Back Pain and Co-occurring Conditions: Findings From a Nationally Representative Sample.

STUDY DESIGN: Cross-sectional population-level health survey.

OBJECTIVE: To describe the frequency of co-occurring conditions with back pain; to identify risk factors for back pain controlling for co-occurring conditions; and to examine the association between back pain and individual co-occurring conditions.

SUMMARY OF BACKGROUND DATA: Back pain shares risk factors with a range of other conditions. Most studies have considered risk factors for back pain without taking into account the potential influence of co-occurring conditions.

METHODS: Analysis of the 2013 Canadian Community Health Survey (n = 61,854, age ≥15 yr). Back pain status and co-occurring conditions were determined from questions about long-term health conditions diagnosed by a health profession. Multivariable log-Poisson regression analysis was used to assess the adjusted association of back pain with demographic and lifestyle characteristics and co-occurring conditions.

RESULTS: The population prevalence of reported back pain was 19.3%. Most (71%) reported at least one co-occurring condition. Most frequently reported were arthritis (35%), high blood pressure (26%), migraine (18%), and mood disorders (14%). Following the addition of co-occurring condition count to the regression model, being female and being overweight/obese were no longer significantly associated with back pain, and the associations with ages 45 to 54 years and older, low-income, smoking, and being physical inactive were significantly attenuated. The highest prevalence ratio, 3.32 (95% confidence interval: 3.06-3.59), was for 3+ co-occurring conditions. In multivariable regression all but a few individual chronic conditions remained significant associated with back pain.

CONCLUSION: Established risk factors for back pain may be largely a reflection of shared risk factors with co-occurring conditions. The high frequency of co-occurring conditions likely reflects diverse mechanisms related to heterogeneity of back pain. The extent of association of co-occurring conditions with back pain has implications for clinical management and need for further research to characterize subgroups.

LEVEL OF EVIDENCE: 2.