title: No man is an island: living in a disadvantaged neighborhood influences chronic pain development after motor vehicle collision.
abstract: 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 emergency department evaluation. Follow-up evaluations were completed via telephone or Internet survey 6 weeks, 6 months, and 1 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 emergency department; MSP and pain interference with daily activity were assessed at 6 weeks, 6 months, and 1 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<0.0001). The relationship between neighborhood disadvantage and MSP was moderated by a common single nucleotide polymorphism, rs2817038, 5' of the gene encoding FKBP5, a functional regulator of glucocorticoid receptor sensitivity (interaction P-value=0.0015). These data support the hypothesis that low neighborhood socioeconomic status increases the likelihood of worse MSP outcomes after traumatic stress exposures such as MVC, and that this influence is mediated in part via its influence on stress system function.
authors.affiliation: TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Ulirsch
authors.affiliation: Departments of Medicine and Biostatistics, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Andrey V
authors.initials: AV
authors.lastname: Bortsov
authors.affiliation: TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: April C
authors.initials: AC
authors.lastname: Soward
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Peak
authors.affiliation: Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Niels K
authors.initials: NK
authors.lastname: Rathlev
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Domeier
authors.affiliation: Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA.
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: Hendry
authors.affiliation: TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA; Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA. Electronic address: smclean@aims.unc.edu.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
mesh_terms: D000063:Accidents, Traffic; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis* / Q000235:genetics; D059647:Gene-Environment Interaction; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D020641:Polymorphism, Single Nucleotide; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D022021:Tacrolimus Binding Proteins / Q000235:genetics; D035862:Vulnerable Populations; D055815:Young Adult; D000099159:Tacrolimus Binding Protein 5
chemical_list: D022021:Tacrolimus Binding Proteins; D000099159:Tacrolimus Binding Protein 5
keywords: FKBP5; Gene-by-environment interaction; Motor vehicle collision; Musculoskeletal pain; Neighborhood effects
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