National income inequality and adolescent chronic pain: a time series analysis of 29 countries

Chronic pain is a major public health concern in adolescence. It is not evenly distributed across the population, with higher prevalence among adolescents from lower socioeconomic status (SES) backgrounds. Evidence suggests that countries with greater income inequality report worse adolescent health and wider socioeconomic health disparities. However, international research on the role of national income inequality in shaping adolescent chronic pain remains limited. In this study, we examined whether national income inequality was associated with adolescent chronic pain prevalence and chronic pain-related socioeconomic disparities, and whether changes in income inequality over time corresponded to changes in these outcomes. Data were drawn from adolescents across 29 Western countries/regions that participated in 5 waves (2002, 2006, 2010, 2014, and 2018) of the Health Behaviour in School-aged Children surveys (pooled n = 826,563). Chronic pain and SES data were aggregated to create a country-level slope index of inequality and then combined with country-level national income inequality data. Prais-Winsten time-series regression models with panel-corrected standard errors were conducted. Results showed that higher national income inequality was associated with a higher prevalence of chronic pain (B = 0.303; P < 0.001) and greater chronic pain-related socioeconomic disparities (B = 0.003; P < 0.001). In addition, changes in national income inequality over successive survey years were associated with changes in chronic pain-related socioeconomic disparities (B = 0.004; P = 0.014). The study findings highlight the need for policies addressing structural income inequality and for integrating socioeconomic factors, social support, and community resources into interventions and treatments to reduce chronic pain prevalence and eliminate related disparities, especially among adolescents from lower SES backgrounds.