Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 27;9(9):e031749.
doi: 10.1136/bmjopen-2019-031749.

Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study

Jessica J Wong  1   2 , Pierre Côté  1   2   3   4 , Andrea C Tricco  1   4   5 , Laura C Rosella  6   7
Affiliations

Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study

Jessica J Wong et al. BMJ Open. .

Abstract

Introduction: Low back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based studies have assessed the joint effects of LBP and mental health symptoms on healthcare utilisation. This proposed study will characterise the health system burden of LBP and help identify priority groups to inform resource allocation and public health strategies. Among community-dwelling adult respondents of five cycles of the Canadian Community Health Survey (CCHS) in Ontario, we aim to assess the effect of self-reported LBP on healthcare utilisation and costs and assess whether this effect differs between those with and without self-reported mental health symptoms.

Methods and analysis: We designed a dynamic population-based cohort study using linkages of survey and administrative data housed at ICES. The Ontario sample of CCHS (2003-2004, 2005-2006, 2007/2008, 2009/2010, 2011/2012; total of ~1 30 000 eligible respondents) will be used to define the cohort of adults with self-reported LBP with and without mental health symptoms. Healthcare utilisation and costs will be assessed by linking health administrative databases. Follow-up ranges from 6 to 15 years (until 31 March 2018). Sociodemographic (eg, age, sex, education) and health behaviour (eg, comorbidities, physical activity) factors will be considered as potential confounders. Poisson and linear (log-transformed) regression models will be used to assess the association between LBP and healthcare utilisation and costs. We will assess effect modification with mental health symptoms on the additive and multiplicative scales and conduct sensitivity analyses to assess the impact of misclassification and residual confounding.

Ethics and dissemination: This study is approved by the University of Toronto Research Ethics Board. We will disseminate findings using a multifaceted knowledge translation strategy, including scientific conference presentations, publications in peer-reviewed journals and workshops with key knowledge users.

Keywords: cohort; healthcare costs; healthcare utilization; low back pain; mental health symptoms.

PubMed Disclaimer

Conflict of interest statement

Competing interests: PC reports the following outside the submitted work: grants from Aviva Canada, other from European Spine Society, personal fees from European Spine Society, grants from Ontario Ministry of Finance, grants from Canadian Institutes of Health Research—Canada Research Chair Program, other from North American Spine Society, grants from Ontario Trillium Foundation, grants from French Chiropractic Association, other from International Academy of Independent Medical Evaluators, other from Griffith University—Whiplash Symposium 2017, other from World Federation of Chiropractic, personal fees from Canadian Chiropractic Protective Association. None of the other authors have potential competing interests to disclose.

References

    1. World Health Organization Who global disability action plan 2014–2021. Better health for all people with disability, 2015. Available: http://www.who.int/disabilities/policies/actionplan/Disability_action_pl... [Accessed 1 Aug 2017].
    1. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine 1998;23:1860–6. Discussion 7 10.1097/00007632-199809010-00012 - DOI - PubMed
    1. Cassidy JD, Côté P, Carroll LJ, et al. . Incidence and course of low back pain episodes in the general population. Spine 2005;30:2817–23. 10.1097/01.brs.0000190448.69091.53 - DOI - PubMed
    1. Hincapié CA, Cassidy JD, Côté P, et al. . Whiplash injury is more than neck pain: a population-based study of pain localization after traffic injury. J Occup Environ Med 2010;52:434–40. 10.1097/JOM.0b013e3181bb806d - DOI - PubMed
    1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 2000;13:205–17. 10.1097/00002517-200006000-00003 - DOI - PubMed

Publication types