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July 18, 2026BMC Health Services ResearchOpen Access

Greater healthcare barriers are linked to higher 7-day pain severity despite ~98% insurance coverage.

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Why the study?

Are healthcare-related social determinants of health associated with pain severity in adults with comorbid heart failure and chronic pain?

Population

4,026 adults with heart failure and chronic pain enrolled in the All of Us Research Program, mean age 69.90…

Design

Cross-sectional

Key result

Despite 98.48% having insurance, reporting more healthcare barriers (e.g., 34.88% requesting lower-cost prescriptions) was significantly associated with higher 7-day pain severity.

Authors

ASA SmithAKAmelia KnopfYZYehui Zhu

Discussion

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Overview

Healthcare barriers associate with higher pain severity in HF; leaves open whether addressing SDOH improves outcomes.

Key Points

  • This study aims to describe healthcare-related social determinants of health and examine their association with pain severity in individuals with heart failure and chronic pain.
  • Cross-sectional analysis using data from 4,026 adults with heart failure and chronic pain
  • Assessment of pain severity over 7 days using a 0 to 10 scale
  • Descriptive statistics and linear regression analysis were conducted to evaluate the relationship between SDOH and pain severity.
  • Participants with more barriers to healthcare reported significantly higher pain severity on a 7-day scale, with specific percentages indicating transportation (21.82%) and affordability issues (22.45%)
  • Other associated factors for increased pain severity included age, race, sex, comorbidity, depression, and fatigue
  • Despite 98.48% having insurance, significant barriers to accessing care remained, impacting pain severity.

Study Design

Type

Cross-Sectional (n=4,026)

Structured PICO

Are healthcare-related social determinants of health associated with pain severity in adults with comorbid heart failure and chronic pain?

P
Population
4,026 adults (mean age 69.9 years, 58.15% female) with comorbid heart failure and chronic pain enrolled in the All of Us Research Program.
E
Exposure
Healthcare-related social determinants of health (SDOH) including access, affordability, and utilization
O
Outcome
Pain severity over 7 days (0 to 10 scale)patient reported

Healthcare-related social determinants of health, such as affordability and access barriers, are significantly associated with higher pain severity in patients with heart failure and chronic pain.

Limitations

  • Lack of comprehensive pain measures
  • Lack of data on access to pain-specific services

Cite This Study

Smith et al. (2026) conducted a cross-sectional in Heart failure and chronic pain (n=4,026). Healthcare-related social determinants of health (SDOH) barriers vs. Fewer or no healthcare barriers was evaluated on Pain severity over 7 days (0 to 10 scale). Despite 98.48% having insurance, reporting more healthcare barriers (e.g., 34.88% requesting lower-cost prescriptions) was significantly associated with higher 7-day pain severity.

synapsesocial.com/papers/6a5b195c18557b26c203ae5bhttps://doi.org/10.1186/s12913-026-15009-9
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