Prevalence, burden, and factors associated with chronic pain and high-impact chronic pain in U.S. Adults, 2019-2023

Abstract

Given chronic pain remains a major public health concern and focus of national prevention and management objectives, this study examined temporal trends, a complementary prevalence-burden framework, and multilevel correlates of chronic pain and high-impact chronic pain across demographic, sociodemographic, health-related, mental health, and health care access, utilization, and affordability domains. Pooled data from 2019, 2021, and 2023 National Health Interview Survey (N=91,001 adults) were analyzed using survey-weighted logistic regression models sequentially adjusted by domain and fully adjusted for all covariates. Chronic pain prevalence increased from 20.5% in 2019 to 24.3% in 2023, while high-impact chronic pain rose from 7.5% to 8.5%. In fully adjusted models, higher odds of chronic pain were observed among adults aged ≥25 years, those experiencing socioeconomic disadvantage (unemployment, and poverty), individuals reporting poor self-rated health, rheumatic conditions, and frequent anxiety or depressive symptoms, and those reporting greater health care utilization and cost-related barriers to care and prescriptions. Sensitivity analyses using high-impact chronic pain as the outcome demonstrated similar or stronger associations across age groups and for socioeconomic disadvantage, depressive symptoms, health care utilization, and affordability barriers. These findings suggest that rising chronic pain and high-impact chronic pain are closely linked not only to socioeconomic and mental health factors, but also to health care access, utilization, and affordability context, supporting more equitable screening, care planning, and pain management strategies. PERSPECTIVE: Chronic pain affects more than one in five U.S. adults and is closely linked with socioeconomic disadvantage, mental health symptoms, healthcare utilization, and affordability barriers. Distinguishing prevalence from burden helps identify subgroups for screening and case finding while informing resource allocation, care planning, and more equitable pain care.

Keywords: Chronic pain; Health care Access; Health care Utilization; High-Impact Chronic Pain; Population Health.