____________________________________________________________ The Intersection of Pain and Culture
Women in the United States are more likely than men to expe- rience headaches, abdominal pain, and chronic widespread pain. Women are also more likely to report higher pain inten- sity than men, and young girls are more likely to experience pain in multiple areas compared with boys [27]. Reports of chronic pain differ among racial and ethnic minority groups. In one study, Asian Americans had the lowest prevalence of pain (2.4%), while Native Americans had the highest (11.1%) [182]. By comparison, the prevalence of pain is 6.8% for White Americans, 7.6% for Black Americans, and 5% for Hispanic Americans. Roughly 23.5% of non-Hispanic White adults have chronic pain, compared with 6.8% Asian adults and 19.3% African Americans [19]. In one survey, Mexican Americans and African Americans had lower rates of back pain, leg and feet pain, and arm and hand pain compared to their White counterparts [9]. Pain can affect many aspects of a patient’s life. More than 25% of adults with chronic pain indicate that their pain has had an adverse impact on their employment [10]. Approximately 75% of individuals with high-impact chronic pain are unemployed [183]. It is estimated that chronic pain results in costs of $635 billion annually, including more than $60 billion in lost pro- ductivity alone [11; 32]. Direct healthcare costs are estimated to be up to $300 billion [30]. This is more than the costs of cancer, heart disease, and diabetes combined. Pain also affects the emotional and psychologic domains of an individual’s life. Those who experience chronic pain are at increased risk for a variety of psychiatric problems, including substance abuse, depression, and anxiety. For example, patients with migraines are two to four times more likely to have depression than those without migraines [12]. Migraine also more than doubles the risk of anxiety disorder and agoraphobia or panic disorder and increases the likelihood of alcohol use disorder [13].
Mexico, California, the District of Columbia, and Texas are regions in the United States that consist of a “majority-minor- ity,” meaning that more than half of the areas’ populations consist of individuals who are racial/ethnic minorities [15]. With the increase of immigration and the slower birth rate in White families, it is anticipated that the United States is rapidly moving toward becoming a majority minority [15]. As of 2022, 63.7 million people in the United States identified as Hispanic, and they are the largest racial/ethnic minority group [185]. The Hispanic or Latino population is expected to increase from 19.1% in 2022 to 26.9% by 2060 [186]. AFRICAN AMERICANS “African American” is a classification that serves as a descrip- tor; it has sociopolitical and self-identification ramifications. The U.S. Census Bureau defines African Americans or Black Americans as persons “having origins in any of the Black racial groups of Africa” [17]. According to the U.S. Census, African Americans number 49.6 million as of 2021 [31]. The state with the largest Afri- can American population, numbering at 3.9 million, is Texas [187]. By 2060, it is projected they will comprise 17.9% of the U.S. population [31]. In terms of a metropolitan city in the United States, New York City had the largest concentration of African Americans in 2022, numbering at 3.6 million [188]. This group tends to be young; in 2022, the median age of this population was 32.1 years, compared with a nation median age of 38 years [188]. In terms of educational attainment, 90.3% of those 25 years of age and older have a high school diploma or have completed college [31]. ASIAN AMERICANS As of 2021, 24.0 million Americans identified as Asian [189]. California had the largest concentration of Asians (6.5 million) followed by New York (1.8 million) [57]. Between 2000 and 2019, Asians experienced the greatest growth (81%) compared with any other racial group [133]. Between 2016 and 2017, this group had the highest growth rate at 3.0% [132]. The Chinese group represents the largest Asian subgroup in the United States, and it is projected that this population will grow to 35.7 million between 2015 and 2040 [20; 21]. In 2021, Chinese Americans numbered 5.2 million; this number does not include Taiwanese individuals [189]. They also have the highest educational attainment of any racial/ethnic group; 55.1% of Asian Americans 25 years of age and older have a bachelor’s degree or higher [189]. “Asian” is a single term widely used to describe individuals who have kinship and identity ties to Asia, including the Far East, Southeast Asia, and the Indian subcontinent [22]. This encompasses countries such as China, Japan, Korea, Vietnam, Cambodia, Thailand, India, Pakistan, and the Philippines. Pacific Islander is often combined with Asian American in census data. The Pacific Islands include Hawaii, Guam, Samoa,
THE UNITED STATES: A MULTICULTURAL LANDSCAPE
The U.S. Census uses a variety measures to capture national diversity. One approach is the diversity index, which is a cal- culation that tells us how likely two people chosen at random will be from a different race and ethnicity groups. The index ranges from 0 to 100, whereby 0 signifies a lack of diversity and 100 indicates greater diversity [184]. The diversity index for the total U.S. population is 61.1%, which means there is 61.1% chance that any two people chosen at random are from different racial or ethnic groups [184]. In 2010, the U.S. diversity index was 54.9%. According to U.S. Census data, the minority population is growing each year. By 2060, the minority population is expected to increase to 241 million, with the Hispanic popu- lation growing by 142%, the Asian population by 116%, and the African American population by 50% [14]. Hawaii, New
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