Socioeconomic inequalities in low back pain among older people: the JAGES cross-sectional study

Abstract

BackgroundLow back pain is an important public health issue across the world. However, it is unclear whether socioeconomic status (SES) is associated with low back pain. This study determines an association between SES and low back pain among older people.MethodsWe used cross-sectional data derived from the year 2013 across 30 Japanese municipalities. The survey was conducted between October 2013 to December 2013. Functionally independent community-dwelling older adults aged 65 and above (n = 26,037) were eligible for the study. Multilevel Poisson regression analysis with a robust variance estimator was used to examine the association between SES and low back pain. Self-reported low back pain in the past year was used as a dependent variable. Educational attainment, past occupation, equivalized household income, wealth, and subjective economic situation represented SES and were separately analyzed as independent variables, adjusted for covariates including age and sex.ResultsThe prevalence of low back pain was 63.4%. Overall, lower SES were more likely to suffer from low back pain compared with that for the highest. First, as for the educational attainment, the prevalence ratio (PR) (95% credible interval (CI)) for the lowest level was 1.07 (1.02–1.12). Second, as for the past occupation, the PR (95% CI) for the blue-collared workers compared with professionals was 1.06 (1.01–1.11). Third, as for the equalized household income, the PRs (95% CI) for lower middle and the lowest income levels were 1.08 (1.02–1.13) and 1.16 (1.10–1.23), respectively. Fourth, as for the wealth, the PRs (95% CI) for lower middle and the lowest wealth levels were 1.11 (1.04–1.19) and 1.18 (1.11–1.27), respectively. Fifth, as for the subjective economic situation, the PRs (95% CI) for lower middle and the lowest financial conditions were 1.18 (1.10–1.26) and 1.32 (1.22–1.44), respectively.ConclusionsSignificant socioeconomic inequalities were observed in low back pain among older individuals in Japan. Policymakers and clinicians must understand the nature of these inequalities.Electronic supplementary materialThe online version of this article (10.1186/s12939-019-0918-1) contains supplementary material, which is available to authorized users.

The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan

“…We also found that lower occupational classifications, i.e., blue-collared workers, were significantly associated with the prevalence of lower back pain; this finding was also consistent with earlier studies [35,36]. These findings were consistent with our previous study, which was conducted with the older population [22], and which indicated that the association between individual-level SES and lower back pain was propagative.…”

“…We used several covariates on the basis of previous studies [1,21,22,23,24]: age (continuous), gender, educational attainment (≥13 years, <13 years), and occupation (manager, professional, white-collared, blue-collared, and no occupation [including not engaged in an income-earning job]). The cutoff point of educational attainment was also in accordance with previous studies [23,24].…”

Neighborhood Walkability in Relation to Knee and Low Back Pain in Older People: A Multilevel Cross-Sectional Study from the JAGES

“…For individual covariates, sociodemographic data, behavior, and health status were used. Sociodemographic covariates included sex, age (65–69, 70–74, 75–79, 80–84, and ≥85 years old), educational background (<10, 10–12, and ≥13 years), equivalent annual income (<2, 2–3.9, and ≥4 million yen per year), and past occupation (white-collar workers, blue-collar workers, primary industry workers, or never worked before) [30,31]. Primary industry workers in agriculture, forestry, and fisheries were considered separately from other blue-collar workers because those three occupations are known to be strongly associated with musculoskeletal pain [32].…”

Clinical practice pattern of low back pain among physiotherapists in a low-income country

“…Low back pain (LBP) is the top global cause of disability 1 and the incidence rate varies from 0.024-7.0% 2 . The prevalence of LBP is higher among the population groups with low socioeconomic status 3,4 . Data indicated that middle and low-income countries in Asia, Africa, and the Middle East are becoming the epicenter of LBP related disabilities due to an increased number of aged populations and poor health systems in these regions 5 .…”