Chronic Pain-Associated Mortality in the United States: A Population-Based Study, 1999-2023

BACKGROUND: Chronic pain is increasingly recognised as a disease with substantial morbidity, yet large-scale data on chronic pain-associated mortality trends and disparities are lacking. OBJECTIVE: To examine nationwide temporal trends and demographic disparities in chronic pain-associated mortality in the US from 1999 to 2023. METHODS: Death certificate data from the Centres for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database (1999-2023) were extracted. All deaths with chronic pain listed as a contributing cause were included (n = 67,417), reporting chronic pain (ICD-10 codes R52.1 and R52.2). Age-adjusted mortality rates (AAMRs) per 1,000,000 population, standardized to the 2000 US population. Trends were analysed using Joinpoint regression and represented by annual percentage changes (APCs) with 95% confidence intervals. RESULTS: Among 67,417 chronic pain-associated deaths (61.5% female), AAMR increased from 1.97 per 1,000,000 in 1999 to 10,72 per 1,000,000 in 2023 (average APC, +6.3%; 95% CI5.8% to 6.8%). Increases in AAMR were noted across both sexes (females; average APC, 6.1%; males: 6.6%), age groups (≥ 55 years: average APC, 6.5%; < 55 years: 4.7%), race/ethnicities (non-Hispanic White; average APC, 6.3%; non-Hispanic Black: 10.4% to 2019 then stable; Hispanic: similar acceleration), and regions (all average APCS, 5.3% to 6.3%). Females and those ≥ 55 years had higher AAMRS; the South had the highest burden (33.9% of deaths). CONCLUSION: These findings revealed a marked rise in chronic pain-associated mortality, disproportionately affecting females, older adults, non-Hispanic White individuals, and the South, signalling chronic pain as a public health concern. Enhanced documentation, interventions targeting comorbidities and disparity-focused policies are urgently needed to mitigate this burden.