Welfare Policies, Arthritis-related Joint Pain Prevalence and Educational Gaps in 50 U.S. States from 2011 to 2021: A Fixed Effects Analysis
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Objective
Research on geographic disparities in pain and arthritis-related outcomes is still in its infancy, with particularly limited attention to the developing trends over time and the role of state’s welfare policies in shaping pain disparities. This study examines 1) spatiotemporal trends of moderate/severe arthritis-related joint pain prevalences across 50 U.S. states, 2) educational disparities therein, and 3) the impact of welfare policies— i.e., Supplemental Nutrition Assistance Program, Earned Income Credit, minimum wage, unemployment insurance, and Medicaid generosity score.
Data and Methods
We compile a 6-wave biennial state-level panel data using data from the Behavioral Risk Factor Surveillance System (BRFSS). Logistic regressions are conducted to estimate trends of joint pain prevalence, prevalences for different educational groups (i.e., less than high school, high school or some college, bachelor’s degree or above), and educational disparities. Incorporating policy data from the State Policy & Politics Database (SPPD) and the Kaiser Family Foundation’s database (KFF), we use fixed effects regressions, with state- and year-fixed effects, to assess the impact of welfare policies.
Results
Joint pain prevalence has risen in most states, with educational disparities in pain widening in over half, though both trends vary substantially across states. Colorado and North Dakota exhibit considerably sharper increases in both pain prevalence and educational inequalities. A more generous Medicaid program is shown to effectively reduce joint pain prevalence and eliminate educational inequalities in pain.
Conclusion
This study underscores the importance of state welfare policies in addressing pain disparities and calls for targeted interventions to support less-educated populations.
