The data

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The cross-sectional Canadian Community Health Survey (CCHS) collects information about health status, health care use and health determinants for about 98% of the population aged 12 or older.  It covers household residents in the provinces and territories; members of the Canadian Forces and residents of institutions, Indian reserves and other Aboriginal settlements, and some remote areas are excluded.

Data collection for cycle 4.1 began in January 2007 and continued over 24 months.  The sample size was 131,959; the response rate was 76.4%.  To account for survey design effects, in this analysis, standard errors and coefficients of variation were estimated using the bootstrap technique.^22,23 A significance level of p < 0.05 was used.

This analysis pertains to 57,660 CCHS respondents aged 12 to 44, representing an estimated 14.6 million Canadians (Appendix Table A).  Proxy respondents (1,062) were excluded from the study sample.  (The prevalence of pain did not differ significantly between proxy and non-proxy respondents).  An estimated 63% of the study population were aged 25 to 44, and 69% were married or living in common-law relationships.  The majority lived in households where at least one member was a postsecondary graduate (81%) and resided in urban areas (84%).  An estimated 4% were Aboriginal; 76% defined their cultural or racial background as "White."  An estimated 11% reported chronic pain, and more than half of these people characterized their pain as at least "moderate."

Table A Selected characteristics of study sample, household population aged 12 to 44, Canada, 2007/2008

Respondents were asked, "Are you usually free of pain or discomfort?"  Those who answered "No" were considered to have chronic pain and were asked to assess the usual intensity as "mild," "moderate" or "severe."  They were also asked how many activities their pain prevents.  Those who responded "a few," "some" or "most" (versus "none") were considered to have pain that prevents activities.

Respondents were categorized into four age groups:  12 to 17; 18 to 24; 25 to 34; and 35 to 44.

Among respondents aged 25 to 44, marital status was categorized as single (never married); married/common-law; or separated/divorced/widowed.

Based on the highest level of education in the household, respondents were grouped into four categories:  less than secondary graduation, secondary graduation, some postsecondary, and postsecondary graduation.

Racial/Cultural group was defined as White, Aboriginal, or other (includes multiple racial/cultural origins).

Residence identified whether a respondent lived in an urban or rural area based on 2006 Census geography.

The presence of chronic conditions was established by asking respondents if a health professional had diagnosed them as having a condition that had lasted, or was expected to last, at least six months.  The interviewer read a list of conditions.  Individual conditions reported in this study included back problems (excluding fibroymyalgia and arthritis), arthritis, migraine, mood disorder, anxiety disorder, stomach/intestinal ulcers, bowel disorder/Crohn's disease or colitis, and diabetes.

A more comprehensive list of chronic conditions was used to estimate the total number of chronic conditions each respondent had.  In addition to those listed above, cancer, asthma, high blood pressure, heart disease, effects of stroke, urinary incontinence, Alzheimer's disease or other dementia, emphysema, and chronic obstructive pulmonary disease were included.  The count of chronic conditions was categorized into four groups: none, 1, 2, and 3 or more.

Activity restriction was based on a response of "often" or "sometimes" (versus "never") to the questions:  "Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity you can do . . .

• . . . at home?"
• . . . at school?"
• . . . at work?"(respondents aged 25 to 44)
• . . . in other activities, for example, transportation or leisure?"

Perceived health was based on the question, "In general would you say your health is:…"  The five response categories were combined into two groups:  good/very good/excellent and fair/poor.  A similar question was asked for perceived mental health.

Among respondents aged 25 to 44, perceived work stress at the main job or business in the past 12 months was measured by asking:  "Would you say that most days at work were: not at all stressful? a bit stressful? quite a bit stressful? extremely stressful?" Respondents who answered "quite a bit" or "extremely stressful" were classified as having high perceived work stress. 

Based on respondents' working status in the week before the interview, they were classified as worked at a job last week; absent from work last week; did not have a job last week; or permanently unable to work.  These variables were restricted to respondents aged 25 to 44.

This study has a number of limitations.  Respondents were not asked about the duration, frequency or site of their pain, and no distinction is made between cancer and non-cancer pain.   Information on medications, especially those that may have an impact on pain, was not collected.  The data are cross-sectional, so no conclusions can be made about temporal order, that is, whether pain led to activity limitations or vice versa.  Finally, chronic conditions were self-reported and not verified by another source.