Marital status and high-impact pain among middle-aged and older adults: A population-based longitudinal study in the United States.

Despite the prevalence and importance of pain for public health, little is known about how social characteristics affect the experience of pain. Though marital relationships have well documented associations on mental and physical health, research on the effects of relationship status on pain is limited. To address this limitation, we examine how changes in marital status are associated with high-impact pain, drawing on existing theoretical models of the influence of marriage on health. We use longitudinal data from the Health and Retirement Study, a nationally representative sample of American adults over 50, spanning the 1998-2016 waves of collection, capturing 157,130 person-year observations from 19,767 community-dwelling middle-aged and older adults. We estimate fixed effects models predicting the experience of high-impact pain, controlling for time-variant measures of age, socioeconomic status (income, wealth, and employment status), and health behaviors (drinking and smoking). We find that experiencing high-impact pain is significantly less likely for those who transition from marriage to either divorce (b = -0.21, 95% confidence interval: -0.35 to -0.07) or widowhood (b = -0.34, 95% confidence interval: -0.41 to -0.26). The alleviation of stress following marital dissolution and the adaptive nature of stress responses may buffer the immediate psychological impact of the transitions and protect against pain. Our findings highlight not only the relevance of social relationships for understanding pain experiences in older adults but also call for further study on how the diversifying experiences of family life in older ages affect pain. PERSPECTIVE: This study is among the first to examine the longitudinal relationship between marital status and pain at the population level. Transitions from marriage to divorce or widowhood are associated with a reduced risk of high-impact pain, suggesting that stress relief and adaptive responses following marital dissolution may buffer pain experiences.