Pain and Analgesic Utilization in Medically Underserved Areas: Five-Year Prevalence Study from the Rochester Epidemiology Project

Figures & data

Table 1 Baseline Variables of Overall Study Population

Variable	n/N (%) or Mean ± SD
Status of Medical Underservice
MUA	22/27 (81.5)
N-MUA	5/27 (18.5)
Mean IMU Score^a	55.6 ± 8.6
Pain Symptoms (prevalence per 100 people)
Chest Pain	14.0 ± 2.4
Nonspecific Chest Pain	11.6 ± 2.2
Abdominal Pain	19.0 ± 3.6
Lumbago	11.1 ± 2.0
Somatoform Disorder	0.8 ± 0.3
Painful Respiration	2.4 ± 0.6
Analgesic Use (prevalence per 100 people)
Opioid Use	24.6 ± 3.9
Non-opioid analgesic use	10.2 ± 8.2
Salicylates	1.4 ± 1.0
Non-steroidal anti-inflammatory drug	18.7 ± 5.8

Notes: Number of observations per total (n/N) and percentage are provided for categorical variables, and mean and standard deviation (SD) are provided for all continuous variables. These descriptive statistics were performed for five-year prevalence data (January 1, 2011 to January 1, 2016). These prevalence values were directly standardized based on age and sex to the total United States 2010 population. P-value<0.05 is considered statistically significant. ^aIMU: index of medical underservice. Note that this score is only applicable to MUA.

Abbreviations: MUA, medically underserved area; N-MUA, non-medically underserved area.

Figure 1 Medically Underserved Area Status of All Counties in the Rochester Epidemiology Project (REP) Database. Medically underserved area was indicated by red color, and non-medically underserved area was indicated by blue color. Index of Medical Underservice (IMU) scores are provided for all counties with MUA status. The Health Resources and Services Administration (HRSA) database does not provide IMU scores for non-medically underserved areas. Map was amended from the Rochester Epidemiology Project Data Exploration Portal with permission. April 2019, version 3.0. [Accessed 9 September 2021]: https://www.rochesterproject.org/portal/.²⁷

Abbreviation: MUA, medically underserved area.

Table 2 Comparison of Pain Prevalence and Analgesic Use Between Underserved and Non-Underserved Counties

Five-Year Prevalence
Pain Symptoms (prevalence per 100 people)	MUA (n=22)	Not MUA (n=5)	P value
Chronic Pain	13.8 ± 2.5	14.6 ± 2.0	0.543
Nonspecific Chest Pain	11.6 ± 2.2	11.8 ± 2.4	0.879
Abdominal Pain	18.9 ± 3.6	19.4 ± 4.2	0.775
Lumbago	10.9 ± 2.1	11.8 ± 1.9	0.381
Somatoform Disorder	0.8 ± 0.4	0.7 ± 0.2	0.848
Painful Respiration	2.4 ± 0.6	2.6 ± 0.7	0.486
Analgesic Use (prevalence per 100 people)
Opioid Use	24.5 ± 3.8	24.9 ± 4.7	0.846
Non-opioid Analgesic Use	9.5 ± 7.7	13.1 ± 10.5	0.389
Salicylates	1.3 ± 1.0	1.6 ± 0.9	0.547
Non-steroidal Anti-inflammatory Drug	18.2 ± 5.6	20.6 ± 6.9	0.430

Notes: Mean and standard deviation are provided for all continuous variables and stratified based on medically underserved area (MUA) status. Linear regression analysis was performed to compare outcomes based on MUA status. These analyses were performed for five-year prevalence data (January 1, 2011 to January 1, 2016). These prevalence values were directly standardized based on age and sex to the total United States 2010 population. P-value<0.05 is considered statistically significant.

Table 3 Association Between IMU Score and Outcomes of Pain Prevalence and Analgesic Use

Five-Year Prevalence
Pain Symptoms (prevalence per 100 people)	Β-coefficient (95% C.I.)	P value
Chronic Pain	−0.06 (−0.20–0.07)	0.343
Nonspecific Chest Pain	−0.10 (−0.21–0.01)	0.081
Abdominal Pain	−0.09 (−0.28–0.10)	0.328
Lumbago	−0.05 (−0.16–0.06)	0.379
Somatoform Disorder	−0.01 (−0.03–0.01)	0.168
Painful Respiration	−0.04 (−0.07 – −0.01)	0.021*
Analgesic Use (prevalence per 100 people)
Opioid Use	−0.06 (−0.26–0.14)	0.551
Non-opioid Analgesic Use	0.00 (−0.43–0.42)	0.979
Salicylates	−0.01 (−0.06–0.05)	0.806
Non-steroidal Anti-inflammatory Drug	−0.02 (−0.32–0.28)	0.907

Notes: Linear regression analysis was performed to identify any association between the Index of Medical Underservice (IMU) score and variables related to pain symptoms and analgesic use. Beta-coefficient and 95% C.I. (confidence interval) are reported for each association. These analyses was performed for five-year prevalence data (January 1, 2011 to January 1, 2016). These prevalence values were directly standardized based on age and sex to the total United States 2010 population. The association between IMU score and painful respiration was no longer significant after significance threshold adjustment per the Bonferroni method. *P-value<0.05.

Abbreviation: MUA, medically underserved area.

The Rochester Epidemiology Project Data Exploration Portal. Geography. Available from: https://www.rochesterproject.org/portal/. Accessed September 09, 2021

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