BACKGROUND: We aimed to examine the cross-sectional association between occupational class and self-reported low back pain (LBP) in a representative sample of the Japanese general population. METHODS: We used anonymized data from a nationwide survey (31,443 men and 35,870 women aged ≥ 20). Occupational class variables included working status, occupation, employment status, and company size (number of employees). Covariates included age, socio-economic status, lifestyle, and comorbidities. Poisson regression models stratified by gender were used to estimate adjusted prevalence ratio (APR) and 95% confidence interval (CI) for self-reported LBP. RESULTS: The prevalence of self-reported LBP was 11.7% in men and 14.2% in women. After adjustment for covariates and mutual adjustment for all occupational class variables, among both genders, agricultural/forestry/fishery workers and non-workers had a significantly higher prevalence of self-reported LBP: APR (95% CI) of agricultural/forestry/fishery was 1.36 (1.08-1.70) in men and 1.59 (1.30-1.93) in women; that of non-workers was 1.42 (1.18-1.70) in men and 1.23 (1.08-1.40) in women. Among men, non-regular employees were more likely to have self-reported LBP than regular employees: APR (95% CI) was 1.25 (1.07-1.46) in part-timers and casual staff and 1.18 (1.03-1.35) in other types of non-regular employees. Moreover, compared to men working at companies with ≥ 100 employees, men working at companies with 30-99 employees had a significantly higher prevalence of self-reported LBP (APR 1.17; 95% CI, 1.03-1.34). Among women, professionals and technicians (1.26; 1.11-1.43) and sales workers (1.22; 1.04-1.43) had a significantly higher prevalence of self-reported LBP than clerks. Neither employment status nor company size was associated with self-reported LBP in women. After stratified analyses by age group, similar patterns were observed in participants aged 20-64, but not in those aged ≥ 65. CONCLUSION Our results suggest that self-reported LBP is highly prevalent among agricultural/forestry/fishery workers and the unemployed, regardless of gender, and that there are also gender differences in the association of occupational class factors with self-reported LBP. It is necessary, therefore, to take preventive measures against LBP based on gender and occupational class factors in Japan.
Adult ; Aged ; Cross-Sectional Studies ; Employment/statistics & numerical data* ; Female ; Humans ; Japan/epidemiology* ; Low Back Pain/epidemiology* ; Male ; Middle Aged ; Occupational Diseases/epidemiology* ; Occupations/statistics & numerical data* ; Prevalence ; Self Report ; Sex Distribution

BACKGROUND: Both low back pain (LBP) and obesity are important public issues, but the association between them is controversial. This study was conducted to investigate the association of LBP with obesity and abdominal obesity among Koreans aged 50 years or more. METHODS: This cross-sectional study analyzed data from participants aged 50 years or more (n=11,941) who measured height, weight and waist circumference and answered the questions about low back pain in the Korean National Health and Nutrition Examination Survey 2010–2013. To investigate the association of LBP with obesity and abdominal obesity, weighted univariate and multivariate logistic regression analyses were done after adjusting for socioeconomic variables and lifestyle variables. RESULTS: The prevalence of LBP in men and women was 13.1% (standard error [SE], 0.6) and 31.0% (SE, 0.8), respectively, higher in women than men (P < 0.001). For women only, abdominal obesity was significantly associated with an increased prevalence of LBP (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01–1.44) after adjustment of confounding variables, and the odds ratio of LBP in the highest quartile of waist circumference was higher compared to the lowest quartile of waist circumference (OR 1.30, 95% CI 1.02–1.66). For men abdominal obesity was not associated with an increased prevalence of LBP. There were no associations between obesity and LBP in both men and women. CONCLUSIONS: This population-based, nationally representative study suggests that abdominal obesity increases the risk of LBP in women aged 50 years or more.
Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Female ; Humans ; Life Style ; Logistic Models ; Low Back Pain ; Male ; Nutrition Surveys ; Obesity ; Obesity, Abdominal ; Odds Ratio ; Prevalence ; Waist Circumference

Back pain is a worldwide health problem, adding a tremendous burden to modern societies. However, little information on back health is available in China, even though a quarter of the world's population is Chinese. To enhance knowledge in this area, we designed and initiated the Hangzhou Lumbar Spine Study, which is a cross-sectional study of a general sample of mainland Chinese with focusing on disc degeneration, Modic changes, endplate lesions, and back pain. The study consists of a structured questionnaire to measure back pain history and lifetime exposure to suspected risk factors, magnetic resonance imaging of the lumbar spine, bone mineral density study of the spine and hip, and DNA sample analysis. Here we briefly introduce the study methodology, report the test-retest reliability of the questionnaire, and describe the cohort profile to date. Since May 2014, 301 randomly selected subjects (male/female, 122/179; mean age, 51.0 years; range, 20-87 years) have been recruited. Tests-retests of the questionnaire, completed by 40 participants, revealed good reliability. To our knowledge, the Hangzhou Lumbar Spine Study is the first population-based epidemiological study conducted to characterize lumbar spinal phenotypes and back pain, their interaction, and their associations with lifetime environmental exposure, in mainland Chinese. Epidemiological information obtained from a reliable questionnaire, magnetic resonance (MR) imaging data, dual energy X-ray absorptiometry (DXA) measurements, and DNA analysis may serve as a valuable reference for future studies on back health, particularly for mainland Chinese.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Cohort Studies ; Cross-Sectional Studies ; Female ; Health Status ; Humans ; Low Back Pain ; diagnostic imaging ; epidemiology ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Reproducibility of Results ; Surveys and Questionnaires ; Young Adult

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography. OVERVIEW OF LITERATURE: There is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries. METHODS: A retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis. RESULTS: Of 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p<0.001 and 53.01±15.31 vs. 42.44±15.88, p<0.001, respectively). Gender was significantly associated with spondylolisthesis (p=0.029) but not spondylolysis. Of patients who were >60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females. CONCLUSIONS: The prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.
Accidents, Traffic ; Adult* ; Bias (Epidemiology) ; Cross-Sectional Studies ; Developing Countries* ; Female ; Humans ; Low Back Pain ; Multidetector Computed Tomography* ; Neurosurgery ; Orthopedics ; Prevalence ; Retrospective Studies ; Spine ; Spondylolisthesis* ; Spondylolysis ; Spondylosis ; Tomography, X-Ray Computed

STUDY DESIGN: Retrospective review. PURPOSE: We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. OVERVIEW OF LITERATURE: Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability. METHODS: Between January 1, 1998 and March 2011, 30 patients (23 males, 7 females; mean age, 70.43 years; range, 45 to 95 years) with the radiographic diagnosis of AS of the spinal column had 42 fractures. Eight patients presented with significant trauma, 17 after falls, and 5 after minor falls or no recorded trauma. Eleven patients presented with a neurological injury, ranging from mild sensory loss to quadriplegia. RESULTS: There were 16 compression and 10 transverse fractures, two Jefferson's fractures, one type II and two type III odontoid process fractures, and five fractures of the posterior spinal elements (including lamina and/or facet, three spinous process fractures, three transverse process fractures). Twenty-four fractures affected the craniocervical junction and/or cervical vertebrae, 17 were thoracic, and one involved the lumbar spine. The most affected vertebrae were C6 and T10. The mean follow-up was 29.9 months. One patient was lost to follow-up. Eighteen patients were treated conservatively with bed rest and bracing. Twelve patients underwent surgery for spinal stabilization either with an anterior, posterior or combined approach. CONCLUSIONS: Nonsurgical treatment can be considered especially in the elderly patients with AS and spinal trauma but without instability or major neurological deficits. The nonfusion rate in conservatively treated patients is low. When treatment is selected for patients with spinal fractures and AS, the pattern of injury must be considered and the need for individualized treatment is paramount.
Accidental Falls ; Aged ; Bed Rest ; Braces ; Cervical Vertebrae ; Diagnosis ; Epidemiology ; Female ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Mortality ; Odontoid Process ; Quadriplegia ; Retrospective Studies ; Spinal Fractures ; Spinal Injuries* ; Spine ; Spondylitis, Ankylosing*

INTRODUCTIONIn Singapore, the notification of workplace accidents and occupational diseases is a legal requirement under the Workplace Safety and Health (Incident Reporting) Regulations. This review is to identify back injury cases with physical work stresses and propose recommendations for preventive measures.

MATERIALS AND METHODSCases involving back injuries notified to the Ministry of Manpower (MOM) from 1 January 2011 to 31 December 2012 were reviewed. Using predefined criteria, cases with physical work stresses were identified and the associated variables analysed.

RESULTSA total of 1124 notifications involving back injuries were received from 2011 to 2012; 579 cases (52%) were identified to have physical work stresses, of which 447 cases (77%) were males and 375 (64%) of them were between the ages of 21 to 40 years. The commonest physical work stresses were carrying (35%), awkward postures (22%) and lifting (20%). Majority of the cases came from the following sectors: construction (14%), accommodation and food services (12%), transport and storage (12%), manufacturing (10%) and wholesale and retail trade (10%).

CONCLUSIONWe identified the main physical work stresses in the back injury cases as carrying, awkward postures and lifting. The common industries involved were construction, accommodation and food services, and transport and storage sectors. This is useful for programmes aimed at reducing physical work stresses which can lead to improved work and health outcomes for our workers.

Adult ; Back Injuries ; epidemiology ; Commerce ; Construction Industry ; Female ; Food Industry ; Humans ; Low Back Pain ; epidemiology ; Male ; Manufacturing Industry ; Middle Aged ; Occupational Injuries ; epidemiology ; Singapore ; epidemiology ; Transportation ; Weight-Bearing ; Young Adult

OBJECTIVETo investigate the awareness of occupational low back pain and knowledge of related prevention and healthcare measures among midwives, and to determine the incidence of low back pain among them.

METHODSA questionnaire survey was carried out with the use of Roland-Morris Disability Questionnaire (Chinese version) (CRMDQ) among 244 midwives from second- and third-class hospitals in Tianjin, China. Related indices were statistically analyzed.

RESULTSAmong 244 midwives who participated in the survey, only 18.4% knew the definition of occupational low back pain, 28.3% knew the pathogenic mechanism, and 54.1% knew its harm. About 9.4%∼85.2% of midwives mastered at least one method for prevention and health care against occupational low back pain. Proper or improper use of human body mechanics was closely related to the development of occupational low back pain (P < 0.01). There was a high proportion of midwives with a demand for application of human body mechanics principle in operation, and the proportion was as high as 99.2%. All the 24 items in CRMDQ were scored, with the lowest score of 1, the highest score of 24, and an average score of 8.5 ± 7.2.

CONCLUSIONThe awareness rate of occupational low back pain was low among the 244 midwives in this study. The incidence of low back pain, which had influenced the health status and occupational practice, was high among them.

Adult ; Health Knowledge, Attitudes, Practice ; Humans ; Low Back Pain ; epidemiology ; Middle Aged ; Midwifery ; Occupational Diseases ; epidemiology ; Surveys and Questionnaires

BACKGROUND: This study was to evaluate the association of lumbar spine facet joint osteoarthritis (LSFJOA) identified by multi-detector computed tomography (MDCT) with age and low back pain (LBP) in an adult community-based population in Korea. METHODS: A sample of 472 participants (age range, 20 to 84 years) who underwent MDCT imaging for abdominal or urological lesions, not for chief complaints of LBP, were included in this study. LSFJOA based on MDCT findings was characterized using four grades of osteoarthritis of the facet joints. The prevalence of LSFJOA according to age group (below 40 years, 40-49 years, 50-59 years, 60-69 years, and above 70 years), gender, and spinal level was analyzed using chi-square tests and the association between LBP and LSFJOA adjusting for age, gender, and spine level was analyzed using multiple binary logistic regression test. RESULTS: Eighty-three study subjects (17.58%) had LSFJOA (grade > or = 2). The prevalence of LSFJOA was not associated with gender (p = 0.092). The prevalence of LSFJOA increased with age (p = 0.015). The highest prevalence of LSFJOA was observed at L4-5 in men (p = 0.001) and at L5-S1 in women (p = 0.003), and at L5-S1 in the overall population (p = 0.000). LSFJOA was not associated with LBP in men (p = 0.093) but was associated with LBP in women (p = 0.003), especially at L3-4 (p = 0.018) and L5-S1 (p = 0.026). CONCLUSIONS: The prevalence of LSFJOA based on the computed tomography imaging was 17.58% in the adult community Korean population. The prevalence of LSFJOA increased with age, and the highest prevalence was noted at L5-S1. LSFJOA was not associated with LBP at any spinal level and age except at L3-4 and L5-S1 in women.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Low Back Pain/*epidemiology ; *Lumbar Vertebrae ; Male ; Middle Aged ; Multidetector Computed Tomography ; Osteoarthritis/*epidemiology/radiography ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Young Adult ; *Zygapophyseal Joint

STUDY DESIGN: Cross-sectional. PURPOSE: The purpose of the study was to determine the prevalence of low back pain (LBP) in the primary care setting with emphasis on the socio-demographic contributing factors and impact of LBP on lifestyle habits. OVERVIEW OF LITERATURE: LBP is one of the most common medical conditions seen in the Primary Health Care Clinic. METHODS: A representative sample of 2,600 patients were approached and 1,829 subjects agreed to participate in this study (70.0%). Data on socio-demographic characteristics, life style habits and type of treatment were collected through a questionnaire. RESULTS: The prevalence of LBP in the study sample was 56.5% (95% confidence interval, 54.2-58.8). LBP was more prevalent among women (53.9%) compared to men (46.1%). There was significant difference between male and female patients of LBP in terms of ethnicity (p<0.001), marital status (p=0.010), occupation (p<0.001), monthly household income (p=0.004), and cigarette/sheesha smokers (p<0.001). The percentages of different aspects of functional disabilities were statistically significantly higher among females compared to male patients with LBP. Almost a quarter of female patients with LBP (26%) and 18% male patients with LBP reported pain in the arms and legs (p=0.002). In addition, gastrointestinal complaints such as abdominal pain and food intolerance were significantly higher among female patients with LBP as compared to males (31% vs. 24.6%, p=0.018; and 25% vs. 18%, p=0.008, respectively). Complaints about headache and fainting were also significantly higher among female patients as compared to male LBP patients (43% vs. 36%, p=0.029; and 26% vs. 20%, p=0.016, respectively). The multivariate logistic regression revealed that being female, prolonged standing, prolonged sitting, heavy weight lifting, weakness in the legs, regular exercise, and cigarette/sheesh a smoking had a significant effect on the presence of LBP. CONCLUSIONS: LBP is highly prevalent among both genders and in older age. Also, weakness in the legs, smoking, prolonged standing and sitting had a significant effect on LBP. Furthermore, the current study findings support the fact that LBP continues to be an important clinical, social and economic, burden and a public health problem affecting the population of the entire world.
Abdominal Pain ; Arm ; Developing Countries* ; Epidemiology ; Family Characteristics ; Female ; Headache ; Humans ; Leg ; Life Style ; Logistic Models ; Low Back Pain* ; Male ; Marital Status ; Occupations ; Prevalence* ; Primary Health Care* ; Public Health ; Risk Factors ; Smoke ; Smoking ; Syncope ; Weight Lifting ; Surveys and Questionnaires

PURPOSE: To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. MATERIALS AND METHODS: The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. RESULTS: The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). CONCLUSION: The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.
Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; Female ; Humans ; Leg/*pathology ; Low Back Pain/epidemiology/etiology ; Male ; Middle Aged ; Pain/*epidemiology/*etiology ; Prospective Studies ; Questionnaires ; Spinal Stenosis/*complications/*physiopathology/surgery