Summary: Middle-aged Americans are reporting more chronic pain than older generations, and this rise is concentrated among those without a four-year college degree.
Source: Princeton
Contrary to the typical expectation that pain increases steadily with age, recent research finds that in the United States people in midlife report more chronic pain than the elderly. The pattern, published in the Proceedings of the National Academy of Sciences (PNAS), is largely driven by Americans who do not hold a bachelor’s degree.
Researchers Anne Case and Sir Angus Deaton of Princeton University, together with Arthur Stone of the University of Southern California, analyzed survey responses from more than 2.5 million adults to investigate how reported physical pain varies by age, education, and birth cohort. Their results point to a troubling generational trend: each successive cohort of less-educated Americans reports higher levels of pain throughout adulthood than the cohort before it.
This cohort effect means that today’s less-educated middle-aged adults are experiencing more pain than today’s elderly did at the same age. Because these middle-aged adults will become tomorrow’s elderly, the study raises significant concerns about future demand on health care and the management of chronic pain—an issue already entangled with the opioid epidemic and broader public health challenges.
The authors drew on multiple large-scale datasets, including national surveys conducted by Gallup, the U.S. Census Bureau, and international sources, to compare adults across ages 25–79 in the United States and in 20 other wealthy countries. Their American samples focused on Black and White non-Hispanic respondents, and they used four U.S. surveys—the Gallup Health and Wellbeing Index, the Census Bureau’s National Health Interview Survey, the Medical Expenditure Panel Survey from the Department of Health and Human Services, and the University of Michigan’s Health and Retirement Study—to examine birth cohorts born between 1930 and 1990.
Two main findings emerged. First, across wealthy countries and across demographic groups, reported pain generally rises with age, as commonly expected. Second, after accounting for education level, the American pattern diverges: among those with a bachelor’s degree, pain increases with age as in other countries, but among the roughly two-thirds of Americans without a bachelor’s degree, pain peaks in midlife and is higher than that reported by today’s elderly.
Case summarized the discovery as primarily an American phenomenon, noting that this midlife pain peak is not found in other rich countries. For less-educated Americans, each successive birth cohort reports more pain at nearly every adult age than the previous cohort, widening the gap in pain prevalence by education across generations.
The authors link the rise in pain among less-educated cohorts to a broader erosion of social and economic supports for working-class Americans. Factors that may contribute include stagnant wages, job instability, rising social isolation, changes in family structure such as lower marriage rates and higher divorce, and increasing “deaths of despair” from suicide, drug overdose, and alcoholic liver disease—trends documented in prior research by Case and Deaton.
The study’s authors acknowledge alternative explanations and limitations. Survey respondents today might be more willing to report minor pain than earlier generations were, or changes in employment could mean some people move into less physically demanding (but lower-paid) jobs after developing pain. Rising obesity rates could also contribute to higher musculoskeletal strain. Increasing college enrollment across cohorts complicates comparisons, since those with a degree follow a different pain trajectory.
Despite these caveats, the findings have clear policy implications: if cohort trends continue, tomorrow’s elderly population will carry a heavier burden of pain than today’s seniors, placing added strain on a health care system that already struggles to manage chronic pain effectively and safely.
“Pain undermines quality of life, and pain is getting worse for less-educated Americans,” Deaton said. “This not only makes their lives worse, but will pose long-term problems for a healthcare system that is not well equipped to treat chronic pain.”
About this pain research article
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Princeton
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Original Research: Open access
“Decoding the mystery of American pain reveals a warning for the future” by Anne Case et al., PNAS.
Abstract
Decoding the mystery of American pain reveals a warning for the future
Pain is typically expected to rise with age because of accumulated injury, wear and tear, and increasing disease burden. Consistent with this expectation, most wealthy countries show pain rising into old age. In the United States, however, the elderly report less pain than those in midlife—a phenomenon we term the “mystery of American pain.” Using multiple datasets and definitions of pain, we demonstrate that today’s midlife Americans have experienced more pain throughout adulthood than today’s elderly did. When we disaggregate by birth year and by whether a respondent has completed a bachelor’s degree, we find that among those without a college degree, each successive birth cohort has a higher prevalence of pain at a given age—a pattern not observed for college graduates. The widening gap in pain between more- and less-educated Americans cannot be explained by changes in occupation or obesity among the less educated, but aligns with broader patterns of decline in working-class life for those born after 1950. If these cohort trends persist, pain prevalence will continue to rise across the adult population, meaning tomorrow’s elderly will be sicker than today’s, with serious implications for health care systems and policy planning.