| 1. Introduction |
Physical pain is a common health problem with broad individual, economic and social implications.
Understanding the growth and distribution of pain in society is crucial to improving the well-being of citizens and the public health system. However, evidence on pain, trends and disparities in its progression in the world population barely exists.
This article uses nationally representative data from 146 countries (N = 1.6 million respondents) to examine pain trends between 2009 and 2021, possible explanations for these characteristics, and sociodemographic disparities.
Further analysis shows that the percentage of people with pain worldwide increased from 26.3 in 2009 to 32.1 in 2021. Approximately 500 million more people were suffering from pain in 2021 compared to 2009. This work also shows that the Pain growth is unevenly distributed: the increase in physical pain was faster among women, the youngest, the least educated, and the poor.
| 2. Background |
Physical pain has detrimental effects on people’s well-being. Pain has been found to influence economic and health behavior. For example, it is strongly associated with work: loss of productivity, absenteeism, job loss, and drug and alcohol abuse.
By examining pain trends and disparities around the world, the present study contributes to researchers’ efforts to understand and improve utility for individuals.
Physical pain has been widely studied in medicine and biology. More recently, economists and social scientists have begun to examine socioeconomic and psychosocial aspects.
This work argues that social stressors linked to difficult economic conditions can shape individual pain. The present study also contributes to this body of research by exploring socioeconomic and psychosocial factors that may help explain the trends.
The disparities documented here are related to root cause theory. This theory suggests that individuals with greater resources (e.g., better socioeconomic status, higher education) tend to have better health and are more likely to avoid disease than people with less income.
| 3. Methods |
> Data
This article used data from 146 countries from 2009 to 2021 (N = 1.6 million respondents; age range 13-101 years, mean = 42 years).
> Dependent variable
The dependent variable for this study was the individual’s physical pain. Respondents were asked: “Did you experience the following… for much of yesterday? How about... physical pain? People could answer yes (1) or no (0).
> Independent variable and covariate
The main independent variable was a one-year continuous survey period. Sociodemographic characteristics included gender, age (linear and quadratic), education level (primary, secondary, and tertiary), country-year income quintiles, employment status, marital status, and number of children under 15 years of age in the household.
> Statistical analysis
To examine whether physical pain varied over time, regressions adjusted for sociodemographic characteristics were performed.
> Possible explanatory factors
Additional analyzes were conducted to explore factors that may help explain trends in physical pain.
• Age profile of the nation: Since physical pain tends to increase with age, whether the trend in physical pain differed according to the age profile of nations.
• Manufacturing: Jobs that are hard on the human body can play a key role in the development of physical pain. Therefore, countries in which manufacturing increased may exhibit higher rates of pain than countries in which manufacturing decreased.
• Optimism: Optimism about the future has been found to be related to physical pain. People who experienced lower optimism reported greater pain
• Stress: Previous research also found that pain was very similar to stress. Thus, in countries where stress increased, physical pain may also have increased.
| 4. Results |
> Pain trends and disparities
The percentage of people with pain has been trending upward worldwide between 2009 and 2021 ( Fig. 1 ). It is worth noting that these trends show a trough in 2020. The upward trend in physical pain was most pronounced in the 2009-2019 period removing the pandemic years.
Worldwide The proportion of people experiencing physical pain was 26.3% in 2009 and 32.1% in 2021. The proportion of people in pain in higher-income countries increased from 26.8% in 2009 to 29% in 2021 while in low-income countries the proportion of people with pain increased from 25.9% in 2009 to 32.8% in 2021.
Analyzing the crude trends in physical pain across countries by demographic group ( Fig. 2 ) there are two main findings:
1) the aggregate level of physical pain was higher among women, the elderly, the less educated, and the poor in comparison with men, the younger, the more educated and the rich.
2) physical pain increased in all demographic groups.
Physical pain increased over time in low- and high-income countries and in all population groups after adjusting for demographic characteristics. It is also confirmed that pain inequality has widened (that is, pain grew faster in some groups than in others).
In higher-income countries, the trend in physical pain among the elderly (people over 60 years of age) was statistically insignificant. While the increase in physical pain was faster among younger than among middle-aged individuals.
> Possible explanatory factors
• Age profile of the nation: Regression models show that physical pain grew faster in countries with a lower median age than in countries with a higher median age.
• Health spending: Physical pain grew faster in countries with less health care than in countries with more health care.
• Overall government spending: The growth of physical pain was faster in countries with lower public spending than in countries with higher public spending.
• Manufacturing: Physical pain increased in countries where manufacturing decreased and in countries where manufacturing increased. However, the difference in pain growth was not statistically significant.
• Optimism: Regression models show that physical pain increased in countries where optimism increased and decreased with no differences in growth.
• Stress: Regression models show that physical pain increased in countries where stress increased between 2009 and 2021.
| 5. Discussion |
This article provides evidence on the increase in physical pain between 2009 and 2021. The data is nationally representative of the 146 countries involved in the analysis (N = 1.6 million respondents). This strong progress can be seen in higher and lower income nations and among all demographic groups examined.
It is worth noting that the percentage of people with pain decreased from 2019 to 2020.
Perhaps the lifestyle changes introduced by the COVID-19 pandemic had an effect on physical pain at the population level. Future research should explore this possibility.
This work also documents the inequalities of physical pain. The aggregate level of pain was higher among women, the elderly, the less educated and the poor compared to men, the younger, the more educated and the rich. This is in line with previous research that showed that women (vs. men), older adults (vs. young adults), people with low socioeconomic status (vs. high), and with less education (vs. more) tend to experience greater suffering.
Trends in physical pain across education and income groups were fairly consistent universally. In both high- and low-income populations, physical pain grew faster among the least educated (versus the most educated) and among those with the lowest income. These findings are in line with previous research suggesting that socioeconomic disadvantage is strongly related to health-related stressors and chronic pain.
The percentage of people in pain would be expected to increase with the age of the population: the greater the number of elderly people, the greater the number of citizens in pain. However, the results show that physical pain grew faster in countries with a lower median age than in countries with a higher median age. This suggests that increasing trends may not be driven exclusively by the elderly’s pain and that factors affecting quality of life may play an important role.
Increased physical pain may be accompanied by an increase in manufacturing as workers are likely to be at risk for different types of pain. The analyzes showed that the trend in physical pain grew in countries where manufacturing decreased and in countries where manufacturing increased. This finding suggests that jobs that harm the body may be responsible for the increasing trend in pain and that the psychological effect of losing a job (e.g., financial insecurity) may also play a role.
The present study found that although physical pain increased in countries where optimism increased and in countries where optimism decreased, just as physical pain increased in countries where stress increased but did not increase in countries where stress decreased. People may find it easier to report if they are in pain than if they are experiencing stress.
| 6. Conclusions |
The percentage of people with pain increased dramatically between 2009 and 2021 worldwide and among various population groups. Pain inequality has also increased: Progress was faster among women, the youngest, the least educated and the poorest compared to men, the elderly, the most educated and the rich.
The increase in physical pain is a phenomenon that social scientists and politicians need to address. By providing the world’s first evidence on trends and disparities in growth, this paper opens a new line of research and calls for more work to continue decoding the pain that citizens around the world are experiencing.
Understanding how pain level varies over time and across demographic groups is crucial for evaluating and shaping public health policies.
