Introduction

- Social determinants of health (SDoH) are non-medical

factors related to a person’s specific conditions related to how

they were born, grow, work, live and age and are feature that

influence health outcomes.1

- Examples of SDoH include a persons’ own experience with

income and social protection, education, employment,

working life conditions, food insecurity, housing, stress

levels, childhood development, social support, and access to

care.

- Inter-individual perception of pain is an important

characteristic that may contribute to the expectations and

outcomes of patients.

- It is unclear how a persons’ own SDoH measures are related to

pain outcomes.

- OBJECTIVE: To understand better how these various

components of SDoH may be correlated with reported pain

 

Methods:

- This was a retrospective observational study, in which all

patients with available survey data related to SDoH were

analyzed from the All of Us Research Program database.2

- Survey results related to SDoH were provided from ~500,000

patients. This survey elicited numerous questions related to

patient-specific experiences with various SDoH components. In

addition, patients reported their average pain score experienced

daily over the last 7 days (based on the Numeric Rating Scale

[NRS]).

- Responses were provided on a Likert scale (1 – 5), binary

responses (yes or no), numeric scale (1-15), or categorical.

- To measure association of each question using Likert scale

with pain scores, the Spearman’s rank correlation co. efficient

was calculated. To measure association of each question not

using Likert scale, linear regression was performed, and the Rsquared

metric was reported. A P-value <0.001 was considered

statistically significant and a correlation value ≥0.2 was

considered clinically significant.

- Multivariable analysis controlled for age, sex, BMI, chronic

pain, and opioid use disorder

 

Results:

- There were n=183,650 patients included in the analysis.

- The median [quartiles] NRS pain scores were 2 [1, 2.75].

- The survey questions with highest positive correlation with

pain scores (i.e. higher agreement with survey question

associated with higher pain scores) included: ‘'Within the past

12 months, were you worried whether your food would run out

before you got money to buy more?' (r = 0.24, P<0.001) and 'In

the last month, how often have you felt difficulties were piling

up so high that you could not overcome them?' (r = 0.21,

P<0.001).

- The survey questions with highest negative correlation with

pain scores (i.e. higher agreement with survey question

associated with lower pain scores) included “'In the last month,

how often have you felt that things were going your way?' (r = -

0.21, P <0.001) and 'In the last month, how often have you felt

that you were on top of things?' (r = -0.20, P <0.001).

- A multivariable linear regression was performed in which all

question results were modeled to predict pain scores. The

adjusted R-squared value was 0.25 (P<0.001).

 

Discussion:

- Questions related to food insecurity and stress levels were

found to be mostly correlated with pain scores.

- Higher concerns for food insecurity were correlated with

higher pain scores in daily life.

- Lower concerns with daily stress level were correlated with

lower pain scores in daily life.

This highlights the importance of understanding SDoH and

how it may correlate with patient outcomes, specifically with

pain outcomes.