Why is pain more common amongst people living in areas of low socio-economic status? A population-based cross-sectional study

V R Aggarwal, T V Macfarlane, G J Macfarlane
British Dental Journal 2003 April 12, 194 (7): 383-7; discussion 380

STUDY OBJECTIVE: To confirm a relationship between self-reported oro-facial pain and deprivation using an area-based measure of deprivation, and to investigate possible mechanisms of the association.

DESIGN: A cross sectional population based survey.

SETTING: General medical practice in South-East Cheshire (Borough of Congleton, North West England).

PARTICIPANTS: Two thousand, five hundred and four people aged 18-65 years living in the community.

METHODS: A postal questionnaire was sent which asked about pain in the oro-facial region. Information on factors which may 'explain' any relationship between pain and social class was collected: psychological distress, maladaptive responses to illness, sleep problems and local mechanical factors such as teeth grinding and facial trauma. Participants were allocated a Townsend index deprivation score on the basis of their postcode.

MAIN RESULTS: The study achieved an adjusted participation rate of 74% (N = 2,504) and the overall prevalence of oro-facial pain was 26%. Statistical analysis revealed that people in the most deprived areas were more likely to report oro-facial pain compared with the most affluent ones [OR 1.50 (95% confidence interval 1.09, 2.07)]. This relationship remained after adjusting for all potential confounding factors.

CONCLUSION: While the relationship between oro-facial pain and deprivation exists, the mechanisms of such relationships are not clear. Local mechanical factors, trauma or psychological distress did not explain it. The factors linking pain with social deprivation remain to be elucidated.

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