Widespread Pain Doubles Odds of Daily Living Limits in Older Chinese Adults

Older Chinese adults who feel pain in multiple parts of the body show markedly higher odds of developing new difficulty with everyday tasks and new depressive symptoms within two years, according to a longitudinal cohort analysis published in BMC Public Health. Drawing on the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study, researchers led by Gang Lei and Yingying Hu followed 9,728 adults aged 60 and over and found that the association was graded: the more painful body sites a participant reported at baseline, the higher the odds of both outcomes at follow-up.

Their central question was whether the anatomical spread of pain, not merely its presence, carries information about subsequent functional and psychological outcomes. Longitudinal evidence on this question among older Chinese adults had been limited. To address it, the researchers classified participants by pain-site count at baseline into three groups: no pain, pain at one or two sites, or pain at three or more sites.

Two outcomes were tracked over the two-year follow-up. The first was incident limitation in activities of daily living, assessed among the 7,389 participants who had no such limitation at baseline. The second was incident depressive symptoms, measured with the ten-item Center for Epidemiologic Studies Depression scale. Baseline and follow-up scores were handled through multiple imputation across 50 datasets to account for missing values, yielding analytic samples of roughly 6,000 participants for that outcome.

The results showed a clear graded pattern. Compared with participants reporting no pain, those with pain at one or two sites had 40 percent higher odds of developing a new ADL limitation over two years, an odds ratio of 1.40 with a 95 percent confidence interval of 1.18 to 1.65. Their odds of new depressive symptoms were 35 percent higher, at an odds ratio of 1.35 with a confidence interval of 1.14 to 1.59.

For participants with pain at three or more sites, the associations were substantially stronger: odds ratios of 2.56 for incident ADL limitation and 2.06 for incident depressive symptoms. Tests for trend across the pain categories were highly significant for both outcomes, both with P values below 0.001, indicating that the odds climbed steadily as the anatomical footprint of pain widened. The team went beyond simple category comparisons by fitting restricted cubic splines, a statistical technique that models the shape of a relationship without forcing it into a straight line.

These analyses confirmed a significant overall association of pain-site count with both outcomes, with P values below 0.001, and also revealed nonlinearity: the nonlinearity test yielded a P value of 0.007 for incident ADL limitation and below 0.001 for depressive symptoms. What makes these findings notable is the specificity of the exposure. By counting painful sites, the authors treated the anatomical extent of pain as a variable in its own right, and it proved to be strongly associated with both outcomes.

That caution matters because the design is observational. Participants were not randomized to pain; they reported it, and the analysis used multivariable logistic regression to estimate odds ratios, but unmeasured factors, reverse causation and the limits of self-reported data all remain possible explanations for the observed associations.

The authors are explicit that the findings do not establish causal relationships. They also frame pain-site count carefully as a marker of anatomical pain extent rather than as a diagnostic tool or a prognostic threshold, meaning the number of painful sites should not be read as a cutoff that determines who will or will not develop a disability or depressive symptoms.

For now, the takeaway is measured: among older Chinese adults in this cohort, the more widespread the pain, the higher the odds of new difficulty with daily activities and new depressive symptoms over the following two years, with the strongest associations concentrated among those reporting pain at three or more sites. Pain-site count, the authors conclude, may offer complementary information about functional and psychological vulnerability beyond what single-site assessments capture.

Subject of Research: Longitudinal association between multisite pain and incident ADL limitation and depressive symptoms in older Chinese adults

Article Title: Association of multisite pain with incident ADL limitation and depressive symptoms in older Chinese adults: a two-year longitudinal cohort study

Article References: Lei, G., Tong, X., Yang, R., Zhang, S., Xiao, X., & Hu, Y. (2026). Association of multisite pain with incident ADL limitation and depressive symptoms in older Chinese adults: a two-year longitudinal cohort study. BMC Public Health. https://doi.org/10.1186/s12889-026-29572-7

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29572-7

Keywords: multisite pain, older adults, ADL limitation, depressive symptoms, China Health and Retirement Longitudinal Study, longitudinal cohort, disability, odds ratio, restricted cubic spline, aging, public health, Association