Social Determinants of Pain Prevalence: A Cross-National Comparison of Four European Countries

Background/Objectives: Pain is a major public health burden shaped by social and structural factors, yet cross-national evidence on how social determinants influence pain prevalence across socioeconomically diverse European settings remains limited. This study aimed to examine the associations between social determinants and the prevalence of pain in four European countries, and to explore how these associations vary by national context. Methods: We conducted a multinational secondary analysis of cross-sectional data from the third wave of the European Health Interview Survey (EHIS), using Eurostat microdata for Serbia, Bulgaria, Norway and Finland (n = 34,882 respondents aged ≥15 years). Pain prevalence was examined in relation to sociodemographic characteristics, health status, chronic conditions and behavioural determinants. LASSO-selected logistic regression models were fitted separately for each country. Results: Pain prevalence varied markedly across countries, ranging from 35.4% in Serbia to 69.9% in Finland (p < 0.001). Musculoskeletal disorders showed strong associations with pain in countries where this factor was retained in the models (OR range, 3.40–4.26), while accidents/injuries (OR range, 1.43–2.66), greater daily life limitations (OR range, 1.55–2.52), poorer self-rated health (OR range, 1.66–2.22), and female gender (OR range, 1.38–1.91) were consistently associated with higher odds of pain in all countries. The associations of education, employment, income, household composition, and behavioural factors with pain varied across national contexts and may reflect country-specific socioeconomic conditions. Conclusions: Pain prevalence was associated with a broad range of social, demographic and health-related factors, with the magnitude and direction of associations varying across national contexts. Pain prevention and management strategies should address both clinical characteristics and the broader social determinants of health, tailored to the national socioeconomic environment.