Decoding the mystery of American pain reveals a warning for the future.
Decoding the mystery of American pain reveals a warning for the future.
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DOI：
10.1073/pnas.2012350117
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发表时间：
2020-10-06
影响因子：
11.1
通讯作者：
Stone AA
中科院分区：
文献类型：
--
作者：
Case A;Deaton A;Stone AA
在美国，老年人报告的疼痛比中年人要少--这或许表明，一旦人们步入老年，他们的发病率将会下降。不幸的是，在某个时间点按年龄评估疼痛掩盖了这样一个事实，即每个连续出生的队列在任何给定的年龄都比之前的队列报告更多的疼痛。我们不能用今天老年人的经历来预测明天老年人的疼痛流行情况。与今天的中年老人相比，今天的老年人一生中经历的痛苦更少，他们将成为明天的老年人。如果这些模式继续下去，所有成年人的疼痛患病率将继续上升；明天的老年人将比今天的老年人病情更重，这将对医疗保健产生严重影响。有一种预期是，平均而言，疼痛会随着年龄的增长而增加，因为累积的伤害、身体的磨损和日益增加的疾病负担。与这一预期一致的是，在其他富裕国家，疼痛随着年龄的增长而增加。然而，在今天的美国，老年人报告的痛苦比中年人要少。这就是美国人痛苦的奥秘。使用多个数据集和对疼痛的定义，我们表明，今天的中年美国人在整个成年过程中经历的痛苦比今天的老年人更多。按照出生和完成学士学位的年份分解年龄的横截面，我们发现，对于那些受教育程度较低的人来说，每个连续出生的队列在每个年龄都有更高的疼痛患病率--这一结果在拥有学士学位的人中找不到。因此，在每一个连续出生的队列中，受教育程度高和受教育程度低的人之间的痛苦差距都有所扩大。出生人口的增加不能用职业的变化或受教育程度较低的人的肥胖水平来解释，但符合一个更普遍的模式，即1950年后出生的人的工人阶级生活持续受到侵蚀。如果这些模式继续下去，所有成年人的疼痛患病率将继续上升；重要的是，明天的老年人将比今天的老年人病情更重，这可能会对医疗保健产生严重影响。
The elderly in the United States report less pain than those in midlife—suggesting, perhaps, that once people move into old age, their morbidity will fall. Unfortunately, assessing pain by age at one point in time masks the fact that each successive birth cohort reports more pain at any given age than the cohorts that came before it. We cannot use the experience of the elderly today to project pain prevalence of the elderly tomorrow. Today’s elderly have experienced less pain throughout their lives than those in midlife today, who will be tomorrow’s elderly. If these patterns continue, pain prevalence will continue to increase for all adults; tomorrow’s elderly will be sicker than today’s elderly, with serious implications for healthcare. There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today’s midlife Americans have had more pain throughout adulthood than did today’s elderly. Disaggregating the cross-section of ages by year of birth and completion of a bachelor’s degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age—a result not found for those with a bachelor’s degree. Thus, the gap in pain between the more and less educated has widened in each successive birth cohort. The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950. If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow’s elderly will be sicker than today’s elderly, with potentially serious implications for healthcare.
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DOI：
10.2147/ceor.s148405
发表时间：
2018
期刊：
ClinicoEconomics and outcomes research : CEOR
影响因子：
--
作者：
Hadjiat Y;Serrie A;Treves R;Chomier B;Geranton L;Billon S
通讯作者：
Billon S
影响因子：
10.7
作者：
Benjamin, Daniel J.;Heffetz, Ori;Szembrot, Nichole
通讯作者：
Szembrot, Nichole
影响因子：
8.4
作者：
Kaplan, Greg;Schulhofer-Wohl, Sam
通讯作者：
Schulhofer-Wohl, Sam
影响因子：
3.5
作者：
Case, A;Paxson, C
通讯作者：
Paxson, C
DOI：
10.1093/geronb/gbx162
发表时间：
2020-02-01
影响因子：
6.2
作者：
Zimmer, Zachary;Zajacova, Anna
通讯作者：
Zajacova, Anna