Beyond Black vs White: Racial/Ethnic Disparities in Chronic Pain including Hispanic, Asian, Native American, and Multiracial U.S. Adults

Previous literature on race/ethnicity and pain has rarely included all major U.S. racial groups or examined the sensitivity of findings to different pain operationalizations. Using data from the 2010-2018 National Health Interview Surveys on adults 18+ (N=273,972), we calculate the weighted prevalence of six definitions of pain to provide a detailed description of chronic pain in White, Black, Hispanic, Asian, Native American, and multiracial groups. We also estimate logistic models to obtain relative disparities, including net of demographic and socioeconomic (SES) factors; finally, we calculate average predicted probabilities to show prevalence disparities in absolute terms. We find that Asian Americans have the lowest pain prevalence across all pain definitions or model specifications. In contrast, Native American and multiracial adults have the highest pain prevalence. This pain excess is due to the lower SES among Native Americans but remains significant and unexplained among multiracial adults. Whites, Blacks, and Hispanics fall in between. In this trio, Hispanics have the lowest prevalence, an advantage not attributable to immigrant status or SES. While most prior research focused on Black-White comparisons, these two groups differ relatively little. Blacks report lower prevalence of less severe pain definitions than Whites, but higher prevalence of severe pain. Net of SES, however, Blacks have significantly lower pain across all definitions. Overall, racial disparities are larger than previously recognized once all major racial groups are included, and these disparities are largely consistent across different operationalizations of pain.