The Relationship Between Neighborhood Disadvantage and Markers of Chronic Pain Risk: Findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP)

Socioeconomic disadvantage may contribute to racial and ethnic inequities in health outcomes, including chronic pain. Yet, research examining the relationship between socioeconomic disadvantage and chronic pain risk in Native Americans (NAs) is scant. Participants were 272 healthy, chronic pain-free NAs (n=139) and non-Hispanic Whites (NHWs) (n=133) from the Oklahoma Study of Native American Pain Risk (OK-SNAP). Neighborhood disadvantage was measured with the 2015 national Area Deprivation Index (ADI) using mailing addresses provided by participants at study enrollment. Hierarchical regression models assessed whether ADI predicted measures of pain processing that can assess individual differences in chronic pain risk (i.e., peripheral fiber function, pain sensitivity, central sensitization, and endogenous pain inhibition) above-and-beyond individual-level socioeconomic status (SES; i.e., income, education) and ethnicity. Given that minoritized groups may be more susceptible to pronociceptive effects of neighborhood disadvantage, the interaction between ethnicity and ADI was also tested. Higher ADI was associated with lower ischemic pain threshold and tolerance as well as impaired endogenous inhibition of nociceptive flexion reflexes (ps<.05). Additionally, ethnicity moderated the relationship between ADI and warm detection threshold, with a stronger positive relationship between ADI and thresholds in NAs (p=.045). All other relationships were non-significant (ps>.05). The ADI was associated with reduced function of C-fibers, ischemic pain hyperalgesia, and impaired spinal inhibition. This suggests neighborhood disadvantage may yield important information about chronic pain risk above and beyond individual SES and highlights the important relationship between environment and health. Funded by National Institute on Minority Health and Health Disparities (R01MD007807).