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. 2023 May 21;11(10):1499.
doi: 10.3390/healthcare11101499.

Chronic Low Back Pain and Incident Transient Ischemic Attack and Stroke in General Practices in Germany

Louis Jacob  1   2   3 , Lee Smith  4 , Ai Koyanagi  1   5 , Josep Maria Haro  1 , Jae Il Shin  6 , Christian Tanislav  7 , Alexis Schnitzler  2   3 , Karel Kostev  8   9
Affiliations

Chronic Low Back Pain and Incident Transient Ischemic Attack and Stroke in General Practices in Germany

Louis Jacob et al. Healthcare (Basel). .

Abstract

The aim was to investigate the association between chronic low back pain (CLBP) and incident transient ischemic attack (TIA) and stroke in Germany. The present retrospective cohort study included adults aged ≥18 years who were diagnosed for the first time with CLBP in one of 1198 general practices in Germany in 2005-2019 (index date). Patients without CLBP were matched to those with CLBP (1:1) using a propensity score based on age, sex, the index year, the number of medical consultations per year during the follow-up, and the number of years of follow-up. In patients without CLBP, the index date was a randomly selected visit date. Both groups were followed for up to 10 years. There were 159,440 patients included in the study (mean (SD) age: 52.1 (16.5) years; 51.5% women). Within 10 years of the index date, 6.5% and 5.9% of patients with and without CLBP were diagnosed with TIA or stroke, respectively (log-rank p-value < 0.001). The Cox regression analysis corroborated these results, as there was a significant association between CLBP and incident TIA or stroke (HR = 1.28, 95% CI = 1.22-1.35). CLBP was positively and significantly associated with incident TIA and stroke in Germany. More research is warranted to better understand this relationship.

Keywords: Germany; chronic low back pain; epidemiology; retrospective cohort study; stroke; transient ischemic attack.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study participants. Abbreviations: ICD-10, International Classification of Diseases, 10th revision; CLBP, chronic low back pain; TIA, transient ischemic attack. Low back pain corresponded to the presence of at least one of the following two ICD-10 codes: M54.4 (i.e., lumbago with sciatica) and M54.5 (i.e., low back pain).
Figure 2
Figure 2
Ten-year cumulative incidence of transient ischemic attack or stroke in people with and without CLBP (Kaplan–Meier curves). Abbreviation: CLBP, chronic low back pain.
Figure 3
Figure 3
Ten-year cumulative incidence of transient ischemic attack, hemorrhagic stroke, ischemic stroke, and unspecified stroke in people with and without CLBP (Kaplan–Meier curves). Abbreviation: CLBP, chronic low back pain.
See this image and copyright information in PMC

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