Healthcare-related social determinants of health are associated with pain severity among adults with comorbid heart failure and chronic pain

INTRODUCTION: Chronic pain worsens symptom burden and quality of life in individuals with heart failure (HF). Healthcare-related social determinants of health (SDOH) - including access (e.g., stability of coverage), affordability (e.g., medication cost-saving activities), and utilization (e.g., number of provider visits) may influence pain severity. This study aimed to describe these SDOH and examine their relationship with pain severity. METHODS: A cross-sectional analysis was conducted using data from 4,026 adults with HF and chronic pain enrolled in the All of Us Research Program. Pain severity over 7 days (0 to 10 scale) and healthcare-related SDOH were assessed using descriptive statistics and linear regression. RESULTS: Participants averaged 69.90 years old; 58.15% were female and 68.11% White. Although 98.48% had insurance, barriers remained: 21.82% reported transportation issues, 22.45% could not afford dental care, and 34.88% requested lower-cost prescriptions. Participants reporting more barriers to healthcare and more unaffordable healthcare services experienced significantly higher 7-day pain severity. Other variables associated with higher 7-day pain severity were age, race, sex, comorbidity, depression and fatigue. CONCLUSIONS: Despite high insurance coverage, healthcare barriers were common and associated with increased 7-day pain severity. Future research should explore access to pain-specific services with more comprehensive pain measures.