Sex differences in pain in 2 large and diverse US databases

Introduction: Sex differences have been recognized as significant influences on disease suceptibility and progression. Objectives: This study aimed to assess sex differences in pain prevalence using 2 large and diverse US data sources, All of Us and Epic Cosmos. Methods: Pain concepts, labels used to describe type, chronicity, and body locations in electronic health records, were identified from 254,639 individuals in All of Us and 292,549,808 in Epic Cosmos data. Prevalence ratios (PRs) and 95% confidence intervals comparing the prevalence between females and males were computed to determine sex differences in each pain concept, in each data set. Ratios >1 and <1 denoted higher prevalence among females and males, respectively. Results: The search yielded 195 pain concepts available in both All of Us and Epic Cosmos. Of these, 72.9% in All of Us and 82.6% in Epic Cosmos showed higher prevalence among females. Higher prevalence among men was observed in 8.9% (All of Us) and 13.3% (Epic Cosmos) of pain concepts, mainly involving the chest, lower limbs, and inguinal region. Between 4.1% and 18.2% of the concepts did not show evidence of differences in prevalence by sex. Only one conditions displayed opposing direction in PRs, possibly due to differences in sample composition and/or variation in clinical assignment criteria for pain concepts. Conclusion: Higher pain prevalence among females in the United States was observed for most pain concepts in 2 large and diverse databases. These results underscore the importance of pain research, prevention, and management approaches stratified by sex.