Associations of Source and Continuity of Private Health Insurance with Prevalence of Chronic Pain among US Adults

Coverage by private insurance is associated with lower chronic pain prevalence, but the significance of different types of private coverage for the epidemiology of chronic pain is poorly understood. The primary outcome was pain prevalence. Among respondents with chronic pain, secondary outcomes included experiences of severe pain, high-impact pain, and opioid use.

We compared the prevalence of chronic pain among privately insured adults (aged 18-64 years) based on coverage source, coverage continuity, and relation to the policyholder using the 2019-2021 and 2023 rounds of the National Health Interview Survey.

Based on a sample of 52,852 adults, we estimated that 16% of adults aged 18 to 64 years with private coverage had chronic pain, 10% had privately purchased insurance (as opposed to employer-sponsored), 4% experienced coverage gaps within the past year, and 33% were covered by a relative's policy (vs own policy). On multivariable analysis, compared with adults with employer-sponsored insurance, those with privately purchased insurance had lower odds of reporting chronic pain (odds ratio 0.86, 95% confidence interval 0.78-0.95; P = 0.004). Compared with adults with continuous private insurance coverage, those who experienced coverage gaps in the past year had higher odds of chronic pain (odds ratio 1.28, 95% confidence interval 1.11-1.47; P < 0.001). There was no difference in chronic pain prevalence based on relation to the policyholder and no differences in any secondary outcomes based on the study exposures.

These results suggest that protecting the continuity of private coverage may help improve pain management and control the population prevalence of chronic pain.