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      Occupational status and self-reported low back pain by gender: a nation-wide cross-sectional study among the general population in Japan

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          Abstract

          Background

          We aimed to examine the cross-sectional association between occupational class and self-reported low back pain (LBP) in a representative sample of the Japanese general population.

          Methods

          We used anonymized data from a nationwide survey (31,443 men and 35,870 women aged ≥ 20). Occupational class variables included working status, occupation, employment status, and company size (number of employees). Covariates included age, socio-economic status, lifestyle, and comorbidities. Poisson regression models stratified by gender were used to estimate adjusted prevalence ratio (APR) and 95% confidence interval (CI) for self-reported LBP.

          Results

          The prevalence of self-reported LBP was 11.7% in men and 14.2% in women. After adjustment for covariates and mutual adjustment for all occupational class variables, among both genders, agricultural/forestry/fishery workers and non-workers had a significantly higher prevalence of self-reported LBP: APR (95% CI) of agricultural/forestry/fishery was 1.36 (1.08–1.70) in men and 1.59 (1.30–1.93) in women; that of non-workers was 1.42 (1.18–1.70) in men and 1.23 (1.08–1.40) in women. Among men, non-regular employees were more likely to have self-reported LBP than regular employees: APR (95% CI) was 1.25 (1.07–1.46) in part-timers and casual staff and 1.18 (1.03–1.35) in other types of non-regular employees. Moreover, compared to men working at companies with ≥ 100 employees, men working at companies with 30–99 employees had a significantly higher prevalence of self-reported LBP (APR 1.17; 95% CI, 1.03–1.34). Among women, professionals and technicians (1.26; 1.11–1.43) and sales workers (1.22; 1.04–1.43) had a significantly higher prevalence of self-reported LBP than clerks. Neither employment status nor company size was associated with self-reported LBP in women. After stratified analyses by age group, similar patterns were observed in participants aged 20–64, but not in those aged ≥ 65.

          Conclusion

          Our results suggest that self-reported LBP is highly prevalent among agricultural/forestry/fishery workers and the unemployed, regardless of gender, and that there are also gender differences in the association of occupational class factors with self-reported LBP. It is necessary, therefore, to take preventive measures against LBP based on gender and occupational class factors in Japan.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12199-021-01031-2.

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          Most cited references34

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          Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

          Summary Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
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            Epidemiology of chronic low back pain in US adults: National Health and Nutrition Examination Survey 2009-2010.

            To describe epidemiologic characteristics and associations with increased healthcare utilization in US adults with chronic low back pain (cLBP).
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              Estimating the global burden of low back pain attributable to combined occupational exposures.

              There is little information about the global burden of non-traumatic low back pain (LBP) attributable to the effects of physical and psychosocial occupational stressors. Based on a review of the epidemiological evidence, occupation-specific relative risks were used to compute attributable proportions by age, gender, and geographical sub-region for the economically active population aged 15 and older. The reference group was professional/administrative workers; other risk categories were Low, clerical and sales; Moderate, operators (production workers) and service; and High, farmers. Worldwide, 37% of LBP was attributed to occupation, with twofold variation across regions. The attributable proportion was higher for men than women, because of higher participation in the labor force and in occupations with heavy lifting or whole-body vibration. Work-related LBP was estimated to cause 818,000 disability-adjusted life years lost annually. Occupational exposures to ergonomic stressors represent a substantial source of preventable back pain. Specific research on children is needed to quantify the global burden of disease due to child labor. 2005 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                tkimiko@naramed-u.ac.jp
                Journal
                Environ Health Prev Med
                Environ Health Prev Med
                Environmental Health and Preventive Medicine
                BioMed Central (London )
                1342-078X
                1347-4715
                19 November 2021
                19 November 2021
                2021
                : 26
                : 111
                Affiliations
                GRID grid.410814.8, ISNI 0000 0004 0372 782X, Nara Prefectural Health Research Center, , Nara Medical University, ; Kashihara, Nara, Japan
                Author information
                http://orcid.org/0000-0002-9471-6987
                Article
                1031
                10.1186/s12199-021-01031-2
                8603561
                34798806
                03d0510d-d41f-4572-bd09-ebd98b7c0063
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 28 August 2021
                : 3 November 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001691, Japan Society for the Promotion of Science;
                Award ID: JP17K09209
                Funded by: Center Administrative Expense from Nara Medical University
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Occupational & Environmental medicine
                low back pain,epidemiology,cross-sectional studies,occupation,employment status,japan

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