Reproductive Factors and Pain Among Middle-Aged and Older Chinese Women: Cross-Sectional and Longitudinal Evidence from CHARLS
- 1Department of Obstetrics and Gynecology, Shunyi Maternal and Children’s Hospital of Beijing Children’s Hospital, Beijing, People’s Republic of China
Abstract
Purpose: To examine reproductive factors and pain in middle-aged and older Chinese women.
Methods: We used CHARLS data, combining the core survey with the Life History reproductive module. The cross-sectional analysis included 8532 women in 2018; the longitudinal analysis included 3856 women pain-free at the 2011 baseline with pain assessments in 2013, 2015, or 2018. The outcome was self-reported any pain, not clinically diagnosed chronic pain. Survey-weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Menopause exposures were evaluated in a postmenopausal-baseline sensitivity analysis; musculoskeletal pain sensitivity analyses tested robustness.
Results: Cross-sectionally, three or more biological children (vs one, OR 1.30, 95% CI 1.06–1.61) and three or more miscarriages (vs none, OR 1.83, 95% CI 1.07–3.13) were associated with prevalent self-reported any pain in 2018. Longitudinally, 2743 women first reported pain during follow-up. Menarche after age 18 was associated with lower odds of first reported pain in the primary cumulative model (OR 0.66, 95% CI 0.49–0.87) and the discrete-time person-period analysis (OR 0.75, 95% CI 0.61–0.92). Three or more miscarriages were associated with higher odds in the primary longitudinal model (OR 3.66, 95% CI 1.01–13.32) but were imprecise and not significant in the person-period analysis. Early menopause was associated with follow-up pain only in the postmenopausal-baseline sensitivity analysis (OR 1.61, 95% CI 1.08–2.40). Cross-sectional findings were supported by musculoskeletal pain sensitivity analyses.
Conclusion: Later age at menarche was associated with lower odds of self-reported follow-up pain across two complete-case longitudinal modeling approaches, a signal that requires confirmation. Higher parity and multiple miscarriages were associated with prevalent pain cross-sectionally. The longitudinal signals for multiple miscarriages and early menopause were less robust and exploratory. Because the outcome was self-reported any pain rather than clinically diagnosed chronic pain, these associations are hypothesis-generating; prospective studies with standardized, chronic-pain-specific outcomes are needed.
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BibTeX
@article{ding2026reproductive,
title = {{Reproductive Factors and Pain Among Middle-Aged and Older Chinese Women: Cross-Sectional and Longitudinal Evidence from CHARLS}},
author = {Ning Ding and Hongmin Sun and Jie Zhao and Ying Xie and Shuna Bu and Xin Mi},
journal = {International Journal of Women's Health},
year = {2026},
month = oct,
doi = {10.2147/ijwh.s632451},
url = {https://doi.org/10.2147/ijwh.s632451},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Reproductive Factors and Pain Among Middle-Aged and Older Chinese Women: Cross-Sectional and Longitudinal Evidence from CHARLS
AU - Ning Ding
AU - Hongmin Sun
AU - Jie Zhao
AU - Ying Xie
AU - Shuna Bu
AU - Xin Mi
PY - 2026
DA - 2026/10/31
JO - International Journal of Women's Health
DO - 10.2147/ijwh.s632451
UR - https://doi.org/10.2147/ijwh.s632451
AB - Purpose: To examine reproductive factors and pain in middle-aged and older Chinese women. Methods: We used CHARLS data, combining the core survey with the Life History reproductive module. The cross-sectional analysis included 8532 women in 2018; the longitudinal analysis included 3856 women pain-free at the 2011 baseline with pain assessments in 2013, 2015, or 2018. The outcome was self-reported any pain, not clinically diagnosed chronic pain. Survey-weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Menopause exposures were evaluated in a postmenopausal-baseline sensitivity analysis; musculoskeletal pain sensitivity analyses tested robustness. Results: Cross-sectionally, three or more biological children (vs one, OR 1.30, 95% CI 1.06–1.61) and three or more miscarriages (vs none, OR 1.83, 95% CI 1.07–3.13) were associated with prevalent self-reported any pain in 2018. Longitudinally, 2743 women first reported pain during follow-up. Menarche after age 18 was associated with lower odds of first reported pain in the primary cumulative model (OR 0.66, 95% CI 0.49–0.87) and the discrete-time person-period analysis (OR 0.75, 95% CI 0.61–0.92). Three or more miscarriages were associated with higher odds in the primary longitudinal model (OR 3.66, 95% CI 1.01–13.32) but were imprecise and not significant in the person-period analysis. Early menopause was associated with follow-up pain only in the postmenopausal-baseline sensitivity analysis (OR 1.61, 95% CI 1.08–2.40). Cross-sectional findings were supported by musculoskeletal pain sensitivity analyses. Conclusion: Later age at menarche was associated with lower odds of self-reported follow-up pain across two complete-case longitudinal modeling approaches, a signal that requires confirmation. Higher parity and multiple miscarriages were associated with prevalent pain cross-sectionally. The longitudinal signals for multiple miscarriages and early menopause were less robust and exploratory. Because the outcome was self-reported any pain rather than clinically diagnosed chronic pain, these associations are hypothesis-generating; prospective studies with standardized, chronic-pain-specific outcomes are needed.
SN - 1179-1411
ER -