Educational Disparities in Disability in Mid- to Late-Life: How Much is Attributable to Pain?

Abstract

Background

Educational disparities in disability are substantial, but the contribution of pain remains underexplored.

Research Design

Using 2002–2018 National Health Interview Survey data, we examined the role of site-specific pain—joint, low back, neck, headache/migraine, and facial/jaw—in educational disparities in physical, cognitive, work, and social limitations, as well as activities of daily living (ADLs) and instrumental ADLs (IADLs). Karlson–Holm–Breen decomposition estimated the proportion of disparities mediated by pain, and Oaxaca-Blinder decomposition assessed whether differences reflected pain prevalence or differential impacts of pain across education levels.

Results

Pain explained 18–34% of the disability gap between adults with less than a high school education and those with a bachelor’s degree or higher, largely attributable to higher pain prevalence among the less educated. Contributions were greater in midlife than older age, while sex differences were negligible.

Conclusions

These findings identify chronic pain as a key, understudied pathway through which education shapes disability inequalities across later adulthood.