No Man is an Island: living in a disadvantaged neighborhood influences chronic pain development after motor vehicle collision, and this effect is moderated by common genetic variation influencing HPA axis function

Living in a lower socioeconomic status neighborhood has been shown to alter stress system function and is associated with a number of adverse health outcomes, but its influence on musculoskeletal pain (MSP) outcomes after traumatic stress exposures such as motor vehicle collision (MVC) has not been assessed. We performed a multicenter, prospective study that enrolled 948 European-American individuals within 24 hours of MVC who were discharged home after ED evaluation. Follow-up evaluations were completed via telephone or internet survey six weeks, six months, and one year after MVC on 91%, 89%, and 91% of participants, respectively. A robust aggregate measure of census tract neighborhood disadvantage was derived, and individual-level characteristics assessed included socioeconomic and demographic characteristics, pain prior to MVC, litigation status, and opioid use. MSP was assessed in the ED, MSP and pain interference with daily activity were assessed at six weeks, six months, and one year. After adjustment for individual-level factors, living in more disadvantaged neighborhoods was associated with increased MSP (p=0.0009) and increased pain interference with daily function (p