# Demographic and socioeconomic risk factors for pain progression and recurrence in middle-aged and older adults: multistate analysis of a prospective English cohort study

## TL;DR

This study finds that women and people with lower socioeconomic status are more likely to experience persistent or recurring pain over time.

## Contribution

The study uses multistate models to analyze how pain progresses, remits, and recurs in a long-term cohort.

## Key findings

- Females were less likely to experience pain improvement or remission and more likely to experience recurrence.
- Higher education and wealth were associated with better pain outcomes and lower risk of worsening or recurrence.
- Pain trajectories are socially patterned, with disparities linked to sex and socioeconomic status.

## Abstract

While demographic and socioeconomic factors such as female sex and socioeconomic disadvantage are well-established risk factors for pain onset, previous studies examining long-term pain trajectories give mixed results and often overlook how pain fluctuates. This study identified demographic and socioeconomic risk factors for pain progression, remission and recurrence using multistate models to capture the dynamic nature of long-term pain.

Data were drawn from 9369 adults aged 50–98 from the English Longitudinal Study of Ageing (study years: 2002/03–2021/23). The baseline wave for each participant was their first wave of pain (moderate–severe or mild pain). Pain severity at subsequent waves was categorised into three states: (i) moderate–severe; (ii) mild; or (iii) none. We used multistate models to examine associations of demographic and socioeconomic factors with pain improvement (state 1–2), worsening (state 2–1), remission (state 1–3) and recurrence (state 3–1).

Findings particularly highlighted sex and socioeconomic disparities: compared with males, females were less likely to experience pain improvement (hazard ratio [HR] = 0.84, 95% confidence interval = 0.74–0.96) or remission (HR = 0.72, 0.64–0.80), and more likely to experience recurrence (HR = 1.45, 1.25–1.68). More education was associated with pain improvement (HR = 1.43, 1.16–1.76) and remission (HR = 1.30, 1.07–1.58), and lower risk of worsening (HR = 0.52, 0.42–0.64) and recurrence (HR = 0.67, 0.52–0.85); similar patterns were observed for wealth, with greater wealth associated with more favourable pain trajectories.

Pain fluctuates over time, following socially patterned trajectories, with women and socioeconomically disadvantaged individuals more likely to experience persistent or recurring pain. These findings highlight the importance of risk-stratified approaches, including proactive monitoring and management.