Sociodemographically differential patterns of chronic pain progression revealed by analyzing the all of us research program data

TL;DR

The study finds that chronic pain conditions progress differently among various demographic groups, highlighting the need for personalized treatment approaches.

Contribution

This study is the first to reveal sociodemographic influences on the progression of chronic overlapping pain conditions using large-scale data.

Findings

Black or African Americans with a COPC condition show increased progression to other COPCs or mental disorders.

Females are more likely to develop chronic low back pain after anxiety and depression.

Low-income individuals face higher risks of progressing from one COPC to another or to mental disorders.

Abstract

The differential progression of ten chronic overlapping pain conditions (COPC) and four comorbid mental disorders across demographic groups have rarely been reported in the literature. To fill in this gap, we conducted retrospective cohort analyses using All of Us Research Program data from 1970 to 2023. Separate cohorts were created to assess the differential patterns across sex, race, and ethnicity. Logistic regression models, controlling for demographic variables and household income level, were employed to identify significant sociodemographic factors associated with the differential progression from one COPC or mental condition to another. Among the 139 frequent disease pairs, we identified group-specific patterns in 15 progression pathways. Black or African Americans with a COPC condition had a significantly increased association in progression to other COPCs (CLBP- > IBS, CLBP- > MHA, or IBS- > MHA, OR≥1.25, adj.p ≤ 4.0x10-3) or mental disorders (CLBP- > anxiety, CLBP- > depression, MHA- > anxiety, MHA- > depression, OR≥1.25, adj.p ≤ 1.9x10-2) after developing a COPC. Females had an increased likelihood of chronic low back pain after anxiety and depression (OR≥1.12, adj.p ≤ 1.5x10-2). Additionally, the lowest income bracket was associated with an increased risk of developing another COPC from a COPC (CLBP- > MHA, IBS- > MHA, MHA- > CLBP, or MHA- > IBS, OR≥1.44, adj.p ≤ 2.6x10-2) or from a mental disorder (depression- > MHA, depression- > CLBP, anxiety- > CLBP, or anxiety- > IBS, OR≥1.50, adj.p ≤ 2.0x10-2), as well as developing a mental disorder after a COPC (CLBP- > depression, CBLP- > anxiety, MHA- > anxiety, OR≥1.37,adj.p ≤ 1.6x10−2). To our knowledge, this is the first study that unveils the sociodemographic influence on COPC progression. These findings suggest the importance of considering sociodemographic factors to achieve optimal prognostication and preemptive management of COPCs.

Understanding the differential progression of chronic overlapping pain conditions (COPC) can inform patients and clinicians in optimizing the disease management. Although differential manifestations have been extensively reported for individual COPCs, differential patterns along the progression from one COPC to another have been rarely studied. The study addresses this gap specifically by identifying differential COPC progression associated with sex, race, and ethnicity, providing valuable insights for patients and clinicians to plan for their prevention or treatment strategies in the context of sociodemographic relative risk.

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