Racial Differences in Chronic Pain and Quality of Life among Adolescents and Young Adults with Moderate or Severe Hemophilia.
BACKGROUND AND OBJECTIVE
We explored racial differences in adherence to recommended clotting factor treatment regimens, chronic pain, and quality of life (QoL) among adolescents and young adults (AYAs) diagnosed with moderate or severe hemophilia.


METHODS
A convenience sample of hemophilia patients aged 13-25 years completed an online cross-sectional survey in 2012. Chronic pain was measured using the revised Faces Pain Scale (FPS-R) and dichotomized as high (FPS-R ≥ 4) or low (FPS-R < 4). QoL was measured with the SF-36.


RESULTS
Of 80 AYA participants (79 male), most had severe disease (91 %) and hemophilia A (91 %). Most were white (76 %) and non-Hispanic (88 %). At the univariate level, compared to whites, non-whites were more likely to have produced an inhibitor against clotting factor treatment (74 vs 38 %, p < .01), less likely to have commercial health insurance (16 vs 63 %, p < .001), more likely to report high levels of chronic pain (FPS-R ≥ 4) (63 vs 26 %, p < .01), and had lower SF-36 physical composite summary (PCS) scores. Adjusted logistic and quantile regression modeling, respectively, revealed that non-whites were 5.31 (95 % CI 1.62, 17.4; p < .01) times more likely to report high chronic pain and had median PCS scores that were 26.0 (95 % CI 11.0, 40.9; p < .01) points lower than whites.


CONCLUSIONS
Targeted efforts to prevent and manage chronic pain among non-white AYAs with moderate or severe hemophilia are necessary. After accounting for demographic and clinical differences, there were no racial differences in adherence to recommended clotting factor treatment regimens; however, non-whites were more than five times more likely to report high levels of chronic pain, which predicted worse overall physical QoL, bodily pain, physical and social functioning, and greater role limitations due to physical health.
['McLaughlin|John M|JM|', 'Lambing|Angela|A|', 'Witkop|Michelle L|ML|', 'Anderson|Terry L|TL|', 'Munn|James|J|', 'Tortella|Bartholomew|B|']
D000293:Adolescent D000328:Adult D001779:Blood Coagulation Factors D059350:Chronic Pain D003430:Cross-Sectional Studies D005260:Female D054624:Health Status Disparities D006467:Hemophilia A D006630:Hispanic or Latino D006801:Humans D008297:Male D055118:Medication Adherence D010147:Pain Measurement D011788:Quality of Life D044469:Racial Groups D012720:Severity of Illness Index D044465:Whites D055815:Young Adult
Pain Quality of life Hemophilia Adherence Clotting factor Race Racial disparity