1098 Journals of Gerontology: Social Sciences cite as: J Gerontol B Psychol Sci Soc Sci, 2023, Vol. 78, No. 6, 1098–1108 https://doi.org/10.1093/geronb/gbac199 Advance Access publication December 23, 2022 © The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Research Article Global Pain and Aging: A Cross-Sectional Study on Age Differences in the Intensity of Chronic Pain Among Middle- Aged and Older Adults in 20 Countries Esteban Calvo, PhD, 1,2, * , Cynthia Córdova, MS, 1 Robin Shura, PhD, 3 Kasim Allel, MS, 2,4 Alvaro Castillo-Carniglia, PhD, 1,5 Katherine M. Keyes, PhD, 6 Christine Mauro, PhD, 6 Pia M. Mauro, PhD, 6, José T. Medina, MS, 1,2 Thelma Mielenz, PhD, 6 Carla Taramasco, PhD, 2,7 and Silvia S. Martins, PhD, MD 8 1 Society and Health Research Center, School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Región Metropolitana, Chile. 2 Millennium Nucleus on Sociomedicine, Santiago, Región Metropolitana, Chile. 3 Department of Sociology, Kent State University at Stark, North Canton, Ohio, USA. 4 Institute for Global Health, University College London, London, UK. 5 Millennium Nucleus for the Evaluation and Analysis of Drug Policies, Santiago, Región Metropolitana, Chile. 6 Mailman School of Public Health, Columbia University, New York City, New York, USA. 7 Facultad de Ingeniería, Universidad Andres Bello, Santiago, Región Metropolitana, Chile. 8 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA. *Address correspondence to: Esteban Calvo, PhD, Department of Epidemiology, Mailman School of Public Health, Columbia Aging Center, 722 W. 168th Street, Office 412, New York, NY 10032, USA. E-mail: esteban.calvo@columbia.edu Received: May 17, 2022; Editorial Decision Date: December 13, 2022 Decision Editor: Anna Zajacova, PhD Abstract Objectives: This study aims to examine age differences in the intensity of chronic pain among middle-aged and older adults, where intensity is measured on a scale differentiating between chronic pain that is often troubling and likely requires in- tervention versus more endurable sensations. We aim to explore whether individual health and national gross domestic product (GDP) explain these differences as well. Methods: Cross-nationally harmonized data from 20 countries on self-reported intensity of chronic pain (0 = no, 1 = mild, 2 = moderate, 3 = severe) in 104,826 individuals aged 50+ observed in 2012–2013. Two-level hierarchical ordinal linear models with individuals nested within countries were used to isolate estimations from heterogeneity explained by method- ological differences across single-country studies. Results: Overall, mean participant age was 66.9 (SD = 9.9), 56.1% were women, and 41.9% of respondents reported any chronic pain. Chronic pain intensity rose sharply with age in some countries (e.g., Korea and Slovenia), but this association waned or reversed in other countries (e.g., the United States and Denmark). Cross-country variation and age differences in chronic pain were partly explained (85.5% and 35.8%, respectively) by individual-level health (especially arthritis), country-level wealth (as indicated by GDP per capita), and demographics. Discussion: Chronic pain intensity is not an inevitable consequence of chronological age, but the consequence of poten- tial selection effects and lower activity levels combined with individual-level health and country-level wealth. Our findings suggest further investigation of health conditions and country affluence settings as potential targets of medical and policy interventions aiming to prevent, reduce, or manage chronic pain among older patients and aging populations. Keywords: Cross-national, Life course, Old age, Pain intensity, Social epidemiology Downloaded from https://academic.oup.com/psychsocgerontology/article/78/6/1098/6958489 by Promedica Health System user on 29 August 2023