Race-related differences in acute pain complaints among inner-city women: the role of socioeconomic status
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Race‑related differences in acute pain complaints among inner‑city women: the role of socioeconomic status Teresa A. Lillis1 · John Burns1 · Frances Aranda1,2 · Helen J. Burgess1,3 · Yanina A. Purim‑Shem‑Tov4 · Stephen Bruehl5 · Jean C. Beckham6,7 · Linzy M. Pinkerton1 · Stevan E. Hobfoll1
Received: 21 April 2018 / Accepted: 3 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/ White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data * Teresa A. Lillis [email protected] 1
Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612, USA
were extracted from psychosocial questionnaires completed at the participants’ baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women’s pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women. Keywords Acute pain · SES · Race · Ethnicity · Health disparities
2
Center on Mental Health Services Research and Policy, University of Illinois Chicago, 1601 W. Taylor St., MCE 912, Chicago, IL 60612, USA
3
Department of Psychiatry, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
Introduction
4
Department of Emergency Medicine, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA
5
Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave. South, Nashville, TN 37212, USA
6
Mid‑Atlantic MIRECC, VA Medical Center, Durham VA Health Care System, 508 Fulton St., Durham, NC 27705, USA
7
Department of Psychiatry, Duke University School of Medicine, 40
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