Pain During Midlife: A Cross-National Analysis of Cohort Differences in Reports of Pain in the United States, Europe, South Korea, and Mexico

Over the past several decades, middle-aged Americans have exhibited troubling trends of declining mental and physical health over successive cohorts. Interestingly, this trend has not been observed in peer nations in Europe, Asia, and Mexico. Later-born cohorts in other countries typically report better midlife mental and physical health than their earlier-born counterparts. It is less clear the extent to which physical pain shows similar trends to what has been observed in the U.S. and comparison peer nations. The goal of the current study was to examine how self-reports of pain have historically changed during midlife and investigate whether differences emerge between the U.S. and peer nations. We used harmonized data on pain from nationally representative longitudinal panel surveys from the U.S., 13 European nations, South Korea, and Mexico to directly quantify similarities and differences in historical change in midlife pain. Our results supported the hypothesis that midlife pain is higher amongst later-born cohorts in the U.S. A similar pattern of historical increases in pain was observed in Continental and Nordic Europe. In England, Mediterranean Europe, South Korea, and Mexico, the opposite pattern was observed with historical declines in pain. Historical increases in reports of pain in the U.S. emerged more quickly for later-born cohorts at earlier stages of midlife. These results suggest there could be aspects of American midlife today that are exacerbating reports of pain, and these aspects may be shared in some European nations but absent or less influential in other peer nations. Our discussion focuses on potential explanations for this pattern, such as population level discrepancies in health, differential use of health care services, and the inter/intrapersonal costs of westernization, as well as how pain is conceptualized across nations.