Article Text

Download PDFPDF
Factors associated with racial and ethnic disparities in chronic pain after acute traumatic injury
  1. Sara F Jacoby1,
  2. Eunice C Wong2,
  3. Terry L Schell2,
  4. Mark B Powers3,
  5. Ann Marie Warren3,
  6. Therese S Richmond1
  1. 1 School of Nursing and the Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 RAND Corporation, Santa Monica, California, USA
  3. 3 Baylor University Medical Center at Dallas, Dallas, Texas, USA
  1. Correspondence to Dr Therese S Richmond, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; terryr{at}


Background Chronic pain represents a substantial health burden and source of disability following traumatic injury. This study investigates factors associated with racial and ethnic disparities in chronic pain.

Methods Prospective, longitudinal, panel study. Seriously injured patients were recruited from two trauma centres in the Northeastern and Southwestern USA. Data from medical records and individual surveys were collected in-hospital, and at 3-month and 12-month postinjury from a balanced cohort of non-Hispanic black, non-Hispanic white and Hispanic patients. We used linear regression to estimate the associations between race and ethnicity and 3-month and 12-month pain severity outcomes. We grouped all available cohort data on factors that theoretically influence the emergence of chronic pain after injury into five temporally ordered clusters and entered each cluster sequentially into regression models. These included: participant race and ethnicity, other demographic characteristics, preinjury health characteristics, acute injury characteristics and postinjury treatment.

Results 650 participants enrolled (Hispanic 25.6%; white 38.1%; black 33.4%). Black participants reported highest relative chronic pain severity. Injury-related factors at the time of acute hospitalisation (injury severity, mechanism, baseline pain and length of stay) were most strongly associated with racial and ethnic disparities in chronic pain outcomes. After controlling for all available explanatory factors, a substantial proportion of the racial and ethnic disparities in chronic pain outcomes remained.

Conclusion Racial and ethnic disparities in chronic pain outcomes may be most influenced by differences in the characteristics of acute injuries, when compared with demographic characteristics and postacute treatment in the year after hospitalisation.

  • pain
  • longitudinal
  • health disparities
  • hospital care

Data availability statement

Data are available on reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request.

View Full Text


  • Twitter @sarafredricka

  • Contributors TSR, TS and EW contributed to the conception and design of the study. TS, TSR, EW, MP and AMW contributed to the acquisition of the data. SFJ, TSR, TS and EW contributed to the anaylis and interpretation of the data. SFJ and TSR drafted and all authors contributed to the critical review and revision of the content, and provided final approval of the manuscript and agreed to be accountable for all aspects of the work. TSR serves as guarantor.

  • Funding This work was funded by the National Institute of Minority Health and Health Disparities (R01MD010372).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.