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

Badley, Elizabeth M., DPhil∗,†; Millstone, Dov B., MPH; Perruccio, Anthony V., PhD∗,†,‡,§

doi: 10.1097/BRS.0000000000002590

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

Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Ontario, Canada

Dalla Lana School of Public Health, University of Toronto, Ontario, Canada

Arthritis Program, Krembil Research Institute, University Health Network, Ontario, Canada

§Department of Surgery, Faculty of Medicine, University of Toronto, Ontario, Canada.

Address correspondence and reprint requests to Elizabeth M. Badley, DPhil, Senior Scientist, Division of Health Care and Outcomes Research, Krembil Research Institute, Toronto Western Hospital, MP 10-310, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada; E-mail:

Received 11 October, 2017

Revised 18 December, 2017

Accepted 10 January, 2018

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.