NB19-03: Socioeconomic Status, Perceptions of Pain, and the Disparity in DI Receipt

There is a well-known socioeconomic gradient in disability insurance receipt. Among people aged 55-64, DI or SSI receipt is four times higher among people with a high school degree or less than among people with a college degree. Setting aside program rules that favor the less educated (due to a narrower set of possible jobs, and a higher replacement rate for those with lower earnings), a good part of the gap in disability insurance receipt is associated with differential rates of experiencing pain and associated functional limitations, especially joint pain (primarily hips and knees) and back/neck pain. The less educated are 10 percentage points more likely to report musculoskeletal pain than are the better educated. Understanding why disability is so tilted to the less educated is key to evaluating the economic importance of disability insurance as well as forecasting future trends. The goal of our proposal is to test three hypotheses for differences in pain across education groups: (1) the less educated have more physical impairments than the better educated; (2) the less educated have less access to health care to address musculoskeletal impairment; and (3) the less educated have different social or financial resources to address living with health impairments. Our analysis will analyze multiple data sets to consider these different reasons for experiences of pain and disability by education status. We will:
• Gather data on reports of pain, medical care use, X-ray and MRI images of anatomy, and social and
financial resources of people with incident pain.
• Analyze the relationship between pain reports and three sets of variables: physical anatomy; use of medical care; and social/financial resources.
• Write one or more research papers and a policy brief explaining the findings and disseminate them as widely as possible.