A USC/Princeton study released Monday found that middle-aged Americans are now reporting more pain than the elderly — and it has to do with their level of education and that pain is rising more quickly in younger people.

Using survey responses from more than 2.5 million adults in the United States and the European Union, the researchers found pain is more prevalent among the two-thirds of U.S. adults without a four-year college degree than among older Americans. Strikingly, each generation of less-educated Americans is experiencing higher pain throughout their lives than older generations, according to the researchers.

“Our expectation was that pain would increase as one’s age increases, due to physical deterioration and higher probability of chronic illnesses,” said study co-author Arthur Stone, a professor of psychology at the USC Dornsife College of Letters, Arts and Sciences and director of the Dornsife Center for Self-Report Science. “But our research found middle-aged Americans had higher levels of pain than the elderly, which is especially pronounced for people without a college degree, and the question was, why?”

The study authors also found this pain pattern is unique to the United States compared to other wealthy nations. They say if pain prevalence continues to increase with each generation, Tuesday’s elderly will be sicker than Monday’s elderly. They said the findings, published online in the Proceedings of the National Academy of Sciences, have serious implications for the American healthcare system.

“Pain undermines quality of life, and pain is getting worse for less-educated Americans,” said study co-author Sir Angus Deaton, Presidential Professor of Economics at USC Dornsife and fellow at the USC Schaeffer Center for Health Policy and Economics and the Dwight D. Eisenhower Professor of Economics and International Affairs Emeritus at Princeton University.

“This not only makes their lives worse but will pose long-term problems for a dysfunctional healthcare system that is not good at treating pain,” Deaton said.

The research team used multiple data sets and definitions of pain from surveys conducted by Gallup, the U.S. Census Bureau and the European Union. Reports of pain were recorded between 2006 and 2018 among adults aged 25-79 in the U.S. and 20 other wealthy countries. The American data included only Black and white non-Hispanic adults.

The authors also looked at different birth cohorts born between 1930 and 1990 using data from four U.S. surveys: the Gallup Health and Wellbeing Index, the Census Bureau’s National Health Interview Survey, the Department of Health and Human Services’ Medical Expenditure Panel Survey, and the University of Michigan’s Health and Retirement Study.

In their first set of analyses, they found that men and women living outside of the United States report more pain as they age — the expected result. In their second analysis, after examining education level, they found this to also be true for Americans with a bachelor’s degree but not for the two-thirds of U.S. adults without a college degree, who reported more pain in midlife.

The key to the mystery was examining when people of different ages were born. For example, researchers compared three groups or cohorts of 52-year-olds with less education: those born in 1955, 1960 and 1965, and found that 40y% of the 1965 cohort reported pain at age 52, compared with 32% of the 1955 cohort. For less-educated cohorts, each year of age is associated with an increase in pain prevalence of around one percentage point per year, according to the study findings.

Less-educated Americans also experience more pain as they age. But because each birth cohort reports higher levels of pain throughout their adult life than the cohort before them, those who are middle-aged report more pain at any given age than older adults, who have had lower pain levels throughout their lives.

“The connection between less-educated Americans and pain is shaped by a number of factors from income to social isolation to rising deaths of despair,” said study co-author Anne Case, the Alexander Stewart 1886 Professor of Economics and Public Affairs, Emeritus at the Princeton School of Public and International Affairs. “It’s of great concern to us, as researchers, that it seems to be worsening.”

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