Predictive association between immigration status and chronic pain in the general population: results from the SwePain cohort

Abstract

Background Previous studies suggest that immigration may influence the experience of pain. Objective This population-based study examines whether immigration status is associated with chronic pain (CP), chronic widespread pain (CWSP), and severe CP at a two-year follow-up. We also tested mediation by mood status (i.e., anxiety and depression). Methods 15, 563 participants from a representative stratified random sample of 34,000 individuals living in south-eastern Sweden completed a postal survey, during 2013–2015, that included the following data: immigration status; presence of CP (pain lasting at least 3 months) and CWSP (a modified classification of widespread pain for use in epidemiological studies); severity of CP based on a numeric rating scale; and depression, anxiety, economic situation, and sociodemographic information. We applied logistic regressions using the generalized estimating equations (GEE), with Swedish-born as the reference group and path analyses models. Results Compared to the Swedish-born participants (n = 14,093;90%), the immigrants (n = 1470;10%) had an elevated risk of all pain outcomes (CP: odds ratio [OR] = 1.18; 95% confidence interval [CI = 1.04–1.33, CWSP: OR = 1.39; 95% CI: 1.15–1.69 and severe CP: 1.51; 95% CI: 1.23–1.87) after adjustments. Path analyses showed that baseline age, immigrant status, and financial hardship had a significant influence on chronic pain outcomes at follow-up with baseline mood status as the mediator. Immigration status was also associated with age and financial hardship. Conclusion Immigrants may have increased risk of chronic pain, widespread pain, and severe pain and this risk is mediated by mood status. Targeted interventions better tailored to the socio-economic and psychological status of immigrants with chronic pain are warranted.

Exploring the Burden of Chronic Musculoskeletal Pain in Immigrant Populations: A Scoping Review

“…Associations between chronic pain and demographic factors in immigrants re ect those found in the general population (26,27). Chronic pain was associated with female gender ( (17,18,20,24), older age (13,18,21), lower education (13,18,21), nancial hardship (21), and being underweight or obese (13), but not with marital status (21). Several immigration factors were also associated with chronic pain: time in transit (18), experience of trauma (18), and immigration status ( 21), but no association was found with migrating alone and not having a residence permit (21).…”

“…As illustrated in Table 4, prevalence of chronic pain, of widespread chronic pain, and of severe chronic pain were signi cantly higher in immigrant populations. Immigrants also had higher odds of reporting all pain outcomes (13,21). Two studies showed that immigrants report higher mean pain intensity and signi cantly higher total body pain than natives (13,25).…”

“…Table 3 presents the summarised quality appraisal; a detailed critical appraisal of each study can be found at Appendix C [2] . Quality varied with four studies (13,17,18,21) being adequate or higher on all ve domains.…”

Oral Health Status among Migrants from Middle- and Low-Income Countries to Europe: A Systematic Review

“…The JBI Critical Appraisal Tool [33] was used in order to evaluate the methodological quality of the included items (Tables 1-4) and to determine the risk of bias in their design, conduct and analysis. The JBI for case-control studies judges each study based on nine items: (1) target population, (2) participants selection methods, (3) sample size, (4) description of study subjects and setting, (5) response rate of participants, (6) diagnostic methods, (7) standardized and reliable way of measurements, (8) statistical analysis, (9) management of the participants' response rate. Cohort studies are investigated by the same tool based on 11 items: (1) population recruitment, (2,3) exposure, (4,5) confounding factors, (6,7) outcome, (8,9,10) follow-up, (11) statistical analysis.…”

“…In the same year, the largest total number of immigrants was reported by Germany, followed by Spain, France and Italy [5]. The reasons that prompt people to move are known: economic inequality, political instability, increased globalization [6], and it has been demonstrated that immigration status is one of the main determinant in health disparities [7][8][9]. Several factors contribute to defining migrants as vulnerable subjects: health risks before, during and after migration, different disease pro-file from that of the population of the receiving countries and barriers in accessing health care services in hosting nations [10].…”