Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey

Abstract

Objective: To describe the epidemiologic characteristics and associations with increased health care utilization in US adults with chronic low back pain (LBP).

Methods: The National Health and Nutrition Examination Survey 2009-2010 was administered to adults ages 20-69 years (n = 5,103). Chronic LBP was defined as pain in the area between the lower posterior margin of the rib cage and the horizontal gluteal fold, with a history of pain lasting almost every day for at least 3 months. Demographic and behavioral characteristics were compared between those with chronic LBP and those without. Factors associated with ≥10 health care visits per year were evaluated in the chronic LBP subgroup (n = 700).

Results: Chronic LBP associations with adjusted odds ratios (OR_adj ) ≥2 included age 50-69 years, less than high school education, annual household income <$20,000, income from disability, depression, sleep disturbances, and medical comorbidities. Subjects with chronic LBP were more likely to be covered by government-sponsored insurance plans (OR_adj 3.23 [95% confidence interval (95% CI) 2.19-4.75] for Medicaid and OR_adj 2.25 [95% CI 1.57-3.22] for Medicare; P < 0.0001), and visited health care providers more frequently (OR_adj 3.35 [95% CI 2.40-4.67] for ≥10 health care visits in the past year; P < 0.0001). In the chronic LBP subgroup, adjusted ORs ≥2 were found for associations between ≥10 visits per year and unemployment, income from disability, depression, and sleep disturbances.

Conclusion: US adults with chronic LBP are socioeconomically disadvantaged, make frequent health care visits, and are often covered by government-sponsored health insurance. The clustering of behavioral, psychosocial, and medical issues should be considered in the care of Americans with chronic LBP.

Figure 1

Health insurance status and healthcare utilization in US adults with cLBP (N = 700). In the cLBP subgroup frequent healthcare users (≥10 healthcare visits per year) were more likely to be insured, than those who had fewer healthcare visits (p = 0.0008), adjusted odds ratio for age, gender, race, education, number of comorbidities (aOR) 2.10 ([95% Confidence interval] 1.03–4.26), p = 0.04. The distribution of health insurance types was significantly different in frequent healthcare users. Among those cLBP subjects, who reported ≥10 healthcare visits in the past year 50.5% were covered by federal or state-subsidized insurance plans (the “other” category includes other government-sponsored plans) vs 34.6% of those who had less frequent healthcare visits (p = 0.006), aOR 2.10 (1.21–3.64) for Medicare, 2.31 (1.35–3.97) for Medicaid, p = 0.001.