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Eur J Pain. 2019 Jan;23(1):35-45. doi: 10.1002/ejp.1255. Epub 2018 Jun 27.

Drivers of international variation in prevalence of disabling low back pain: Findings from the Cultural and Psychosocial Influences on Disability study.

Author information

1
Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK.
2
Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK.
3
School of Nursing, University of São Paulo, Brazil.
4
Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral - IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador.
5
Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia.
6
Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, TX, USA.
7
Center for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA.
8
Program Health, Work and Environment in Central America, Institute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica.
9
North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, Essex, UK.
10
Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain.
11
CIBER of Epidemiology and Public Health, Barcelona, Spain.
12
IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
13
Unidad Central de Contingencias Comunes (U3C), Mutua Asepeyo, Spain.
14
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
15
Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece.
16
Institute of Technology, Estonian University of Life Sciences, Tartu, Estonia.
17
Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Lebanon.
18
Department of Occupational Health, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
19
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
20
Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka.
21
Department for Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan.
22
National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.
23
Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
24
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
25
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.

Abstract

BACKGROUND:

Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.

METHODS:

Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ('pain propensity index'). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression.

RESULTS:

After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58).

CONCLUSIONS:

Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine.

SIGNIFICANCE:

Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.

PMID:
29882614
DOI:
10.1002/ejp.1255
[Indexed for MEDLINE]

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