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Educational Disparities in Disability in Mid- to Late-Life: How Much is Attributable to Pain?
Hangqing Ruan1, Hanna Grol-Prokopczyk1, Zachary Zimmer2
1Department of Sociology and Criminology, University at Buffalo, State University of New York, Buffalo, NY, USA.
Journal of Aging and Health
|January 3, 2026
Summary
Chronic pain significantly contributes to educational disparities in disability, explaining 18-34% of the gap. Higher pain prevalence among less educated adults is the primary driver of these inequalities.
Area of Science:
- Public Health
- Epidemiology
- Social Determinants of Health
Background:
- Educational disparities are linked to significant differences in disability.
- The specific role of pain in these educational disparities remains under-researched.
Purpose of the Study:
- To investigate the contribution of site-specific pain to educational disparities in various limitations.
- To determine if pain prevalence or differential pain impact explains these disparities across education levels.
Main Methods:
- Utilized National Health Interview Survey data (2002-2018).
- Employed Karlson-Holm-Breen and Oaxaca-Blinder decomposition methods.
- Examined pain (joint, back, neck, headache, facial/jaw) and disability (physical, cognitive, work, social, ADLs, IADLs).
Main Results:
- Pain accounted for 18-34% of the disability gap between the least and most educated adults.
- Higher pain prevalence in less educated groups was the main reason for this mediation.
- Pain's contribution was more pronounced in midlife compared to older age.
Conclusions:
- Chronic pain is a critical, under-recognized pathway linking education to disability inequalities.
- Addressing pain may help mitigate educational disparities in functional limitations.
- Findings highlight the importance of considering pain in public health strategies for health equity.
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