Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic

Abstract

The coronavirus disease 19 (COVID-19) pandemic negatively affected children's health in the United States (US), with more severe disruption for marginalized groups. However, potential impact on pediatric chronic pain has not been assessed at the population level. This study aimed to (1) estimate differences in the US national prevalence of pediatric chronic pain during the first year of the COVID-19 pandemic (2020), relative to one year earlier (2019); (2) determine whether differences in prevalence varied across sociodemographic groups; and (3) explore changes in child, caregiver, and family factors associated with chronic pain prevalence. Using data of children 6 to 17 years from the National Survey of Children's Health 2019 and 2020 (n = 50,518), we compared weighted percentages of sample characteristics by year and conducted a series of directed-acyclic graph–informed survey-weighted Poisson regressions. The estimated national prevalence (95% CI) of pediatric chronic pain was 10.8% (9.9, 11.9%) in 2019, decreasing to 7.6% (6.9, 8.3%) in 2020. Contrary to hypotheses, the adjusted prevalence of chronic pain was 31% lower in 2020 than in 2019 (aPR = 0.69, 95% CI: 0.61, 0.79), adjusting for child age, sex, race or ethnicity, caregiver education, neighborhood park or playground, and census region. The 2019 to 2020 change in chronic pain prevalence was similar by age (P = 0.34), sex (P = 0.94), race or ethnicity (P = 0.41), caregiver education (P = 0.49), neighborhood park or playground (P = 0.22), and census region (P = 0.20). Exploratory analyses identified 3 potential contributors to the unexpected decrease in the national prevalence of pediatric chronic pain: lower prevalence of bullying, more frequent family meals, and higher family resilience.

Pediatric chronic pain and exposure to bullying as perpetrator or victim

“…Expanding our analysis of NSCH data to 2021 and 2022, we contrasted trends of chronic pain and bullying victimization to determine if these variables were correlated outside of the 2019 to 2020 period. After 2020, the chronic pain prevalence decreased further, from 8% in 2020 1,3 to 7% in the most recent 2 years of data. Similarly, bullying victimization continued to decrease to 31% in 2021 but rebounded in 2022 to 38%, and bullying perpetration remained at 13% to 14% in 2021 and 2022, respectively.…”

“…

We read with interest the recent paper by Kapos et al 3 describing a decline in the prevalence of pediatric chronic pain from 2019 to 2020, attributed to lower the prevalence of bullying victimization, more frequent family meals, and higher family resilience. The National Survey of Children's Health (NSCH), used for this analysis, collects data on both victimization and perpetration of bullying (variable names BULLIED_R and BULLY, respectively).

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Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic: erratum

“…A variable naming error was identified in our recently published article. 1 All instances of the bullying variable in the text and tables should be referred to as “bullying perpetration” instead of “suffering bullying” as originally described. All presented numeric values are unaffected.…”