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Relationship Between Persistent Pain and 5-Year Mortality: A Population-Based Prospective Cohort Study

Authors

  • Joseph W. Shega MD,

    Corresponding author
    1. Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
    • Address correspondence to Joseph W. Shega, Section of Geriatrics and Palliative Medicine, University of Chicago, (MC 6098), 5841 S. Maryland Ave, Chicago, IL 60637. E-mail: jshega@gmail.com

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  • Melissa Andrew MD,

    1. Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Ashwin Kotwal MA,

    1. Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
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  • Denys T. Lau PhD,

    1. Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
    2. Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
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  • Keela Herr PhD,

    1. College of Nursing, University of Iowa, Iowa City, Iowa
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  • Mary Ersek PhD,

    1. School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Debra K. Weiner MD,

    1. Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennslvania
    2. Department of Medicine, University of Pittsburgh, Pittsburgh, Pennslvania
    3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennslvania
    4. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennslvania
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  • Marshall H. Chin MD,

    1. Section of General Internal Medicine, University of Chicago, Chicago, Illinois
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  • William Dale MD, PhD

    1. Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
    2. Section ofHematology and Oncology, University of Chicago, Chicago, Illinois
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Abstract

Objectives

To assess the association between self-reported noncancer pain and 5-year mortality.

Design

Cohort.

Setting

Community-dwelling older adults.

Participants

Canadian Study of Health and Aging 1996 wave.

Measurements

Registrar of Vital Statistics–established 5-year mortality. Noncancer pain was assessed using the 5-point verbal descriptor scale, dichotomized into no or very mild versus moderate, severe, or very severe pain. Frailty was the accumulation of health deficits. Cognitive status (Modified Mini-Mental State Examination) and depressed mood (five-item mental health screening questionnaire) were also assessed. Multivariable logistic regression and Cox proportional hazards were used to analyze the relationship between pain and 5-year mortality.

Results

Of 5,703 participants, 4,694 (82.3%) had complete data for analysis; 1,663 of these (35.4%) reported moderate, severe, or very severe pain, and 1,343 (28.6%) had died at 5-year follow-up. Four hundred ninety-six of those who died (29.8%) reported moderate, severe, or very severe pain and 847 (27.9%) no or very mild pain. Multivariate logistic analysis found that individuals with moderate, severe, or very severe pain had lower odds of 5-year mortality than those with no or very mild pain (odds ratio = 0.78, 95% confidence interval (CI) = 0.66–0.92; P < .001). The risk of death was lower in persons reporting moderate or greater pain than in those with no or very mild pain (HR = 0.85, 95% CI = 0.75–0.96; P = .01). An interaction between pain and sex explained this effect. Men with pain were not significantly more likely than men without pain to die (HR = 1.00, 95% CI = 0.84–1.19; P = .99), whereas women without pain (HR = 0.54, 95% CI = 0.47–0.63; P < 0.01) and women with pain (HR = 0.40; CI = 0.33–0.47; P < .01) had less risk of death than men without and with pain, respectively.

Conclusion

Older women with pain were less likely to die within 5 years than older women without pain, men in pain, or men without pain.

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