Yulin Yang​ ​
Research
Multilevel Social Determinants of Pain and Aging
My research seeks to understand multilevel social determinants of pain. I explore how individual, social, and environmental factors influence pain experiences and outcomes. I use a life course perspective to examine how these factors change over time and across different populations.
I conduct research on the role of neighborhood social and built environmental factors in shaping pain outcomes. My recent paper found that perceived neighborhood characteristics including social cohesion, physical disorder, social ties, and safety are all associated with the prevalence, incidence, and recovery rate of chronic pain using longitudinal data from HRS (published in the Journal of Aging and Health). To explore further, I have submitted a K99/R00 grant application to the National Institute on Aging (NIA) to study how neighborhood social and built environment affect pain outcomes by linking HRS and electronic health record data with newly available neighborhood data in the National Neighborhood Data Archive (NaNDA).
State policies, operating at the macro-structural level, have been identified as the “causes of the cause of the causes” behind geographic disparities in health. I investigate how state policy shapes individual health outcomes. One project I evaluates the impact of rebalancing of state Medicaid expenditures from long-term support and services (LTSS) in institutional settings (e.g., nursing home) toward home- and community-based services (HCBS) on the prevalence and disparities of unmet care needs among people with disability (published in Health Services Research) and long term care utilization (under review in Health Affairs). The evidence suggests more generous HCBS expenditures are associated with lower prevalence of unmet care needs, but this effect is only for White older adults but not for people of color. In a collaborative study published in Pain, we compared the prevalence of joint pain across U.S. states, estimated educational disparities in joint pain across states, and assessed whether state sociopolitical contexts help explain this cross-state variation.
Racial disparities, criminal justice, and pain outcomes in later life
In this line of research, I collaborated with interdisciplinary teams of epidemiologists, pyschologists, and physicians to evaluate the patterns of racial/ethnic disparities in pain outcomes and to explore the potential drivers for these inequalities.
We found evidence that older adults of color experienced more interferences due to pain than their White peers (published in Journal of Gerontology, Medical Sciences). Moreover, structural racism can be embodied in many social processes and mass incarceration is one of them. We argue that being formerly incarcerated is an adverse event and disproportionately affects racially minoritized populations and may have both direct and indirect impacts on later-life pain and end-of-life outcomes. One paper I led found that incarceration histories were associated elevated risk of reporting pain in later life, even after using a propensity score analysis to account for the selection bias (forthcoming in Innovation in Aging).
Social Consequences of Pain
I study how older adults’ social lives are shaped by chronic pain experiences. Through engaging with medical sociology, the life course perspective, social gerontology, and pain research, my research evaluated the role of chronic pain in shaping social relationships among older adults. Theoretically, I argued that chronic pain challenges the classic sick role perspective due to its invisibility and subjectivity; chronic pain patients may thus have difficulty achieving the sick role and hence receive social support from family and friends.
To answer this question, I analyzed data from the Health and Retirement Study (HRS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE) and applied advanced statistical methods (e.g., group-based trajectory modeling, dyadic analysis, and lagged variable approach) to understand if, when, and how chronic pain predicts changes in social relationships. I found that the timing (i.e., onset and trajectory) and the severity (none, mild, moderate, and severe) of pain may have distinct or opposite impacts on relationship structure (e.g., number of friends) and quality (e.g., perceived support and strain). In the study published in the Journal of Gerontology, Social Sciences, I found newly onset of chronic pain predicts an increase in the number of friends among whose with moderate pain, but not among those with severe pain.
In another study published in Social Science & Medicine, I found similar partterns that onset of pain predicted an increase in quantity (i.e., number of social ties, diversity of the type of social ties), but a decrease in quality (i.e., closeness, satisfaction) of one’s social network. Moreover, the health and social lives of older adults were disproportionately impacted by the Covid-19 Pandemic and related polices. I used HRS covid data in 2020 to compare the psychological distress during the pandemic among older adults with pain to those without pain, and examined whether using technology for social purpose moderates the associations between pain and psychological distress (published in Pain Medicine).