Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle-Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE)

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Abstract

Background

Back pain is a common disabling chronic condition that burdens individuals, families and societies. Epidemiological evidence, mainly from high-income countries, shows positive association between back pain prevalence and older age. There is an urgent need for accurate epidemiological data on back pain in adult populations in low- and middle-income countries (LMICs) where populations are ageing rapidly. The objectives of this study are to: measure the prevalence of back pain; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 50 years and older, in six LMICs from different regions of the world. The findings provide insights into country-level differences in self-reported back pain and disability in a group of socially, culturally, economically and geographically diverse LMICs.

Methods

Standardized national survey data collected from adults (50 years and older) participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analysed. The weighted sample (n = 30, 146) comprised respondents in China, Ghana, India, Mexico, South Africa and the Russian Federation. Multivariable regressions describe factors associated with back pain prevalence and intensity, and back pain as a determinant of disability.

Results

Prevalence was highest in the Russian Federation (56%) and lowest in China (22%). In the pooled multi-country analyses, female sex, lower education, lower wealth and multiple chronic morbidities were significant in association with past-month back pain (p<0.01). About 8% of respondents reported that they experienced intense back pain in the previous month.

Conclusions

Evidence on back pain and its impact on disability is needed in developing countries so that governments can invest in cost-effective education and rehabilitation to reduce the growing social and economic burden imposed by this disabling condition.

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Most cited references 33

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A consensus approach toward the standardization of back pain definitions for use in prevalence studies.

Clermont E Dionne, Kate Dunn, Peter Croft … (2008)

A modified Delphi study conducted with 28 experts in back pain research from 12 countries. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.

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The association between obesity and low back pain: a meta-analysis.

Rahman Shiri, Jaro Karppinen, Päivi Leino-Arjas … (2010)

This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.

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1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

GORDON WADDELL (1987)

Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects--especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and understanding of illness by physicians and patients alike makes real change possible.

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Author and article information

Contributors

Alessandra Marengoni: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 4 June 2015

Publication date Collection: 2015

Volume: 10

Issue: 6

Electronic Location Identifier: e0127880

Affiliations

[1 ]Department Public Health and Clinical Medicine Epidemiology and Global Health, Umeå University, Umeå, Sweden

[2 ]Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia

[3 ]Human Sciences Research Council, Pretoria, South Africa

[4 ]Department of Psychology, University of the Free State, Bloemfontein, South Africa

[5 ]ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand

[6 ]Department of Community Health, University of Ghana, Accra, Ghana

[7 ]National Research Institute of Public Health (FSBI, RAMS), Moscow, Russian Federation

[8 ]Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China

[9 ]International Institute of Population Sciences, Deonar, Mumbai, India

[10 ]World Health Organization Study on global AGEing and adult health, Geneva, Switzerland

[11 ]Surveys, Measurement and Analysis Unit, World Health Organization, Geneva, Switzerland

Karolinska Institutet, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: JSW NN SC. Analyzed the data: JSW NN SC. Wrote the paper: JSW NN SC. Contributed to the design and implementation of the study, data collection and review of the manuscript: KP AY RB TM FW PA PK.

* E-mail: Jennifer.stewart.williams@ 123456epiph.umu.se

Article

Publisher ID: PONE-D-15-02189

DOI: 10.1371/journal.pone.0127880

PMC ID: 4456393

PubMed ID: 26042785

SO-VID: 877f2a4c-e9a2-4620-b52b-240b076d2997

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 22 January 2015

Date accepted : 20 April 2015

Page count

Figures: 0, Tables: 6, Pages: 21

Funding

In this work, Jennifer Stewart Williams and Nawi Ng were supported by the FORTE grant for the Umeå Centre for Global Health Research (No. 2006-1512). Nawi Ng was also supported by the Swedish Research Council’s “Linnestöd” grant (No 2006-21576-35119-66) for the Ageing and Living Conditions Programme at Umeå University, Sweden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability The SAGE data are in the public domain. See http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/sage.

Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle-Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE)

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Most cited references 33

A consensus approach toward the standardization of back pain definitions for use in prevalence studies.

The association between obesity and low back pain: a meta-analysis.

1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

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