Prevalence of Pain Reporting in Different Ethnic Groups in the UK: Results from a Large Biobank

Background/Purpose: Very large epidemiological studies designed to investigate genetic and environmental influences on disease, known as ‘biobanks’ can be used to look at associations between rare exposures and health for which smaller studies may lack power. The purpose of this study was to look at the association between ethnicity and pain in the UK Biobank.

Methods: UK Biobank recruited ½ million people across Great Britain. Participants attended assessment centers and answered questions on health and lifestyle by touch-screen questionnaire. They were asked “In the last month have you experienced any of the following that interfered with your usual activities?”, and could indicate: headache, face pain, neck/shoulder pain, back pain, abdominal pain, hip pain, knee pain, or pain all over. For each positive answer, participants were asked if the pain had lasted at least three months, which was defined as chronic. Questions were also asked on gender, age, ethnicity, income, employment status, adverse life events and mental health. Self-reported ethnicity was classed as white, mixed, south Asian, black, Asian (Chinese), or other. Life events recorded were: serious illness, injury, or death to a partner or close relative, marital separation, and financial difficulties. Mental health included mood swings, feelings of guilt and loneliness, and being tense. Prevalence of any pain, chronic pain, and regional pains was calculated for each ethnic group, standardised to age/gender structure in the UK 2011 Census. Risk ratios adjusted for age and sex with 99% confidence intervals were calculated using white as the referent group. Risk ratios for any pain and chronic pain were adjusted for income, employment status, life events, and mental health.

Results: Pain questions were answered by 498,071 participants between the ages of 40 and 69. Compared to the white group (prevalence 60.3%), persons identified as mixed (66.3%), south Asian (71.8%), black (70.2%), or other (71.5%) were more likely to report pain (see table). Relationships were similar for chronic pain, although less strong. Asian (Chinese) were no more likely to report pain (61.0%) and less likely to report chronic pain. After adjustment for potential confounders differences between groups remained but were smaller. Excess prevalence of regional pains was observed for all groups compared to whites apart from Asian (Chinese), who were more likely than whites to report neck or shoulder pain, and less likely to report hip pain and facial pain.

Conclusion: This study has shown differences in pain reporting according to self-reported ethnicity. These are partly explained by socio-economic and psychosocial factors, and adverse life events. The large numbers of centers in this study means the results are more generalizable compared to those from single center studies. Difference in pain prevalence between groups has implications for allocation of healthcare resources where populations differ.
Ethnic group specific prevalence (%)
WhiteMixedSouth AsianBlackAsian (Chinese)Any other
Any PainStandardised Prevalence60.366.371.870.261.071.5
RR (99% CI)111.09 (1.05-1.13)1.19 (1.17-1.21)1.15 (1.13-1.18)1.00 (0.95-1.06)1.18 (1.15-1.21)
RR adj (99% CI)211.03 (0.99-1.08)1.11 (1.08-1.14)1.06 (1.03-1.09)0.98 (0.91-1.06)1.09 (1.05-1.13)

Chronic PainStandardised Prevalence42.646.747.745.236.547.0
RR (99% CI)111.11 (1.05-1.17)1.15 (1.12-1.19)1.08 (1.05-1.12)0.86 (0.79-0.95)1.13 (1.08-1.18)
RR adj (99% CI)211.04 (0.98-1.11)1.05 (1.01-1.09)0.95 (0.91-0.99)0.89 (0.79-1.004)1.01 (0.95-1.07)

HeadacheStandardised Prevalence22.0225.530.228.423.731.8
RR (99% CI)110.99 (0.91-1.08)1.29 (1.23-1.34)1.13 (1.07-1.18)0.94 (0.83-1.06)1.29 (1.21-1.37)

Facial PainStandardised Prevalence1.92.71.62.10.81.7
RR (99% CI)111.25 (0.93-1.70)0.87 (0.70-1.09)1.04 (0.84-1.28)0.36 (0.16-0.80)0.86 (0.63-1.16)

Shoulder/neck PainStandardised Prevalence23.028.730.725.528.728.7
RR (99% CI)111.24 (1.15-1.35)1.35 (1.30-1.41)1.11 (1.05-1.17)1.24 (1.11-1.39)1.25 (1.17-1.33)

Back painStandardised Prevalence25.827.633.431.327.334.7
RR (99% CI)111.07 (0.99-1.16)1.28 (1.23-1.33)1.21 (1.16-1.27)1.06 (0.95-1.19)1.34 (1.27-1.42)

Abdominal PainStandardised Prevalence9.314.011.114.510.214.4
RR (99% CI)111.31 (1.15-1.48)1.13 (1.04-1.22)1.39 (1.28-1.50)0.98 (0.80-1.21)1.40 (1.27-1.56)

Hip PainStandardised Prevalence10.310.08.310.86.78.9
RR (99% CI)111.10 (0.95-1.27)0.92 (0.85-1.01)1.19 (1.09-1.30)0.72 (0.56-0.92)0.97 (0.86-1.10)

Knee PainStandardised Prevalence20.421.925.425.317.923.1
RR (99% CI)111.19 (1.09-1.29)1.35 (1.30-1.41)1.40 (1.33-1.46)0.96 (0.84-1.10)1.25 (1.17-1.34)

1RR adjusted for age/sex, standardised
2RR (adj) additionally adjusted for income, employment, adverse life events, and mental health