., Durham, NC, 27705, USA

    Jean C. Beckham

  7. Department of Psychiatry, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA

    Jean C. Beckham

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  1. Teresa A. Lillis
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  9. Stevan E. Hobfoll
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Correspondence to Teresa A. Lillis.

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Conflict of interest

Dr. Burgess is a consultant for Natrol, LLC. Teresa A. Lillis, John Burns, Frances Aranda, Helen J. Burgess, Yanina A. Purim-Shem-Tov, Stephen Bruehl, Jean C. Beckham, Linzy M. Pinkerton, Stevan E. Hobfoll do not have any conflicts of interest to disclose.

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Lillis, T.A., Burns, J., Aranda, F. et al. Race-related differences in acute pain complaints among inner-city women: the role of socioeconomic status. J Behav Med 43, 791–806 (2020). https://doi.org/10.1007/s10865-019-00123-3

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