Association Between Sedentary Behavior and the Development of New-Onset Chronic Pain in Older American Adults:...

PurposeExplore the causal relationship between sedentary behavior (SB) and the new onset of chronic pain (NOCP) in Americans aged ≥50 years.DesignRetrospective secondary data analysis.Setting/SampleIn a target trial emulation framework, a dataset comprising four consecutive waves (2012, 2014, 2016, and 2018) from the longitudinal Health and Retirement Study was investigated.Measures/AnalysisUnivariable and multivariable analyses were conducted using survey-weighted, mixed-effects Poisson regression models with one-level random intercepts and linearized standard errors. Using the same approach, causal mediation analyses were carried out to examine the potential role of obesity, depression, and sleep disturbances as mediators in the relationship between SB and NOCP. The role of education level, race, and sex as potential effect modifiers was also evaluated.ResultsIn the multivariable analysis, the risk of NOCP in participants who reported not having pain in the 2012 interview increased by 22% in those with SB vs those reporting no SB (95% CI = 1.12, 1.33; P < .001). The mediation effect attributed to obesity and depression was 58.2% (95% CI = 50.5, 71.3; P < .001) and 8.8% (95% CI = 1.6, 14.1; P < .001), respectively. The risk of NOCP in participants reporting SB was increased by 24.8% in women vs men (incidence rate ratio 1.25; 95% CI = 1.02, 1.52; P = .03).ConclusionThere is strong evidence for an association between SB and NOCP in the American subpopulation of women aged $\ge$50 years. This effect seems to be mainly mediated by obesity.