The Role of Discrimination, Childhood Maltreatment, and Social Determinants of Health in Adult BIPOC Pain Disparities

Abstract

Objectives Chronic pain disproportionately affects Black and Indigenous people and other people of color (BIPOC). Disparities may be related to increased chronic stress due to discrimination, trauma exposure, and social determinants of health (SDoH). Methods Using data from families (n = 1307) in the family matters study (collected 2017-2019), a secondary data analysis explored SDoH of baseline pain severity and change in pain at 18 months, and the moderating effects of childhood maltreatment and discrimination on SDoH-pain relationships. General estimating equations (GEE) modeling was used. Results Childhood maltreatment was associated with higher baseline pain severity, and discrimination was the strongest correlate of worse pain 18 months later. Childhood maltreatment exacerbated risk for higher pain severity for women, individuals under the federal poverty line, and individuals living in areas with low financial privilege. Discrimination increased risk for higher baseline pain for Black and Latinx individuals. Conclusions Discrimination and traumatic event exposure may be important contributors to BIPOC pain disparities. Pain interventions may benefit from additional attention to the toll of oppressive systems and chronic stressors on BIPOC health.