Pain and functional disability in older adults with cardiovascular disease: A cross-national comparison of India, China, and Mexico

Pain is highly prevalent among older adults with cardiovascular disease (CVD) and may compromise functional independence. However, the nature of this relationship in different cultural and healthcare contexts is not well understood. We examined the association between pain and functional limitations among adults aged 60 years and older with self-reported cardiovascular disease (CVD) using nationally representative data from the Longitudinal Aging Study in India (LASI, n = 11,247), the China Health and Retirement Longitudinal Study (CHARLS, n = 3733) and the Mexican Health and Aging Study (MHAS, n = 5108). Pain was assessed through self-report, and functional status was evaluated across activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. Cross-sectional associations were estimated using multivariable logistic regression, and longitudinal analyses examined the effect of baseline pain on incident disability at 3-year follow-up in the Chinese and Mexican cohorts. Pain was reported by 43.7%, 36.2%, and 43.6% of participants in India, China, and Mexico, respectively. After adjustment for covariates, pain was significantly associated with ADL disability in all three countries (India OR=1.86, China OR=2.22, Mexico OR=2.32), with similar associations observed for IADL and mobility limitations. Strong dose-response relationships were identified between pain frequency or severity and functional limitations. Longitudinal analyses further showed that baseline pain predicted new-onset ADL and IADL disability at follow-up. These findings demonstrate that pain is consistently associated with functional decline among older adults with CVD, underscoring the importance of pain assessment and management in geriatric cardiovascular care globally. PERSPECTIVE: This study reveals consistent cross-national associations between pain and functional disability among older adults with cardiovascular disease. Pain independently predicts future functional decline, underscoring its value as a clinical marker for early intervention and as a modifiable target in integrated cardiovascular and geriatric care programs.