BACKGROUND: High-impact chronic pain (HICP) represents a severe subset of chronic pain characterized by substantial functional interference. Although chronic pain is known to be more prevalent in rural areas, the magnitude and determinants of urban-rural disparities in HICP among older adults in China remain inadequately understood. METHODS: We conducted a community-based cross-sectional study among residents aged ≥ 60 years in Anning City, Yunnan Province, a region characterized by a distinct urban-rural composition. Chronic pain was identified via a structured questionnaire, and high-impact chronic pain (HICP) was assessed using the validated Chinese version of the PEG scale, operationally defined as a score ≥ 4 on any of the three domains(Pain intensity, Enjoyment of life, and General activity). Data on sociodemographic characteristics, lifestyle factors, comorbidities, and healthcare utilization were collected. Urban-rural comparisons were performed using Chi-square tests. To identify independent risk factors for HICP, we employed a two-stage binary logistic regression approach on the full analytical sample of chronic pain patients: univariate analyses were conducted first to examine crude associations, followed by multivariable logistic regression to estimate adjusted effects while controlling for potential confounders. RESULTS: Among 2,800 participants, the overall prevalence of chronic pain was 28.5%, with a significantly higher rate in rural areas (36.01%) than in urban areas (23.01%) (P < 0.001). Of those with chronic pain, 68.7% met the criteria for HICP, demonstrating a pronounced urban-rural disparity (81.92% rural vs. 53.49% urban, P < 0.001). In univariate logistic regression, rural residence exhibited the strongest crude association with HICP (odds ratio OR = 3.82, 95% confidence interval CI: 2.67-5.48). Additional factors significantly associated with increased odds included age ≥ 71 years (OR = 1.61, 95% CI: 1.14-2.28), occupation as a farmer (OR = 1.89, 95% CI: 1.31-2.71) or being unemployed (OR = 4.23, 95% CI: 1.98-9.02), and daily sedentary time ≥ 4 h (OR = 1.61, 95% CI: 1.14-2.28). In the fully adjusted multivariable model, rural residence remained the predominant independent risk factor for HICP (adjusted OR aOR = 3.56, 95% CI: 2.28-5.54). Advanced age (≥ 71 years) retained an independent association with elevated HICP risk (aOR = 1.48, 95% CI: 1.02-2.16). Notably, the significant crude effects of occupation and sedentary time were attenuated and no longer statistically significant after multivariable adjustment. Furthermore, good or very good self-reported sleep quality was independently associated with higher odds of HICP (aOR = 1.53, 95% CI: 1.04-2.25). Rural patients predominantly reported pain in weight-bearing joints and faced significant financial barriers to healthcare access. CONCLUSION: Profound urban-rural disparities exist in HICP among older adults in Southwest China, with rural residents exhibiting a markedly elevated risk of progressing to this most disabling form of chronic pain. These findings underscore the urgent need to integrate HICP screening into primary care and to develop tailored, community-based pain management strategies for rural aging populations.
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