Borders that hurt: The link between anti-immigration attitudes in Europe and the epidemic of chronic pain in adolescence

Global immigration is increasing and is expected to continue rising due to the growing frequency of environmental disasters and sociopolitical conflicts. Emerging research shows that adolescents who immigrated to Europe are disproportionately affected by chronic pain compared to their non-immigrant peers. Anti-immigration attitudes, which are also rising in Europe, may contribute to this disparity by fostering social exclusion and discrimination, which can heighten psychological distress and contribute to chronic pain. Using an intersectional approach, this study examined: (1) the association between country-level anti-immigration attitudes and chronic pain in immigrant adolescents; and (2) whether this association differed by gender and socioeconomic status. Cross-sectional data were drawn from 5,621 immigrant adolescents across 20 European countries using the Health Behaviour in School-aged Children 2018 survey. Country-level anti-immigration attitudes were obtained from the European Social Survey 2018. Weighted mixed-effects logistic regression models assessed the association between anti-immigration attitudes and chronic pain and tested for interaction effects with gender and socioeconomic status. Results showed that stronger country-level anti-immigration attitudes were significantly associated with a higher prevalence of chronic pain among immigrant adolescents (OR=1.17; 95%CI = 1.11-1.38) and that this association was stronger in immigrants with low socioeconomic status (OR=1.39; 95%CI = 1.08-1.77). Sociopolitical exclusion of immigrants may contribute to higher chronic pain rates in immigrant adolescents, especially those with lower socioeconomic status. Country-specific responses must acknowledge the public health burden of anti-immigration rhetoric. Findings underscore the need for structural interventions to reduce anti-immigration sentiments at societal and political levels.