The Geography of Chronic Pain in the United States and Canada

Our understanding of population pain epidemiology is largely based on national-level analyses. This focus, however, neglects potential cross-national, and especially sub-national, geographic variations in pain, even though geographic comparisons could shed new light on factors that drive or protect against pain. This article presents the first comparative analysis of pain in the U.S. and Canada, comparing the countries in aggregate and analyzing variation across states and provinces. Analyses are based on cross-sectional data collected in 2020 from 2,124 U.S. and 2,110 Canadian adults 18 years and older. Our pain measure is a product of pain frequency and pain-related interference with daily activities. We use regression and decomposition methods to link socioeconomic characteristics and pain, and inverse-distance weighting spatial interpolation to map pain scores. We find significantly and substantially higher pain in the U.S. than in Canada. The difference is accounted for by Americans9 lower economic wellbeing. Additionally, we find variation in pain within countries; the variation is statistically significant across U.S. states. Further, we identify nine hotspot states in the Deep South, Appalachia, and the West where respondents have significantly higher pain than those in the rest of the U.S. or Canada. This excess pain is partly attributable to economic distress, but a large part remains unexplained; we speculate that it may reflect the sociopolitical context of the hotspot states. Overall, our findings identify areas with high need for pain prevention and management; they also other scholars to consider geographic factors as important contributors to population pain.