Family Relationship Quality Linked to Pain Phenotype Trajectories for Aging Black Adults: Second-Order Latent Class Analysis

Context Links between family relationships and how chronic pain outcomes co-occur and unfold during aging may provide targets for intervention to ameliorate persistent pain disparities experienced by older Black adults.Objective Identify distinct longitudinal pain phenotype trajectories and links to family relationship quality for aging Black Americans.Study Design/Analysis We identified cross-sectional pain phenotypes at each wave via latent class analysis (LCA), followed by second-order LCA to determine participants’ movement in and out of these phenotypes resulting in 14-year pain phenotype trajectories. We tested the extent to which family relationship quality was linked to pain phenotype trajectories via multinomial logistic regression.Dataset Health and Retirement Study, a nationally representative longitudinal study of aging (biennial 2006-2020 waves).Population Studied Aging Black Americans who reported on chronic pain incidence (N = 2586).Instrument Valid, reliable measures of support and strain in family, parent-child, and intimate partner relationships to assess family relationship quality.Outcome Measures Pain incidence, severity, interference, and medication use at each wave; all were entered into each cross-sectional LCA to identify clustering of pain indicators.Results Three pain phenotypes were identified at each wave, cross-sectionally: severe high-impact chronic pain, mild-to-moderate chronic pain, no chronic pain. Second-order LCA determined each participant’s probability of experiencing each phenotype at each wave, simultaneously, resulting in five pain phenotype trajectories: No Chronic Pain (n = 1222), Persistent Mild-to-Moderate Chronic Pain; Persistent Severe High-Impact Chronic Pain; Chronic Pain Recovery; Chronic Pain Worsening. Compared to pain-free adults, the odds of Persistent Mild-to-Moderate Pain were lower for those who reported greater intimate partner support (OR=.74) and higher with greater intimate partner strain (OR=1.35). The odds of Persistent Severe High-Impact Chronic Pain were lower with greater intimate partner (OR=.64), family (OR=.72), and parent-child support (OR=.73), and higher with greater family (OR=1.46) and parent-child strain (OR=1.40). Greater parent-child strain was linked to higher odds of Chronic Pain Worsening (OR=1.39).Conclusions Pain management interventions targeting family relationships may be a key biopsychosocial strategy to improve aging Black Americans’ pain outcomes.