Associations between chronic pain, depression, and social vulnerability in US adults with colon cancer.

Abstract

e15698 Background: Chronic pain is a frequent and disabling sequela of colon cancer treatment, yet nationally representative U.S. data evaluating the contribution of social vulnerability and mental health remain limited. We examined associations between social determinants of health, psychosocial factors, and chronic pain among adults with colon cancer. Methods: We conducted a cross-sectional analysis of pooled 2021 and 2023 National Health Interview Survey data accessed through IPUMS, identifying adults aged ≥18 years with self-reported history of colon cancer. Chronic pain was defined as pain occurring on most or every day for ≥3 months. Social vulnerability indicators included federal poverty status, food insecurity, delayed or forgone medical care due to cost, and lack of a usual source of care. Psychosocial variables included self-reported lifetime depression and anxiety. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for age, sex, and race/ethnicity. Interaction terms tested effect modification by depression and anxiety across poverty strata. Model discrimination was assessed using receiver operating characteristic (ROC) curves, and calibration was evaluated with Hosmer-Lemeshow goodness-of-fit tests. Survey-weighted sensitivity analyses incorporating NHIS sampling weights, strata, and primary sampling units were performed to assess robustness. Results: Among 380 adults with colon cancer, median age was 62 years (interquartile range, 54–71), 54% were female, and 32% identified as racial or ethnic minority groups. Overall, 207 individuals (54%) reported chronic pain. In adjusted analyses, female sex (aOR 2.16, 95% CI 1.33–3.56) and depression (aOR 3.72, 95% CI 1.97–7.24) were independently associated with higher odds of chronic pain. Living below the federal poverty level was associated with lower odds of chronic pain compared with ≥200% of the poverty threshold (aOR 0.23, 95% CI 0.08–0.59). Anxiety was not independently associated with pain after adjustment. Poverty-by-depression and poverty-by-anxiety interactions were nonsignificant. The final model demonstrated moderate discrimination (AUC 0.72) and adequate calibration (Hosmer-Lemeshow P = .27). Survey-weighted sensitivity analyses yielded consistent effect estimates, with depression remaining the strongest predictor of chronic pain. Conclusions: More than half of U.S. adults with colon cancer reported chronic pain. Depression was strongly associated with pain burden, independent of demographic and socioeconomic factors. These findings support integrating routine psychosocial screening and mental health services into survivorship care to mitigate long-term pain-related morbidity.