Socioeconomic variation in back and joint pain in Finland

Differences in the prevalence of back and joint pain by occupational class and education were studied in surveys representative of adult Finns. The effects of lifestyle factors and mental distress on these differences were also analysed. The material comprised 3915 women and 3629 men, all occupationally active. Occupational class and level of education were associated with back and joint pain; the associations were more obvious in men than in women. Among men, the age-adjusted odds ratio of joint pain in farmers was 3.2 (95% CI: 2.1–5.0), in manual workers 2.6 (1.9–3.6), in entrepreneurs 2.4 (1.5–3.7) and in lower white-collar workers 1.7 (1.1–2.4) as compared with upper white-collar employees. Similar odds ratios of back pain were 2.1 (1.6–2.9) in farmers, 1.8 (1.5–2.3) in manual workers, 1.7 (1.2–2.4) in entrepreneurs and 1.4 (1.1–1.7) in lower white-collar workers. Most of the associations persisted in multivariate analyses, in which height, marital status, lifestyle (smoking, leisure-time physical activity and body mass index (BMI)) and mental distress were considered; in these models, mental distress was consistently associated with pain. Back pain was associated with smoking in men and with BMI in women; BMI was also associated with joint pain in both sexes. In women, height showed an association with back pain for which a doctor had been consulted. Marital status, alcohol consumption, leisure-time physical activity and the urbanization level of the community were not important as determinants of pain. Conclusion: Obvious differences occurred in back and joint pain by indicators of social class that were not due to socioeconomic differences in lifestyle, height or mental distress.

[1]  L. Manchikanti.  Epidemiology of low back pain. , 2000, Pain physician.

[2]  P. Leino.  Does leisure time physical activity prevent low back disorders? A prospective study of metal industry employees. , 1993, Spine.

[3]  D. Felson,et al.  Educational attainment and osteoarthritis: differential associations with radiographic changes and symptom reporting. , 1992, Journal of clinical epidemiology.

[4]  V. H. Hildebrandt,et al.  Psychosocial factors at work and musculoskeletal disease. , 1993, Scandinavian journal of work, environment & health.

[5]  D. Wakefield,et al.  Use of the Appropriateness Evaluation Protocol for Estimating the Incremental Costs Associated With Nosocomial Infections , 1987, Medical care.

[6]  Svensson Ho,et al.  Low back pain in forty to forty-seven year old men. II. Socio-economic factors and previous sickness absence. , 1982 .

[7]  J. Kelsey,et al.  Epidemiology of musculoskeletal impairments and associated disability. , 1984, American journal of public health.

[8]  P. Leino,et al.  Depressive and distress symptoms as predictors of low back pain, neck-shoulder pain, and other musculoskeletal morbidity: a 10-year follow-up of metal industry employees , 1993, Pain.

[9]  A. Garg,et al.  Epidemiology of low-back pain in industry. , 1992, Occupational medicine.

[10]  R. Prättälä,et al.  Consistency and variation in unhealthy behaviour among Finnish men, 1982-1990. , 1994, Social science & medicine.

[11]  P. Puska,et al.  Is back pain increasing? Results from national surveys in Finland during 1978/9-1992. , 1994, Scandinavian journal of rheumatology.

[12]  R. Acheson,et al.  New Haven survey of joint diseases. XVII. Relationship between some systemic characteristics and osteoarthrosis in a general population. , 1975, Annals of the rheumatic diseases.

[13]  A. Rigby,et al.  Socioeconomic influences on back problems in the community in Britain. , 1994, Journal of epidemiology and community health.

[14]  A. Silman,et al.  Psychologic Distress and Low Back Pain: Evidence From a Prospective Study in the General Population , 1995, Spine.

[15]  J. Cade,et al.  Relationship between diet and smoking--is the diet of smokers different? , 1991, Journal of epidemiology and community health.

[16]  T. Meijman,et al.  Health complaints and working conditions experienced in relation to work and age. , 1996, Occupational and environmental medicine.

[17]  C. Leboeuf‐Yde,et al.  The Prevalence of Low Back Pain in the Literature A Structured Review of 26 Nordic Studies From 1954 to 1993 , 1995, Spine.

[18]  M. Blaxter,et al.  EVIDENCE ON INEQUALITY IN HEALTH FROM A NATIONAL SURVEY , 1987, The Lancet.

[19]  D. Felson,et al.  Epidemiology of hip and knee osteoarthritis. , 1988, Epidemiologic reviews.

[20]  Thomas D. Koepsell,et al.  Formal Education and Back‐Related Disability: In Search of an Explanation , 1995, Spine.

[21]  P. Milner,et al.  Are deprivation indicators a proxy for morbidity? A comparison of the prevalence of arthritis, depression, dyspepsia, obesity and respiratory symptoms with unemployment rates and Jarman scores. , 1993, Journal of public health medicine.

[22]  J. Donovan,et al.  Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health , 1996, BMJ.

[23]  Gower Street,et al.  Health inequalities among British civil servants: the Whitehall II study , 1991, The Lancet.

[24]  A. Sihvonen,et al.  Ill-health and its social patterning in Finland, Norway and Sweden , 1993 .

[25]  T. Kohlmann,et al.  Disorders characterised by pain: a methodological review of population surveys. , 1994, Journal of epidemiology and community health.

[26]  M Szpalski,et al.  Sociocultural factors and back pain. A population-based study in Belgian adults. , 1994, Spine.

[27]  E. Ernst.  Smoking, a cause of back trouble? , 1993, British journal of rheumatology.

[28]  T. Pincus,et al.  Most chronic diseases are reported more frequently by individuals with fewer than 12 years of formal education in the age 18-64 United States population. , 1987, Journal of chronic diseases.

[29]  F J Ascione,et al.  Exploring the Iceberg: Common Symptoms and How People Care for Them , 1987, Medical care.

[30]  R. Deyo,et al.  Descriptive Epidemiology of Low‐back Pain and Its Related Medical Care in the United States , 1987, Spine.

[31]  T. Haines,et al.  Long-term back problems and physical work exposures in the 1990 Ontario Health Survey. , 1996, American journal of public health.

[32]  A. Nachemson.  Spinal disorders. Overall impact on society and the need for orthopedic resources. , 1991, Acta orthopaedica Scandinavica. Supplementum.

[33]  S. Brage,et al.  Musculoskeletal pain and smoking in Norway. , 1996, Journal of epidemiology and community health.

[34]  D. Coggon,et al.  Low back pain in eight areas of Britain. , 1992, Journal of epidemiology and community health.

[35]  D. Mechanic,et al.  Some factors associated with the report and evaluation of back pain. , 1987, Journal of health and social behavior.

[36]  A. Silman,et al.  Estimating the Prevalence of Low Back Pain in the General Population: Evidence From the South Manchester Back Pain Survey , 1995, Spine.

[37]  S. Z. Nagi,et al.  A social epidemiology of back pain in a general population , 1973 .

[38]  R A Deyo,et al.  Lifestyle and Low-Back Pain: The Influence of Smoking and Obesity , 1989, Spine.

[39]  Sander Greenland,et al.  Factors associated with self-reported back-pain prevalence: A populationdashbased study , 1985 .

[40]  G. Smith,et al.  Social selection: what does it contribute to social class differences in health? , 1993 .

[41]  F. Gyntelberg,et al.  One year incidence of low back pain among male residents of Copenhagen aged 40-59. , 1974, Danish medical bulletin.

[42]  S. Greenland,et al.  Factors associated with self-reported back-pain prevalence: a population-based study. , 1985, Journal of chronic diseases.

[43]  J P Leigh,et al.  Prevalence of back pain among fulltime United States workers. , 1989, British journal of industrial medicine.

[44]  H. Svensson.  Low back pain in forty to forty-seven year old men. II. Socio-economic factors and previous sickness absence. , 1982, Scandinavian journal of rehabilitation medicine.

[45]  H. Boshuizen,et al.  Do Smokers Get More Back Pain? , 1993, Spine.