The complete version of this paper is available in the Cadernos de Saúde Pública and was accepted for publication on July 13, 2017 under the title: (CSP_0128 / 17) "Prevalence, associated factors and related limitations in chronic back problems among adults and elderly in Brazil ". ______________________________________________________________ Epidemiology of Chronic Back Pain in Brazil: prevalence, life course, risk factors and activities of daily life limitations. BACKGROUND Chronic Back Pain (CBP) may not be potentially fatal, but it is an important public health problem 1,2,3 . The CBP is highly prevalent, one of the main reasons for medical consultation 4 , responsible for serious losses of quality of life, high suffering and social and personal expenses. As the 2010 Disease Burden study, conducted with 118 surveys and 792 estimates from 47 countries reveals, the CBP is the leading cause of years lost due to disability 5 . In Brazil, CBP is also one of the most frequent chronic diseases in the population, with a prevalence of 18.5% in adults aged 18 years or over (95% CI: 17.8-19.1), according to data from the National Survey of Health (PNS) 2013 6 . Knowing the life cycle of the disease, by age groups and generations, its intensity and impact on the quality of life, provide fundamental inputs for the prevention of spinal problems in the population 7 . However, although a few studies investigating the determinants of back pain and its impact on daily life activities have been conducted in developing countries, the literature is sparse compared with developed countries 2 . In Brazil, research is still not available in this perspective due, mainly, to the lack of population data on the limitations and restrictions of daily activities caused by the CBP. The Brazilian National Health Survey (NHS) that took place in 2013 is the first nationally representative survey to address this issue. Because of the major epidemiological and demographic transitions occurring in emerging economies in all regions of the world, there is now an urgent need to gather accurate comparable epidemiological data on back pain in older adult populations in developing countries. This work intends to contribute to this effort. A systematic review study, centered on this perspective, shows that, although prevalence increases with age, the relationship is not linear and stabilizes at around 60 years 8 . Sex, age, occupation and obesity are factors related to the prevalence of CBP in the literature 4, 9, 10, 11 . The objectives of this study are to measure the prevalence of back pain in Brazil; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 60 years and older. METHODS:
Standardized national data collected from adults (18 years and older) participating in the Brazilian National Health Survey (NHS), 2013, were analyzed. The NHS is a household- based survey with a complex sampling design representative of the population of Brazil, Major Regions, UF`s, metropolitan regions and capitals 12 , in which the central objective is to characterize their health and lifestyle situation, besides collecting information on health care, access and health services. We analyzed the severity and characteristics of Chronic Back Pain (CBP) through prevalence and level of limitation. We measured socioeconomic inequalities and risk factors with a multivariate logistic regression, in a life course perspective, with the presence of CBP as the dependent variable. The independent variables were sex, age, educational level, household location, race/color, SRH, associated chronic diseases, BMI and physical activity. For each independent variable, the Odds Ratio (OR) with its respective 95% confidence intervals was calculated from the adjusted logistic models. Since it was a complex sampling design with more than one selection stage, all analyzes were performed using the ComplexSample module of the SPSS 21 statistical package. RESULTS: The prevalence of CBP was 18.5 (95% CI: 17.8-19.1), being higher for women and increasing with the age, reaching 28.1% (95% CI: 26.6-29.7) at the age of 60. CBP causes limitations in ADL in 67% of people, being 32.6% of low severity, 18.3% moderate and 16.4% intense. From the age of 50, 70% of CBP sufferers have some limitation and about 20% suffer from severe ADL limitations. The limitations gradually increase with age, stabilizing around the age of 50. Women had a higher risk of CCP than men (OR = 1.24, 95% CI: 1.14-1.35), with more disadvantages in the young to adult life stage (OR = 1.33, 95% CI: 1.20- 1.48). The lower educational level has a significant relationship with the CBP. People who have never attended school or with incomplete primary school are more likely to have CBPs in all age groups than those with college education or higher. Rural residents were 14% more likely to have CBP when compared to urban residents (OR = 1.14 95% CI: 1.01- 1.29). Race/color showed no significant association with CPB. SRH status has a high association with PCC. People with bad and very bad avaliation have four times more CBP (4.98 CI95%: 4.11-6.04) than those with very good SRH. With regular SRH the PCC is 3 times higher (OR 3.10 95% CI: 2.61-3.68). The effect of SRH on CBP decreases with age. Several chronic diseases are associated with the presence of CBP. Arthritis is the most associated disease with CBP, presenting a three times higher risk for those who have it (OR = 2.78, 95% CI: 2.45-3.15), depression presents twice as much (OR = 2.0% CI 95% : 1.77-2.25). Chronic heart disease increases the chance of having CBP by 30% (OR 1.31 95% CI: 1.09-1.58), and the risk increases between 18 and 49 years (OR 1.61 95% CI: 1 , 13-2, 28). Having high blood pressure increases the risk of CBP by 14% in the general population (OR 1.14 95% CI: 1.03-1.27) and in 34% in the age range between 18 and 49 years (OR 1.34 95% CI: 1.15-1.57). Having asthma also increases the chance of having PCC, especially among the elderly. Having diabetes proved to be protective for the population and almost all age groups except 50-59 years.
BMI did not show a significant relation to the general population. By age group, it is observed that for those 18 to 49 years of age, being overweight is a risk condition compared to normal weight (OR = 1.25, 95% CI: 1.09-1.44). Obesity was a protective factor (OR = 0.74, 95% CI: 0.56-0.97). Being physically active did not prove to be significant for any of the age groups.
Recommend
More recommend
