New research from The University of Texas at Arlington shows that differences in state welfare policies are linked to rising arthritis-related joint pain across much of the U.S.
The study, led by Feinuo Sun, UT Arlington assistant professor of kinesiology and the senior author of the paper in The Journal of Pain, investigated how state-level policies— including minimum wage laws, Medicaid coverage, other welfare programs and education levels—affect pain outcomes.
"For the first time, we examined the development of arthritis pain over 10 years and how state welfare policies shape these trends," Dr. Sun said.
Arthritis pain has become more common over the last decade, now affecting an estimated 58.5 million Americans, according to the Centers for Disease Control and Prevention. Between 2011 and 2021, an additional 4.6 million people reported moderate to severe joint pain.
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The study analyzed data from the Behavioral Risk Factor Surveillance System from 2011 to 2021, tracking arthritis-related pain over a full decade. This approach differs from previous research, which typically relied on cross-sectional data capturing only a single year.
Texas is among the states showing a significant increase in overall joint pain. Colorado saw the largest rise, with an average increase of 26.2%, followed by Hawaii, Nebraska, Kansas, North Dakota and Texas. Only four states—Montana, Wyoming, South Dakota and New York—showed a decreasing trend.
However, among the states with a significant increase in overall joint pain, Texas was the only one to see a decrease in the educational gap—meaning the difference in pain prevalence between adults with high and low education levels narrowed, Sun said.
"In Colorado, both the education gap and overall pain prevalence have risen, indicating that pain has been increasing most rapidly among adults with the lowest education levels," she said. "In contrast, in Texas, the education gap narrowed while overall pain prevalence still increased, suggesting that the rise was primarily driven by growing pain prevalence among higher-educated adults."
Identifying states with both rising pain prevalence and widening education gaps, Sun said, is a key takeaway from the study, as it highlights where interventions may be most needed.
Related: UTA researcher takes geographic approach to health
Another important finding is the impact of Medicaid generosity in reducing both overall pain and disparities across education levels. The study found that states with more generous Medicaid programs not only have lower joint pain prevalence but also smaller education gaps in pain. The score for Medicaid generosity was measured across four dimensions: income eligibility, immigrant benefits, administrative burden and benefit levels.
"Medicaid generosity is a comprehensive measure of how accessible and beneficial the program is," Sun said. "And we found that more generous Medicaid programs help reduce arthritis-related pain, particularly among adults with lower levels of education."
Next steps for the research include exploring how individuals' experiences with pain are influenced by changes in state-level policies, helping researchers better understand how geography and governance shape public health.
About The University of Texas at Arlington (UTA)
Celebrating its 130th anniversary in 2025, The University of Texas at Arlington is a growing public research university in the heart of the thriving Dallas-Fort Worth metroplex. With a student body of over 42,700, UTA is the second-largest institution in the University of Texas System, offering more than 180 undergraduate and graduate degree programs. Recognized as a Carnegie R-1 university, UTA stands among the nation's top 5% of institutions for research activity. UTA and its 280,000 alumni generate an annual economic impact of $28.8 billion for the state. The University has received the Innovation and Economic Prosperity designation from the Association of Public and Land Grant Universities and has earned recognition for its focus on student access and success, considered key drivers to economic growth and social progress for North Texas and beyond.
