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The Incidence of Low Back Pain in Active Duty United States Military Service Members

Knox, Jeffrey MD*; Orchowski, Joseph MD*; Scher, Danielle L. MD; Owens, Brett D MD; Burks, Robert PhD§; Belmont, Philip J. MD

doi: 10.1097/BRS.0b013e3181f40ddd

Study Design. Epidemiological study.

Objective. To investigate the incidence and risk factors for developing low back pain in active duty military population to include age, sex, race, and rank, and military service.

Summary of Background Data. Low back pain is among the most common musculoskeletal conditions worldwide and is estimated to affect nearly two-thirds of the US population at some point in their lives. Low back pain is a multifactorial disease and many risk factors have been implicated including age, race, sex, and marital status.

Methods. A query was performed using the US Defense Medical Epidemiology Database (DMED) for the International Classification of Diseases, Ninth Revision, Clinical Modification code for low back pain (724.20). 13,754,261 person-years of data were investigated. Multivariate Poisson regression analysis was used to estimate the rate of low back pain per 1000 person-years, whereas controlling for sex, race, rank, service, age, and marital status.

Results. The overall unadjusted incidence rate of low back pain was 40.5 per 1000 person-years. Women, compared with men, had a significantly increased incidence rate ratio for low back pain of 1.45. The incidence rate ratio for the 40+ age group compared with the 20 to 29 years of age group was 1.28. With junior officers as the referent category, junior- and senior-enlisted rank groups had increased incidence rate ratio for low back pain, 1.95 and 1.35, respectively. Each service, when compared with the Marines as the referent category, had a significantly increased incidence rate ratio of low back pain: Army: 2.19, Navy: 1.02, and Air Force: 1.54. Compared with single service members, significantly increased incidence rate ratio for low back pain were seen in married service members: 1.21.

Conclusion. Female sex, enlisted rank groups, service in the Army, Navy, or Air Force, age greater than 40 years, and a marital status of married were all risk factors for low back pain.

Low back pain is a multifactorial disease process with many occupational, psychosocial, and demographic associations. Increased risk of low back pain was demonstrated in women, older age groups, lower ranking service members, service in the Army or Air Force, and marital status other than single.

*Orthopaedic Surgery Service, Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii

Orthopaedic Surgery Service, Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas

Orthopaedic Surgery Service, Department of Surgery, Keller Army Hospital, West Point, New York

§Graduate School of Operational and Information Sciences, Naval Postgraduate School, Monterey, California.

Address correspondence and reprint requests to CPT Jeffrey Knox, MD, Orthopaedic Surgery Department, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859; E-mail:

Acknowledgement date: March 22, 2010. Revision date: May 18, 2010. Acceptance date: July 21, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

© 2011 Lippincott Williams & Wilkins, Inc.