State social policies reduce joint pain prevalence, according to UB study

States with more generous social policies, such as Medicaid expansion and higher minimum wage, have fewer people reporting chronic joint pain related to arthritis, according to a new study by a UB researcher.

The paper, published in The Journal of Pain, used data from all 50 states compiled from 2011 to 2021. Since most research on pain prevalence looks at individuals at a single point in time, the new paper provides valuable insights about pain trends both nationally and at the state level, while at the same time underscoring the importance of studying the large-scale social policies affecting pain prevalence.

The wider research perspective broadens the focus of pain research. Rather than looking at just the person in pain, the current study seeks to identify macro social solutions to better pain prevention and management.

“Previous studies have documented pronounced educational and geographic disparities in arthritis-related pain, but that research rarely tests macro-level drivers such as welfare policies,” says Rui Huang, a PhD candidate in the Department of Sociology and Criminology and the paper’s corresponding author. “That’s what we’re doing with this study.”

And the findings are clear.

“Our study provides concrete evidence showing that policy matters. Investing in stronger safety nets that offer more benefits and easier access to care means fewer people living with pain and less pain disparities,” says Huang.

“For society as a whole, that means better well-being, higher productivity and greater equity.”

Huang says expanded Medicaid programs (a federal program administered by individual states with different rules) reduced both the overall state-level pain prevalence, the prevalence among less-educated groups and associated pain inequalities. An increase in the minimum wage was associated with decreased pain prevalence for individuals with a high school diploma and some college.

“Medicaid can effectively increase access to health care, reduce financial strain and lower people’s stress levels, benefits that are material and psychological,” says Huang.

Chronic pain is a costly and prevalent medical condition linked to negative outcomes like sleep disorders, disability and premature mortality. Considerable social costs, including stress, isolation and relationship conflict, compound the problem. Arthritis, a major cause of chronic pain, affects nearly 1 in 4 American adults, or 58.5 million people, with significant disparities in prevalence across states.

Huang used data from the Behavioral Risk Factor Surveillance System, which provides biennial information on arthritis-related pain, and the State Policy & Politics Database, an annual compilation of policies related to population health. She examined trends in joint pain prevalence from state to state, trends in educational disparities and the impact of five major welfare policies: the Supplemental Nutrition Assistance Program (SNAP), Earned Income Tax Credit, minimum wage, unemployment insurance and Medicaid.

Joint pain prevalence rose nationally from 10.5% to 11.6% during the research period, an increase of 4.6 million people reporting chronic joint pain over 10 years.

At the state level, trends varied significantly, increasing everywhere in the country except Montana, New York, South Dakota and Wyoming. Colorado had the largest increase in pain prevalence (26.2%), followed by Hawaii, Nebraska, Kansas and North Dakota.

“Colorado and North Dakota showed particularly fast rising pain prevalence and educational inequality,” says Huang. “Urgent interventions are needed in these states, as the data show that the less-educated appear to be more vulnerable to joint pain and are more likely to experience more pain-related health issues in the future.

“Based on our estimates, a 1% increase in Medicaid generosity would result in roughly 70,000 fewer people in these states experiencing pain,” says Huang. “Likewise, a 1% increase in the minimum wage could potentially benefit around 68,000 individuals with a high school diploma and some college.”