Perceived neighborhood environment and multidimensional pain burden among U.S. adults

Chronic pain constitutes a multidimensional public health crisis. Environmental determinants may significantly influence pain experiences, yet the specific impact of perceived neighborhood walkability, infrastructure, and safety remains underexplored.

We analyzed data from 31,568 U.S. adults in the 2020 National Health Interview Survey (NHIS), utilizing Multiple Imputation by Chained Equations (MICE) to address missingness. To minimize conceptual overlap and Type I error, pain frequency was designated as the primary outcome, with pain intensity and functional interference as secondary outcomes. Exposures were operationalized as a composite Total Neighborhood Score (higher = more favorable) and three functional domains (Safety, Access, and Leisure). We employed survey-weighted proportional odds ordinal logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). A Joint Domains Model was constructed to simultaneously analyze the three domains, with comprehensive covariate adjustment informed by a Directed Acyclic Graph.

In fully adjusted models, a higher Total Neighborhood Score was significantly associated with lower cumulative odds of experiencing more frequent pain (aOR = 0.95, 95% CI: 0.94-0.97). When evaluated in the Joint Domains Model, safety domain demonstrated the strongest independent protective association against frequent pain (aOR = 0.84, 95% CI: 0.80-0.89). Leisure domain also independently correlated with reduced pain frequency (aOR = 0.95, 95% CI: 0.91-1.00), whereas utilitarian access domain was attenuated after mutual adjustment. Consistent independent protective effects of safety and leisure were observed across all secondary outcomes.

Perceived neighborhood safety and access to restorative leisure environments are independently associated with a reduced multidimensional burden of pain among U.S. adults. Integrating interdisciplinary urban planning strategies, such as traffic calming, crime reduction, and accessible green spaces, into public health initiatives may serve as essential non-pharmacologic interventions to mitigate chronic pain.