OBJECTIVES: Use a non-linear decomposition method to estimate the relative contribution of biological, social determinants, and clinical factors to cognitive impairment among adults with and without pain.

METHODS: We adopted a cross-sectional design using data from the 2015 Medical Expenditure Panel Survey on non-institutionalized civilian adults (N = 21,374). We identified cognitive impairment (yes/no) from the household file by asking if the person (1) experienced confusion or memory loss, (2) had problems making decisions, or (3) required supervision for their safety. The pain variable was measured by asking “how much pain interfered with normal work” during the past 4 weeks. It was categorized as: ‘Pain’ (Moderate, Severe, and Extreme) and ‘No Pain’ (Not at all and a little bit). We controlled for other individual-level factors i.e., biological [sex, age, race], social [employment, marital status, poverty status, education health insurance, prescription coverage], clinical [asthma, COPD, cancer, diabetes mellitus, mental health conditions, hypercholesterolemia], and lifestyle factors [body mass index, exercise, smoking status]. A post-regression Fairlie non-linear decomposition technique was used to examine individual-level variables explaining the difference in cognitive impairment between the two pain groups.

RESULTS: Adults with pain constituted 21.1% of the study sample. Among adults with and without pain, 31.2% and 6.0% had cognitive impairment, respectively [difference= 25.2 percentage points]. After controlling for individual-level variables, adults with pain were more likely to report any impaired cognition than those without pain (AOR= 3.02, 95%CI= 2.70, 3.37). Post-regression decomposition analyses revealed that 10.4 percentage points of the difference in cognitive impairment were explained by differences in individual characteristics. Social determinants (i.e., employment, education, marital status, and poverty status) and mental health were the leading drivers of poor cognition among adults with pain.

CONCLUSIONS: Health in All Policies across health and non-health sectors could lead to an improvement in cognitive functioning of adults with pain.