Socioeconomic Inequalities and Adolescent Chronic Pain: A Time Series Analysis of 29 Countries

Socioeconomic status (SES) is a significant determinant of health inequities, and growing evidence suggests that countries with higher income inequity report worse adolescent health outcomes and greater socioeconomic health inequalities.<br/>However, international studies on the influence of national income inequality on adolescent chronic pain are limited. We examined the association between national income inequality and chronic pain prevalence, as well as chronic pain-related socioeconomic disparities in adolescents. We also examined whether changes in national income inequality over time were associated with changes in chronic pain prevalence and chronic pain-related socioeconomic disparities. Data were drawn from adolescents across 29 Western countries/regions that participated in five consecutive 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, 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&lt;0·001) and greater chronic pain-related socioeconomic disparities (B=0·003; p&lt;0·001). Additionally, 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 eliminate chronic pain disparities, especially among adolescents from lower SES backgrounds.<br/>