Chronic pain is associated with increased health care use among community-dwelling older adults in Brazil: the Pain in the Elderly (PAINEL) Study

Abstract

Background Chronic pain is known to increase health care use in high-income countries, but in Brazil, little is known. Objective To investigate the association between chronic pain and health care use among Brazilian older adults and explore the relationship between pain severity and health care use. Methods This cross-sectional study was derived from the population-based study Frailty in Brazilian Older People-FIBRA. Chronic pain, pain intensity and pain-related disability were assessed through additional telephone interviews. Health care use was measured by the number of doctor visits, hospitalization events and high health care use (highest quartile of the distribution for number of doctor visits) in the last 12 months. Associations were tested in regression analyses adjusted for predisposing, enabling and illness-level components from the Andersen Model. Results The 383 participants were predominantly female (71.0%), mean age was 75.6 (6.1 SD). The prevalence of chronic pain was 30.0%. Chronic pain was associated with number of doctor visits [unstandardized B coefficient 1.48; 95% confidence interval (CI) = 0.35–2.62] and high health care use [odds ratios (OR) = 2.27; 95% CI = 1.39–3.72]. Pain intensity was associated with high health care use in univariate (OR = 1.13; 95% CI = 1.06–1.20) but not multivariate analysis (OR = 1.12; 95% CI = 0.94–1.33). Pain-related disability was not associated with any outcome. Conclusion Chronic pain increased health care use among Brazilian older adults. Improving the quality of primary care management of individuals at greater risk of chronic pain should be a cornerstone of health policies directed towards reducing the personal and societal burden of ageing.

Prevalence of chronic pain in Brazil: systematic review

“…This increase in age has already been identified as a factor strongly associated with a higher prevalence of CP 18 , a fact reinforced by the studies included in the present review 20,24,32,[35][36][37] . The location chosen to collect the sample is also a determining factor for the prevalence of CP, and this was observed in the present study, since the data collected at the interviewees' homes showed a lower prevalence of chronic pain [16][17][18]21,23,25,27 than that of studies from online data collection 37 , or specialized health centers 22 .…”

“…This fact can infer that the presence of CP is not directly associated with the economic context of each nation. Regarding gender, CP in Brazil predominated in females [15][16][17][18][19][20]22,23,[25][26][27][28][29][31][32][33][35][36][37]40,[43][44][45][46][47]49 , as well as in studies from other countries 50,[52][53][54][55][56] . Moreover, a large portion of the samples was composed of adults and elderly individuals, with CP being more prevalent among the elderly.…”

“…The form of collection was convenient in nine studies 15,26,28,31,35,37,41,42,47 , favoring agility in gathering the desired number of sample, but hindering a broader view of adverse characteristics. Eight studies had a high non-response bias, failing to reach the stipulated sample [22][23][24]26,27,31,36,47 .…”

“…The data collection method is very important for the reliability of information, so six studies were classified with moderate risk 21,27,33,36,37,43 due to the telephone interview, since the face-to--face interview may be more reliable in capturing data from the individuals. In addition, the method of collection should ideally be performed in the same way for all individuals in the survey, which did not happen in two studies 37,43 .…”

Andersen Model

“…For example, in mainland China (thereafter China), plenty of studies have primarily focused on general healthcare utilization in the total population or in old age population (Gong et al 2016;Li et al 2016;Zhang et al 2019), nonurgent emergency department visits (Jiang et al 2020), oral health services (Xu et al 2019), social services (Zhu 2015; see "Social Services Utilization"), respite services among caregivers of frail older adults (Sun et al 2020), and long-term care services (Fu et al 2017). In Brazil, the Andersen Model has been applied to dental services utilization (Herkrath et al 2020), doctor visits and hospitalization (Torres et al 2018), and use of prescription drugs (Viana et al 2015). Limpuangthip et al (2019) applied the Model to older Thai people in use of denture services.…”