Welfare Policies, Joint Pain Prevalence and Educational Gaps in 50 U.S. States from 2011 to 2021: A Fixed Effects Analysis.

Research on geographic disparities in pain and arthritis-related outcomes is still in its infancy, with little attention to the developing trends over time and the role of state's welfare policies in shaping pain disparities. This study examines 1) spatiotemporal trends of moderate/severe arthritis-related joint pain prevalence across 50 U.S. states, 2) educational disparities therein, and 3) the impact of welfare policies- i.e., Supplemental Nutrition Assistance Program, Earned Income Credit, minimum wage, unemployment insurance, and Medicaid generosity. This study compiles 6-wave biennial state-level panel data using data from the Behavioral Risk Factor Surveillance System (BRFSS). Logistic regressions are conducted to estimate trends of joint pain prevalence, prevalence for different educational groups (i.e., less than high school, high school or some college, bachelor's degree or above), and educational disparities. Incorporating policy data from the State Policy & Politics Database (SPPD) and the Kaiser Family Foundation's database (KFF), fixed effects regressions were used, with state- and year-fixed effects, to assess the impact of welfare policies. Results show that joint pain prevalence has risen in most states, with educational disparities in pain widening in over half, though both trends vary substantially across states. Colorado and North Dakota exhibit considerably sharper increases in both pain prevalence and educational inequalities. Generous Medicaid programs are associated with decreased joint pain prevalence for general population and the least-educated, and marginally linked to smaller educational inequalities therein. This study underscores the importance of state welfare policies in addressing pain disparities and calls for targeted interventions to support less-educated populations. PERSPECTIVES: This article draws on state-level panel data and data on state welfare policies to underscore the importance of studying macro-level policy determinants on pain and related disparities.