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      Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies

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          Abstract

          Background

          Chronic diseases and musculoskeletal conditions have a significant global burden and frequently co-occur. Musculoskeletal conditions may contribute to the development of chronic disease; however, this has not been systematically synthesised. We aimed to investigate whether the most common musculoskeletal conditions, namely neck or back pain or osteoarthritis of the knee or hip, contribute to the development of chronic disease.

          Methods

          We searched CINAHL, Embase, Medline, Medline in Process, PsycINFO, Scopus and Web of Science to February 8, 2018, for cohort studies reporting adjusted estimates of the association between baseline musculoskeletal conditions (neck or back pain or osteoarthritis of the knee or hip) and subsequent diagnosis of a chronic disease (cardiovascular disease, cancer, diabetes, chronic respiratory disease or obesity). Two independent reviewers performed data extraction and assessed study quality. Adjusted hazard ratios were pooled using the generic inverse variance method in random effect models, regardless of the type of musculoskeletal condition or chronic disease. PROSPERO: CRD42016039519.

          Results

          There were 13 cohort studies following 3,086,612 people. In the primary meta-analysis of adjusted estimates, osteoarthritis ( n = 8 studies) and back pain ( n = 2) were the exposures and cardiovascular disease ( n = 8), cancer ( n = 1) and diabetes ( n = 1) were the outcomes. Pooled adjusted estimates from these 10 studies showed that people with a musculoskeletal condition have a 17% increase in the rate of developing a chronic disease compared to people without (hazard ratio 1.17, 95% confidence interval 1.13–1.22; I 2 52%, total n = 2,686,113 people).

          Conclusions

          This meta-analysis found that musculoskeletal conditions may increase the risk of chronic disease. In particular, osteoarthritis appears to increase the risk of developing cardiovascular disease. Prevention and early treatment of musculoskeletal conditions and targeting associated chronic disease risk factors in people with long standing musculoskeletal conditions may play a role in preventing other chronic diseases. However, a greater understanding about why musculoskeletal conditions may increase the risk of chronic disease is needed.

          Electronic supplementary material

          The online version of this article (10.1186/s12916-018-1151-2) contains supplementary material, which is available to authorized users.

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          Most cited references28

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

          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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            Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society.

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              Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study.

              A population-based, prospective cohort study. To determine whether overweight, obesity, or more generally an elevated body mass index (BMI) increase the probability of experiencing chronic low back pain (LBP) after an 11-year period, both among participants with and without LBP at baseline. Chronic LBP is a common disabling disorder in modern society. Cross-sectional studies suggest an association between an elevated BMI and LBP, but it is not clear whether this is a causal relationship. Data were obtained from the community-based HUNT 2 (1995-1997) and HUNT 3 (2006-2008) studies of an entire Norwegian county. Participants were 8733 men and 10,149 women, aged 30 to 69 years, who did not have chronic LBP at baseline, and 2669 men and 3899 women with LBP at baseline. After 11 years, both groups indicated whether they currently had chronic LBP, defined as pain persisting for at least 3 months continuously during the last year. A significant positive association was found between BMI and risk of LBP among persons without LBP at baseline. The odds ratio for BMI 30 or more versus BMI less than 25 was 1.34 (95% confidence interval [CI], 1.08-1.67) for men and 1.22 (95% CI, 1.03-1.46) for women, in analyses adjusted for age, education, work status, physical activity at work and in leisure time, smoking, blood pressure, and serum lipid levels. A significant positive association was also established between BMI and recurrence of LBP among women. LBP status at baseline had negligible influence on subsequent change in BMI. High values of BMI may predispose to chronic LBP 11 years later, both in individuals with and without LBP. The association between BMI and LBP is not explained by an effect of LBP on later change in BMI.
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                Author and article information

                Contributors
                +61 2 4924 6152 , amanda.j.williams@hnehealth.nsw.gov.au
                steven.kamper@sydney.edu.au
                john.wiggers@hnehealth.nsw.gov.au
                kate.obrien@hnehealth.nsw.gov.au
                hopin.lee@newcastle.edu.au
                luke.wolfenden@hnehealth.nsw.gov.au
                serene.yoong@hnehealth.nsw.gov.au
                emma.robson@hnehealth.nsw.gov.au
                j.mcauley@neura.edu.au
                jhartvigsen@health.sdu.dk
                christopher.m.williams@hnehealth.nsw.gov.au
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                25 September 2018
                25 September 2018
                2018
                : 16
                : 167
                Affiliations
                [1 ]ISNI 0000 0000 8831 109X, GRID grid.266842.c, School of Medicine and Public Health, , University of Newcastle, ; Callaghan, NSW 2308 Australia
                [2 ]Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287 Australia
                [3 ]Centre for Pain, Health and Lifestyle, Ourimbah, NSW Australia
                [4 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, School of Public Health, , University of Sydney, ; Lvl 10, King George V Building, Camperdown, NSW 2050 Australia
                [5 ]ISNI 0000 0000 8900 8842, GRID grid.250407.4, Neuroscience Research Australia (NeuRA), ; PO Box 1170, Randwick, NSW 2031 Australia
                [6 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, , University of Oxford, ; Oxford, UK
                [7 ]ISNI 0000 0001 0728 0170, GRID grid.10825.3e, Department of Sports Science and Clinical Biomechanics, , University of Southern Denmark, ; Campusvej 55, 5230 Odense M, Denmark
                [8 ]ISNI 0000 0004 0402 6080, GRID grid.420064.4, Nordic Institute of Chiropractic and Clinical Biomechanics, ; Campusvej 55, 5230 Odense M, Denmark
                Author information
                http://orcid.org/0000-0002-9213-9178
                Article
                1151
                10.1186/s12916-018-1151-2
                6154805
                30249247
                ab844dcc-fa20-4499-a2f9-80e5b7cb1da3
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.

                History
                : 12 October 2017
                : 14 August 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Medicine
                osteoarthritis,back pain,chronic disease,meta-analysis
                Medicine
                osteoarthritis, back pain, chronic disease, meta-analysis

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