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Drivers of international variation in prevalence of disabling low back pain: Findings from the cultural and psychosocial influences on disability study

Drivers of international variation in prevalence of disabling low back pain: Findings from the cultural and psychosocial influences on disability study
Drivers of international variation in prevalence of disabling low back pain: Findings from the cultural and psychosocial influences on disability study
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.
1090-3801
35-45
Coggon, D.
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Ntani, G.
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Palmer, K.T.
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Felli, V.E.
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Harari, F.
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Quintana, L.A.
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Felknor, S.A.
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Rojas, M.
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Cattrell, A.
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Vargas-Prada, S.
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Bonzini, M.
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Solidaki, E.
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Merisalu, E.
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Habib, R.R.
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Sadeghian, F.
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Kadir, M.M.
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Warnakulasuriya, S.S.P.
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Matsudaira, K.
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Nyantumbu, B.
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Kelsall, H.L.
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Harcombe, H.
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Coggon, D.
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Ntani, G.
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Palmer, K.T.
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Felli, V.E.
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Harari, F.
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Quintana, L.A.
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Felknor, S.A.
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Rojas, M.
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Cattrell, A.
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Vargas-Prada, S.
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Bonzini, M.
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Solidaki, E.
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Merisalu, E.
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Habib, R.R.
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Sadeghian, F.
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Kadir, M.M.
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Warnakulasuriya, S.S.P.
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Matsudaira, K.
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Nyantumbu, B.
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Kelsall, H.L.
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Harcombe, H.
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Coggon, D., Ntani, G., Palmer, K.T., Felli, V.E., Harari, F., Quintana, L.A., Felknor, S.A., Rojas, M., Cattrell, A., Vargas-Prada, S., Bonzini, M., Solidaki, E., Merisalu, E., Habib, R.R., Sadeghian, F., Kadir, M.M., Warnakulasuriya, S.S.P., Matsudaira, K., Nyantumbu, B., Kelsall, H.L. and Harcombe, H. (2019) Drivers of international variation in prevalence of disabling low back pain: Findings from the cultural and psychosocial influences on disability study. European Journal of Pain, 23 (1), 35-45. (doi:10.1002/ejp.1255).

Record type: Article

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.

Text
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Accepted/In Press date: 4 June 2018
e-pub ahead of print date: 8 June 2018
Published date: January 2019

Identifiers

Local EPrints ID: 422795
URI: http://eprints.soton.ac.uk/id/eprint/422795
ISSN: 1090-3801
PURE UUID: 3204150d-0c9a-487d-9b8a-4317de39636c
ORCID for D. Coggon: ORCID iD orcid.org/0000-0003-1930-3987

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Date deposited: 06 Aug 2018 16:30
Last modified: 07 Oct 2020 01:39

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Contributors

Author: D. Coggon ORCID iD
Author: G. Ntani
Author: K.T. Palmer
Author: V.E. Felli
Author: F. Harari
Author: L.A. Quintana
Author: S.A. Felknor
Author: M. Rojas
Author: A. Cattrell
Author: S. Vargas-Prada
Author: M. Bonzini
Author: E. Solidaki
Author: E. Merisalu
Author: R.R. Habib
Author: F. Sadeghian
Author: M.M. Kadir
Author: S.S.P. Warnakulasuriya
Author: K. Matsudaira
Author: B. Nyantumbu
Author: H.L. Kelsall
Author: H. Harcombe

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