Prevalence, associated factors, and limitations related to chronic back problems in adults and elderly in Brazil

Romero, Dalia Elena; Santana, Diego; Borges, Paulo; Marques, Aline; Castanheira, Débora; Rodrigues, Jéssica M.; Sabbadini, Leticia

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ARTICLE • Cad. Saúde Pública 34 (2) • 2018 • https://doi.org/10.1590/0102-311X00012817 copy

Prevalence, associated factors, and limitations related to chronic back problems in adults and elderly in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

The objective was to analyze the epidemiological characteristics of chronic back problems in Brazil and study the association between their prevalence and demographic and socioeconomic factors, lifestyle, and health conditions. The study used micro-data from the Brazilian National Health Survey (PNS), 2013. The epidemiological indicators were: prevalence, time with chronic back problems, life cycle (from young adults to the elderly), limitations in activities of daily living, and mean age at onset of symptoms, according to sex and age bracket. In order to analyze inequality in chronic back problems according to socioeconomic characteristics and risk factors, a multivariate logistic regression model was used, based on life cycle stages, with the presence of chronic back problems as the dependent variable and the following independent variables: sex, schooling, area of residence, race/color, self-rated health, types of chronic diseases, body mass index (BMI), and physical activity. Prevalence of chronic back problems in Brazil was 18.5%, and was higher in women than in men (21.1%; 95%CI: 20.2-21.9). Mean age at onset of chronic back problems was 35 years. There was an association between chronic back problems and lower schooling, poor self-rated health, and presence of the majority of the selected chronic diseases. Area of residence, BMI, age, and race/color were weakly associated or not associated with chronic back problems. Prevalence of chronic back problems stabilized at 50 years of age, but the severity of limitations increased at older ages. As in other countries, high prevalence and the impact on living conditions revealed the need for epidemiological studies on chronic back problems in Brazil. The results suggest that health promotion and the prevention of chronic back problems should be intensified, especially before 50 years of age, considering the on-going population aging in Brazil.

Keywords:
Spine; Spinal Diseases; Chronic Disease; Aged

Categories	Total [N = 60,202]	Men	Women	Prevalence of chronic back problems
Categories	%	%	%	%	95%CI
Total	100.0	47.1	52.9	18.5	17.8-19.1
Age bracket (years)
18-49	65.8	66.9	64.8	13.9	13.3-14.6
50-59	16.2	16.4	16.0	26.2	24.6-27.8
≥ 60	18.0	16.7	19.2	28.1	26.6-29.7
Sex
Male	-	-	-	15.5	14.8-16.4
Female	-	-	-	21.1	20.2-21.9
Schooling
None	13.7	13.6	13.8	25.6	23.9-27.4
Incomplete primary or equivalent	25.2	26.3	24.3	24.0	22.8-25.3
Complete primary or incomplete secondary	15.5	16.5	14.6	15.8	14.5-17.2
Complete secondary	28.0	27.4	28.6	14.2	13.3-15.2
University or greater	17.5	16.3	18.6	14.0	12.8-15.3
Area of residence
Rural	13.8	15.0	12.7	18.0	17.3-18.7
Urban	86.2	85.0	87.3	21.3	19.6-23.1
Color or race
White	47.5	46.8	48.0	19.3	18.4-20.2
Brown	42.0	42.8	41.2	17.7	16.9-18.6
Black	9.2	9.2	9.2
Asian-descendant	0.9	0.8	1.0	17.8	16.2-19.6
Indigenous	0.4	0.4	0.5
Self-rated health
Very bad	1.2	0.9	1.4	43.9	41.1-46.8
Bad	4.7	3.9	5.4
Fair	28.0	24.9	30.8	28.4	27.1-29.7
Good	52.8	55.4	50.5	12.9	12.3-13.7
Very good	13.3	14.9	11.9	8.4	7.4-9.6
Body mass index
Normal	29.9	30.7	29.1	16.7	15.7-17.8
Underweight	1.5	1.2	1.8	17.4	13.0-22.8
Overweight	24.7	29.5	20.4	19.5	18.3-20.6
Obese	13.1	12.7	13.5	22.3	20.7-24.0
Does not know (sum)	30.8	25.8	35.2	17.8	16.8-18.8
Hypertension
No	78.6	81.7	75.8	15.5	14.9-16.2
Yes	21.4	18.3	24.2	29.2	27.7-30.7
Depression
No	92.4	96.1	89.1	16.7	16.1-17.4
Yes	7.6	3.9	10.9	39.3	36.9-41.8
Arthritis
No	93.6	96.5	91.0	16.3	15.7-16.9
Yes	6.4	3.5	9.0	50.4	47.8-53.0
Diabetes
No	93.8	94.6	93.0	17.9	17.3-18.5
Yes	6.2	5.4	7.0	26.9	24.4-29.4
Asthma
No	95.6	96.4	94.9	18.0	17.3-18.6
Yes	4.4	3.6	5.1	29.3	26.3-32.6
Chronic heart disease
No	95.8	96.1	95.6	17.6	17.0-18.3
Yes	4.2	3.9	4.4	37.3	33.8-41.0
Physically active
No	68.5	63.1	73.2	16.0	15.1-17.1
Yes	31.5	36.9	26.8	19.6	18.9-20.3
Population with chronic back problems [n = 11,118]	18.5	39.6	60.4	-	-
Time with chronic back problems (years)
< 1	4.5	3.8	4.9	-	-
1 to 4	22.1	21.4	22.6	-	-
≥ 5	73.4	74.9	72.5	-	-

Age bracket (years)	Mean age at onset	Degree of limitation (%)
Age bracket (years)	Mean age at onset	Absent	Mild	Moderate	Intense
Total
Total	35	32.7	32.6	18.3	16.4
18-19	14	52.8	37.2	7.2	2.8
20-24	16	54.0	26.6	13.0	6.4
25-29	20	48.9	34.6	10.5	6.0
30-34	23	42.7	32.4	13.8	11.1
35-39	26	36.7	36.4	13.4	13.5
40-44	31	30.9	31.7	18.2	19.2
45-49	33	27.7	34.0	20.5	17.8
50-54	37	26.3	33.2	18.7	21.8
55-59	40	28.8	28.5	22.5	20.3
60-64	42	28.5	32.0	21.2	18.2
65-69	47	29.1	33.6	21.0	16.3
70-74	52	24.9	32.2	24.6	18.3
≥ 75	56	24.6	34.3	21.0	20.2
Men
Total	35	35.4	31.6	18.0	15.0
18-19	14	53.0	33.8	13.2	0.0
20-24	15	59.6	26.6	7.7	6.1
25-29	20	54.2	30.3	9.0	6.5
30-34	23	50.0	26.5	13.6	9.9
35-39	25	39.7	35.4	14.2	10.8
40-44	31	34.5	29.1	17.2	19.2
45-49	34	29.7	33.1	19.4	17.7
50-54	37	27.9	33.0	20.7	18.4
55-59	38	31.3	27.5	22.2	19.0
60-64	41	28.2	26.5	22.3	23.0
65-69	48	27.5	36.1	20.3	16.0
70-74	51	27.1	32.5	27.2	13.2
≥ 75	54	29.6	41.9	16.7	11.8
Women
Total	35	30.8	33.3	18.5	17.3
18-19	14	52.7	38.9	4.1	4.2
20-24	17	50.9	26.7	15.9	6.5
25-29	20	44.8	38.0	11.6	5.6
30-34	23	37.6	36.6	13.9	11.9
35-39	26	34.6	37.1	12.8	15.4
40-44	31	28.8	33.3	18.8	19.2
45-49	33	26.4	34.6	21.2	17.8
50-54	37	24.9	33.4	17.1	24.6
55-59	42	27.0	29.2	22.6	21.2
60-64	43	28.7	34.9	20.7	15.7
65-69	46	30.1	32.1	21.4	16.5
70-74	52	23.6	32.0	22.9	21.5
≥ 75	56	21.5	29.4	23.7	25.5

Category	Total		18-49 years		50-59 years		≥ 60 years
Category	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI
Sex
Male	1.00		1.00		1.00		1.00
Female	1.18	1.11-1.25	1.26	1.15-1.38	1.02	0.90-1.16	1.14	1.01-1.27
Age bracket (years)
18-49	1.00
50-59	1.35	1.25-1.46	-	-	-	-	-	-
≥ 60	1.27	1.17-1.37	-	-	-	-	-	-
Schooling
University or more (6-7 years)	1.00		1.00		1.00		1.00
Complete secondary (5 years)	0.99	0.89-1.10	0.99	0.86-1.13	0.97	0.75-1.25	1.07	0.86-1.34
Complete primary or incomplete secondary (3-4 years)	1.02	0.91-1.14	1.00	0.87-1.15	1.21	0.92-1.58	0.86	0.66-1.11
Incomplete primary or equivalent	1.21	1.10-1.35	1.21	1.05-1.39	1.29	1.02-1.61	1.14	0.94-1.39
None	1.26	1.12-1.41	1.23	1.05-1.44	1.24	0.96-1.59	1.26	1.02-1.56
Area of residence
Urban	1.00		1.00		1.00		1.00
Rural	1.10	1.01-1.20	1.11	1.00-1.24	1.16	1.00-1.34	1.01	0.88-1.17
Race/Color
White	1.00		1.00		1.00		1.00
Brown	0.91	0.85-0.97	0.93	0.85-1.01	0.86	0.76-0.97	0.92	0.83-1.03
Black/Indigenous/Asian-descendant	0.90	0.81-0.99	0.88	0.76-1.02	0.87	0.72-1.06	0.91	0.77-1.08
Self-rated health
Very good	1.00		1.00		1.00		1.00
Good	1.45	1.26-1.67	1.53	1.28-1.82	1.38	0.96-1.97	1.06	0.79-1.42
Fair	2.59	2.23-3.00	2.92	2.43-3.51	2.34	1.63- 3.36	1.66	1.24-2.21
Bad/Very bad	3.32	2.84-3.87	3.76	3.05-4.63	2.99	2.06-4.33	2.16	1.59-2.92
Hypertension
No	1.00		1.00		1.00		1.00
Yes	1.09	1.02-1.17	1.24	1.11-1.38	0.99	0.88-1.13	1.06	0.95-1.19
Depression
No	1.00		1.00		1.00		1.00
Yes	1.51	1.41-1.63	1.59	1.41-1.79	1.55	1.36-1.76	1.36	1.17-1.57
Arthritis
No	1.00		1.00		1.00		1.00
Yes	1.76	1.64-1.89	1.82	1.58-2.09	1.73	1.52-1.98	1.82	1.63-2.03
Diabetes
No	1.00		1.00		1.00		1.00
Yes	0.83	0.75-0.91	0.68	0.53-0.86	0.93	0.78-1.10	0.88	0.77-1.00
Asthma
No	1.00		1.00		1.00		1.00
Yes	1.26	1.14-1.40	1.27	1.08-1.49	1.12	0.92-1.37	1.27	1.07-1.50
Chronic heart disease
No	1.00		1.00		1.00		1.00
Yes	1.15	1.03-1.28	1.31	1.06-1.63	1.04	0.86-1.27	1.15	0.99-1.33
Body mass index
Normal	1.00		1.00		1.00		1.00
Underweight	0.97	0.73-1.27	0.89	0.65-1.22	1.45	0.76-2.77	0.96	0.59-1.56
Overweight	1.07	0.99-1.16	1.19	1.06-1.33	0.90	0.76-1.05	0.96	0.83-1.11
Obese	1.01	0.92-1.11	1.02	0.89-1.17	0.82	0.69-0.98	1.11	0.93-1.32
Does not know	0.79	0.74-0.85	0.80	0.72-0.89	0.78	0.67-0.90	0.80	0.70-0.92
Physically active
Yes	1.00		1.00		1.00		1.00
No	0.96	0.90-1.02	0.99	0.90- 1.09	0.89	0.78-1.03	0.88	0.78-1.00

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