ORIGINAL ARTICLE • Rev. bras. epidemiol. 25 24 Oct 20222022 • https://doi.org/10.1590/1980-549720220032   copy

Chronic back pain among Brazilian adults: data from the 2019 National Health Survey

Deborah Carvalho Malta Regina Tomie Ivata Bernal Edmar Geraldo Ribeiro Erica de Matos Reis Ferreira Rafael Zambelli Pinto Cimar Azeredo Pereira About the authors

ABSTRACT

Objective:

To estimate the prevalence of chronic back pain (CBP) and its associated factors.

Methods:

This cross-sectional study analyzed the 2019 National Health Survey, with 88,531 adults, using logistic regression to identify associated factors.

Results:

CBP was reported by 21.6% of adults and was more likely to occur among women (odds ratio — OR=1.27; 95% confidence interval — 95%CI 1.19–1.35), increased with age: 25–34 years (OR=1.30; 95%CI 1.11–1.51), 35–44 (OR=1.78; 95%CI 1.54–2.07), 45–54 years (OR=2.23; 95%CI 1.91–2.59), 55–64 years (OR=2.47; 95%CI 2.12–2.88), and 65 years or older (OR=2.17; 95%CI 1.85–2.54); among smokers (OR=1.24; 95%CI 1.13–1.35); ex-smokers (OR=1.30; 95%CI 1.21–1.39); those who mentioned heavy housework (OR=1.41; 95%CI 1.31–1.53); obesity (OR=1.12; 95%CI 1.03–1.21); hypertension (OR=1.21; 95%CI 1.11–1.32); high cholesterol (OR=1.53; 95%CI 1.42–1.65); with self-rated health — with a very good reference — in the gradients: good (OR=1.38; 95%CI 1.23–1.55), regular (OR=2.64; 95%CI 2.34–2.98), poor (OR=4.24; 95%CI 3.64–4.94), and very poor (OR=5.24; 95%CI 4.13–6.65); its likelihood was lower in adults with complete elementary school/incomplete high school (OR=0.82; 95%CI 0.75–0.90) and complete high school/incomplete higher education (OR=0.87; 95%CI 0.81–0.95).

Conclusion:

Back pain has a high prevalence and shows associations with demographic and socioeconomic factors, lifestyle, chronic diseases, and self-rated health.

Low back pain; Health surveys; Adult; Risk factors

INTRODUCTION

Back pain is a common health problem that results in disability, reduced functional capacity, and work leaves11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... . The demand for health services, such as appointments, examinations, medications, physical therapy, hospitalizations, and surgeries, has increased among individuals with back pain11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,22. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391(10137): 2356-67. https://doi.org/10.1016/S0140-6736(18)30480-X
https://doi.org/10.1016/S0140-6736(18)30... . These events often cause absenteeism, decreased productivity, leaves, high social security costs, and early retirement22. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391(10137): 2356-67. https://doi.org/10.1016/S0140-6736(18)30480-X
https://doi.org/10.1016/S0140-6736(18)30... –55. Meziat Filho N, Silva GA. Disability pension from back pain among social security beneficiaries, Brazil. Rev Saude Publica 2011; 45(3): 494-502. https://doi.org/10.1590/s0034-89102011000300007
https://doi.org/10.1590/s0034-8910201100... .

Back pain includes neck pain, thoracic back pain, and low back pain resulting from different musculoskeletal diseases, intervertebral disc disorders, spondylosis, or radiculopathies55. Meziat Filho N, Silva GA. Disability pension from back pain among social security beneficiaries, Brazil. Rev Saude Publica 2011; 45(3): 494-502. https://doi.org/10.1590/s0034-89102011000300007
https://doi.org/10.1590/s0034-8910201100... ; however, it may not present a specific cause66. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389(10070): 736-47. https://doi.org/10.1016/S0140-6736(16)30970-9
https://doi.org/10.1016/S0140-6736(16)30... . The literature indicates that stress, incorrect movements during physical activity, and work overload can intensify back pain77. Silva DR, Werneck AO, Malta DC, Romero D, Souza-Júnior PRB, Azevedo LO, et al. Changes in movement behaviors and back pain during the first wave of the COVID-19 pandemic in Brazil. Braz J Phys Ther 2021; 25(6): 819-25. https://doi.org/10.1016/j.bjpt.2021.07.006
https://doi.org/10.1016/j.bjpt.2021.07.0... .

Population-based surveys have shown an increased prevalence of these diseases. In 2008, the National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios — PNAD) revealed that 13.5% of the adult population reported back pain88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... . In 2013, the National Health Survey (Pesquisa Nacional de Saúde — PNS 2013) estimated a chronic back pain (CBP) prevalence of 18.6% (95% confidence interval — 95%CI 17.8–19.1)88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... ,99. Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.. Despite the differences in research methodology, since PNAD interviewed the person responsible for the household while PNS randomly selected the respondent, back pain was the second cause of reported morbidity in both studies88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... ,99. Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.. In addition, in both studies, the prevalence was higher among women and tended to increase with age, especially after 50 years88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... ,99. Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.. A study conducted during the coronavirus disease 2019 (COVID-19) pandemic found an estimated prevalence of back pain of 45.2% (95%CI 43.7–46.6). This high value was attributed to a worse lifestyle, increased anxiety and stress, and higher sedentary and home office time, often without adjusting the workstation77. Silva DR, Werneck AO, Malta DC, Romero D, Souza-Júnior PRB, Azevedo LO, et al. Changes in movement behaviors and back pain during the first wave of the COVID-19 pandemic in Brazil. Braz J Phys Ther 2021; 25(6): 819-25. https://doi.org/10.1016/j.bjpt.2021.07.006
https://doi.org/10.1016/j.bjpt.2021.07.0... .

Given the high CBP prevalence and growth, as well as its negative effects on work, health services, the economy, and quality of life, monitoring this health problem77. Silva DR, Werneck AO, Malta DC, Romero D, Souza-Júnior PRB, Azevedo LO, et al. Changes in movement behaviors and back pain during the first wave of the COVID-19 pandemic in Brazil. Braz J Phys Ther 2021; 25(6): 819-25. https://doi.org/10.1016/j.bjpt.2021.07.006
https://doi.org/10.1016/j.bjpt.2021.07.0... becomes important, and the 2019 PNS is a relevant instrument for this follow-up. Thus, the current study aims to estimate the CBP prevalence and its associated factors. The findings of this work may contribute to improving the knowledge of the CBP scenario and assist in the elaboration of specific actions to control the factors associated with this problem.

METHODS

This is a cross-sectional study based on data from the 2019 PNS, conducted by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística — IBGE) in partnership with the Ministry of Health. PNS is representative of Brazilian adults living in private households in urban and rural areas, the five geographic macro-regions, the 26 states and the federal district, and state capitals99. Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020..

The sample size calculation used the results of some 2013 PNS indicators, and the sampling plan adopted was a three-stage cluster sampling with stratification of primary sampling units (PSU), composed of census tracts or sets of tracts. The first stage involved randomly selecting PSUs with probability proportional to size. The second stage selected a number of households in each PSU, totaling 108,525. The third stage randomly picked a resident aged 15 years or older from the list of eligible residents of the chosen household1010. Stopa SR, Szwarcwald CL, Oliveira MM, Gouvea ECDP, Vieira MLFP, Freitas MPS, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude 2020; 29(5): e2020315. https://doi.org/10.1590/s1679-49742020000500004
https://doi.org/10.1590/s1679-4974202000... . The final sample consisted of 94,114 households, with interviews and a response rate of 93.6%. The database results from a complex sampling plan with unequal selection probabilities, including a correction factor for losses99. Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.,1010. Stopa SR, Szwarcwald CL, Oliveira MM, Gouvea ECDP, Vieira MLFP, Freitas MPS, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude 2020; 29(5): e2020315. https://doi.org/10.1590/s1679-49742020000500004
https://doi.org/10.1590/s1679-4974202000... .

Data were collected using personal digital assistants. The adult selected for the individual interview answered the chronic diseases module. This study selected residents aged 18 years or older who answered positively to the question: “Do you have a chronic back condition, such as chronic back or neck pain, low back pain, sciatic pain, vertebrae or disc problems?”. The number of respondents was 88,531 individuals. Thus, the outcome analyzed in the study was the CBP prevalence measured by the positive response to the previous question.

The literature highlights that CBP is associated with sociodemographic variables, such as gender, age, unhealthy lifestyles, comorbidities, and exposure to excessive work11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,1111. Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal PC. Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study. Rev Bras Fisioter 2011; 15(1): 31-6. https://doi.org/10.1590/S1413-35552011005000001
https://doi.org/10.1590/S1413-3555201100... . We used this theoretical model of association to include the following explanatory variables:

  • Sociodemographic characteristics: gender; age group in years (18−24, 25−34, 35−44, 45−54, 55−64, 65 or more); schooling (illiterate/incomplete elementary school; complete elementary school/incomplete high school; complete high school/incomplete higher education; complete higher education); ethnicity or skin color (white, black, multiracial); area of residence (urban and rural);

  • Lifestyles: smoking (non-smoker; ex-smoker; smoker); heavy housework (yes or no); heavy physical activity at work (yes or no); watching TV for more than three hours (yes or no); consumption of five or more healthy food groups that are fresh or minimally processed and considered protective for chronic diseases the day before the interview (yes or no); consumption of five or more ultra-processed food groups the day before the interview (yes or no); recommended consumption of fruits and vegetables — five or more daily servings (yes or no); consumption of red meat in five or more days a week (yes or no); regular candy consumption — five or more days a week (yes or no); regular soft drink consumption — five or more days a week (yes or no); alcohol abuse — five or more days a week (yes or no); high salt consumption (yes or no);

  • Metabolic risk factors and morbidities: measured and classified by body mass index (BMI) (normal, overweight — BMI≥25, or obesity — BMI≥30, calculated according to self-reported weight and height responses) and presence of self-reported chronic diseases: hypertension, high cholesterol (yes or no);

  • Health status assessment (very good, good, regular, poor, and very poor). We performed a chi-square test between the outcome variable and the explanatory variables considering a 0.05 significance level. The multiple logistic regression model was used to obtain odds ratio (OR) estimates and the 95%CI1212. Paula GA. Modelos de regressão com apoio computacional. São Paulo: Universidade de São Paulo, Instituto de Matemática e Estatística; [Internet]. 2013 [acessado em 1 set. 2022]. Disponível em: https://www.ime.usp.br/∼giapaula/texto_2013.pdf
    https://www.ime.usp.br/∼giapaula/texto_2...     . The first model selected explanatory variables associated with the outcome (CBP), and the final model consisted of variables with p<0.0512. The analysis was performed in the survey module for complex samples of the Data Analysis and Statistical software (STATA), version 14 (StataCorp., CollegeStation, United States of America).

PNS data are available online for public access and use (https://www.ibge.gov.br/estatisticas/sociais/saude/9160-pesquisa-nacional-de-saude.html?=&t=microdados).

The National Human Research Ethics Committee of the Ministry of Health approved the research (opinion no. 3,529,376, 2019 edition). All participants signed the informed consent form (ICF).

RESULTS

In Brazil, CBP was reported by 21.6% of adults, of whom 24.5% (95%CI 23.7–25.2) were women. The CBP prevalence was higher with increasing age of 25–34 years, 13% (95%CI 12–14); among illiterate individuals/those with incomplete elementary school, 29.2% (95%CI 28.2–30.1); and those living in rural areas, 23.7% (95%CI 22.5–25.0). Regarding lifestyle, CBP was more prevalent among ex-smokers, 27.4% (95%CI 26.3–28.4) and smokers, 24.1% (95%CI 22.7–25.5); and respondents who mentioned heavy housework, 26.7% (95%CI 25.4–28.0). Regarding metabolic factors, the CBP prevalence was higher in overweight individuals, 22.1% (95%CI 21.3–22.9), obese individuals, 25.9% (95%CI 24.7–27.0), and those who reported hypertension, 33.2% (95%CI 31.9–34.5) or high cholesterol, 36.4% (95%CI 34.9–37.9). The health status assessment showed a higher dose-response gradient among those who considered their health very poor, 52.9% (95%CI 47.8–58). The other categories showed no statistically significant difference (Table 1).

Thumbnail
Table 1.
Prevalence and 95% confidence interval (95%CI) of chronic back pain in individuals aged 18 years or older, according to sociodemographic characteristics, lifestyles, morbidity, metabolic risk factors, and health status assessment. 2019 National Health Survey, Brazil.
After adjustment for all model variables, those that remained associated with CBP and statistically significant (p<0.05) were:

  • Sociodemographic characteristics: female gender (OR=1.27; 95%CI 1.19–1.35) and adults aged 55 to 64 years (OR=2.47; 95%CI 2.12–2.88). Adults with complete high school/incomplete higher education (OR=0.87; 95%CI 0.81–0.95) were less likely to have CBP;

  • Lifestyles: the probability of having CBP was higher in ex-smokers (OR=1.30; 95%CI 1.21–1.39), those who reported alcohol abuse — five or more days a week (OR=1.11 95%CI 1.01–1.21), and heavy housework (OR=1.41; 95%CI 1.31–1.53). We found no association between food consumption and back pain;

  • Metabolic risk factors: the chance of having CBP was higher in individuals with obesity (OR=1.12; 95%CI 1.03–1.21), hypertension (OR=1.21; 95%CI 1.11–1.32), and high cholesterol (OR=1.53; 95%CI 1.42–1.65);

  • Health assessment: the likelihood of CBP was higher among those who self-rated their health as very poor (OR=5.24 95%CI 4.13–6.65), with the reference being very good (Table 2).

Thumbnail
Table 2.
Factors associated with chronic back pain in adults aged 18 years or older, adjusted for all model variables. 2019 National Health Survey, Brazil.

DISCUSSION

The 2019 PNS data showed that approximately one-fifth of the adult Brazilian population (21.6%) reported CBP. After adjustment for all model variables, those that remained associated with a higher CBP prevalence were: female gender, age greater than 25 years; low schooling; history of smoking and ex-smoking; alcohol abuse; heavy housework; obesity; hypertension; high cholesterol; and worse self-rated health status.

The study revealed that women have higher chances of developing CBP than men, corroborating the literature1313. Aguiar DP, Souza CPQ, Barbosa WJM, Santos-Júnior FFU, Oliveira AS. Prevalence of chronic pain in Brazil: systematic review. BrJP. São Paulo 2021; 4(3): 257-67. https://doi.org/10.5935/2595-0118.20210041
https://doi.org/10.5935/2595-0118.202100... –1515. Garcia JBS, Hernandez-Castro JJ, Nunez RG, Pazos MA, Aguirre JO, Jreige A, et al. Prevalence of low back pain in Latin America: a systematic literature review. Pain Physician 2014; 17(5): 379-91. PMID: 25247896. According to 2013 PNS studies, CBP prevalence was greater among women, 21.1% (95%CI 20.2–22.0), compared to men, 15.5% (95%CI 14.7–16.4), although the growth among men was higher in the period (18%)11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... . Explanations for the higher prevalence among women involve anatomical features, such as shorter stature, lower muscle mass, lower bone mass, and more fragile joints, resulting in increased spinal overload33. Clark S, Horton R. Low back pain: a major global challenge. Lancet 2018; 391(10137): 2302. https://doi.org/10.1016/s0140-6736(18)30725-6
https://doi.org/10.1016/s0140-6736(18)30... ,44. Silva LL, Neta AAP, Prates CF, Soares JS, Araújo TA, Costa AMA, et al. Analysis of the prevalence of lower back pain associated with occupational activities: an integrative literature review. Brazilian Journal of Development 2021; 7(2): 11729-43. https://doi.org/10.34117/bjdv7n2-004
https://doi.org/10.34117/bjdv7n2-004... ,1111. Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal PC. Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study. Rev Bras Fisioter 2011; 15(1): 31-6. https://doi.org/10.1590/S1413-35552011005000001
https://doi.org/10.1590/S1413-3555201100... . Other evidence shows that, during pregnancy, women experience greater flexibility of spinal and hip ligaments due to the action of hormones such as relaxin, estrogen, and progesterone, resulting in increased lordosis, muscle contractures, and abnormal posture, given the progressive fetal growth11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... . Back pain also tends to increase in the postpartum period as a consequence of inadequate positions when breastfeeding, the child’s weight, and other factors11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,1414. Barros MBA, César CLG, Carandina L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. https://doi.org/10.1590/s1413-81232006000400014
https://doi.org/10.1590/s1413-8123200600... ,1616. Machado GPM, Barreto SM, Passos VMA, Lima-Costa MFF. Health and aging study: prevalence of chronic joint symptoms among the elderly in Bambuí. Rev Assoc Med Bras (1992) 2004; 50(4): 367-72. https://doi.org/10.1590/s0104-42302004000400024
https://doi.org/10.1590/s0104-4230200400... .

Housework remained associated in the multivariate model. It often results in intense, repetitive work, with non-ergonomic posture, which can lead to back pain11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,1515. Garcia JBS, Hernandez-Castro JJ, Nunez RG, Pazos MA, Aguirre JO, Jreige A, et al. Prevalence of low back pain in Latin America: a systematic literature review. Pain Physician 2014; 17(5): 379-91. PMID: 25247896,1616. Machado GPM, Barreto SM, Passos VMA, Lima-Costa MFF. Health and aging study: prevalence of chronic joint symptoms among the elderly in Bambuí. Rev Assoc Med Bras (1992) 2004; 50(4): 367-72. https://doi.org/10.1590/s0104-42302004000400024
https://doi.org/10.1590/s0104-4230200400... . In general, this activity is more practiced by women due to society’s sexist culture, which defines this work as female work1717. Hallal PC, Knuth AG, Reis RS, Rombaldi AJ, Malta DC, Iser BPM, et al. Tendências temporais de atividade física no Brasil (2006-2009). Rev Bras Epidemiol 2011; 14(suppl 1): 53-60. https://doi.org/10.1590/s1415-790x2011000500006
https://doi.org/10.1590/s1415-790x201100... .

A study conducted in the city of Bauru (São Paulo) found a higher prevalence of low back pain in women (60.9%) compared to men1818. Bento TPF, Genebra CVS, Maciel NM, Cornelio GP, Simeão SFAP, Vitta A. Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther 2020; 24(1): 79-87. https://doi.org/10.1016/j.bjpt.2019.01.012
https://doi.org/10.1016/j.bjpt.2019.01.0... . For women, low back pain was associated with occupational activity, involving frequent weight lifting, forward-leaning standing position, forward-leaning sitting position, and sitting position at the computer three or more days a week. This finding reinforces that uncomfortable ergonomic positions in occupational activities are associated with CBP in the female population1818. Bento TPF, Genebra CVS, Maciel NM, Cornelio GP, Simeão SFAP, Vitta A. Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther 2020; 24(1): 79-87. https://doi.org/10.1016/j.bjpt.2019.01.012
https://doi.org/10.1016/j.bjpt.2019.01.0... .

Ergonomic and occupational factors (such as self-reported uncomfortable or tiring position and work stress) are significantly associated with low back pain only in females, according to results from a study conducted in New Zealand1919. Widanarko B, Legg S, Stevenson M, Devereux J, Eng A, Mannetje A, et al. Gender differences in work-related risk factors associated with low back symptoms. Ergonomics 2012; 55(3): 327-42. https://doi.org/10.1080/00140139.2011.642410
https://doi.org/10.1080/00140139.2011.64... . Women who worked in more uncomfortable positions for a quarter- or half-time period were 1.45 (95%CI 1.11–1.91) and 1.51 (95%CI 1.04–2.20) more likely to report lumbar symptoms than those whose work did not involve such situations, respectively. In addition, the CBP likelihood in women who declared their work as mildly/moderately stressful and very/extremely stressful was 1.77 (95%CI 1.27–2.46) and 2.27 (95%CI 1.46–3.52), respectively, indicating that CBP is associated not only with uncomfortable postures among women but also with work stress1919. Widanarko B, Legg S, Stevenson M, Devereux J, Eng A, Mannetje A, et al. Gender differences in work-related risk factors associated with low back symptoms. Ergonomics 2012; 55(3): 327-42. https://doi.org/10.1080/00140139.2011.642410
https://doi.org/10.1080/00140139.2011.64... .

Increasing age resulted in greater CBP, corroborating previous Brazilian studies, such as 2003 PNAD, 2008 PNAD11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... , and 2013 PNS11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... . As age advances, individuals experience reduced flexibility and progressive musculoskeletal degeneration, with postural problems becoming more frequent. Data from the Ministry of Social Security indicate that back pain progresses with age and is more frequent after 55 years2020. Meziat Filho N, Silva GA. Invalidez por dor nas costas entre segurados da Previdência Social do Brasil. Rev Saúde Pública 2011; 45(3): 494-502. https://doi.org/10.1590/S0034-89102011000300007
https://doi.org/10.1590/S0034-8910201100... .

People with low schooling showed a higher chance of having CBP, agreeing with the previous studies 2008 PNAD88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... and 2013 PNS11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... . This fact may be associated with this population’s higher exposure to low-skilled, strenuous work, in addition to the high proportion of older adults with low schooling. Another explanation would be their lower access to health services and treatments11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,77. Silva DR, Werneck AO, Malta DC, Romero D, Souza-Júnior PRB, Azevedo LO, et al. Changes in movement behaviors and back pain during the first wave of the COVID-19 pandemic in Brazil. Braz J Phys Ther 2021; 25(6): 819-25. https://doi.org/10.1016/j.bjpt.2021.07.006
https://doi.org/10.1016/j.bjpt.2021.07.0... .

The study found a higher CBP prevalence among smokers and ex-smokers, even after adjustment for all variables. The literature points to nicotine as a cause of immune system activation, predisposing to rheumatic diseases and low back pain11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,2121. Wijnhoven HAH, de Vet HCW, Picavet HSJ. Explaining sex differences in chronic musculoskeletal pain in a general population. Pain 2006; 124(1-2): 158-66. https://doi.org/10.1016/j.pain.2006.04.012
https://doi.org/10.1016/j.pain.2006.04.0... . The finding of an association with alcohol abuse has not been described in the literature and needs to be better explored.

Obesity is an important factor associated with greater back pain, and its prevalence has increased in the Brazilian population99. Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.. Increased weight overloads the muscles and the motor system, resulting in inflammatory processes in the bones and higher vertebral wear, favoring low back pain and disc herniation11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... . Reducing obesity through public health promotion policies, regulating the prices of ultra-processed foods, and encouraging the consumption of healthy foods and the practice of physical activity are crucial2222. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Brasília: Ministério da Saúde; 2011.,2323. World Health Organization. Health topics. Noncommunicable diseases. Geneva: World Health Organization; [Internet]. 2013 [acessado em 1 set. 2022]. Disponível em: https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1
https://www.who.int/health-topics/noncom... .

The presence of chronic diseases, such as hypertension and high cholesterol, was associated with CBP. These chronic diseases are also associated with aging and comorbidities88. Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
https://doi.org/10.1590/S1413-8123201100... ,2424. Malta DC, Bernal RTI, Lima MG, Araújo SSC, Silva MMA, Freitas MIF, et al. Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil. Rev Saúde Pública 2017; 51(suppl 1): 1S-10S. https://doi.org/10.1590/S1518-8787.2017051000090
https://doi.org/10.1590/S1518-8787.20170... .

Worse levels of self-rated health showed higher degrees of association with CBP. These results agree with literature findings, which report a positive association between CBP and worse self-perceived health11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,33. Clark S, Horton R. Low back pain: a major global challenge. Lancet 2018; 391(10137): 2302. https://doi.org/10.1016/s0140-6736(18)30725-6
https://doi.org/10.1016/s0140-6736(18)30... ,2525. Romero DE, Santana D, Borges P, Marques A, Castanheira D, Rodrigues JM, et al. Prevalência, fatores associados e limitações relacionados ao problema crônico de coluna entre adultos e idosos no Brasil. Cad Saúde Pública 2018; 34(2): e00012817. https://doi.org/10.1590/0102-311X00012817
https://doi.org/10.1590/0102-311X0001281... . We emphasize that this qualitative indicator has great sensitivity and predictive capacity for negative health situations, including mortality11. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
https://doi.org/10.1590/S1518-8787.20170... ,2626. Barreto SM, Figueiredo RC. Doença crônica, auto-avaliação de saúde e comportamento de risco: diferença de gênero. Rev Saúde Pública 2009; 43(suppl 2): 38-47. https://doi.org/10.1590/s0034-89102009000900006
https://doi.org/10.1590/s0034-8910200900... .

Study limitations include those inherent in cross-sectional studies with restricted causality inference, which may have affected the associations described herein. Given the self-reported prevalence, the values may have been overestimated. On the other hand, the sample is representative of the Brazilian population. Therefore, the findings of this study are close to the Brazilian reality since they were based on PNS data, considered the gold standard of Brazilian health surveys, as it is the most complete and comprehensive health research in the country1010. Stopa SR, Szwarcwald CL, Oliveira MM, Gouvea ECDP, Vieira MLFP, Freitas MPS, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude 2020; 29(5): e2020315. https://doi.org/10.1590/s1679-49742020000500004
https://doi.org/10.1590/s1679-4974202000... .

In conclusion, the high CBP prevalence in the Brazilian population stands out. CBP was associated with the female gender, increasing age, low schooling, history of smoking and ex-smoking, alcohol abuse, heavy housework, obesity, hypertension, high cholesterol, and worse self-rated health status. Knowing these associations is important to address prevention and health care measures.

The findings of this study contribute to better knowing the scenario of these diseases, demonstrating the need for specific actions aimed at controlling and reducing obesity, smoking, as well as the practice of strenuous physical activity, which are directly associated with this problem.

ACKNOWLEDGEMENTS:

The author Deborah Carvalho Malta thanks the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq) for funding the research productivity grant.

  • FUNDING: National Health Fund, Department of Health Surveillance, Ministry of Health (TED 66/2018).

References

  • 1.
    Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saúde Pública. 2017; 51(suppl 1): 1S-12S. https://doi.org/10.1590/S1518-8787.2017051000052
    » https://doi.org/10.1590/S1518-8787.2017051000052
  • 2.
    Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391(10137): 2356-67. https://doi.org/10.1016/S0140-6736(18)30480-X
    » https://doi.org/10.1016/S0140-6736(18)30480-X
  • 3.
    Clark S, Horton R. Low back pain: a major global challenge. Lancet 2018; 391(10137): 2302. https://doi.org/10.1016/s0140-6736(18)30725-6
    » https://doi.org/10.1016/s0140-6736(18)30725-6
  • 4.
    Silva LL, Neta AAP, Prates CF, Soares JS, Araújo TA, Costa AMA, et al. Analysis of the prevalence of lower back pain associated with occupational activities: an integrative literature review. Brazilian Journal of Development 2021; 7(2): 11729-43. https://doi.org/10.34117/bjdv7n2-004
    » https://doi.org/10.34117/bjdv7n2-004
  • 5.
    Meziat Filho N, Silva GA. Disability pension from back pain among social security beneficiaries, Brazil. Rev Saude Publica 2011; 45(3): 494-502. https://doi.org/10.1590/s0034-89102011000300007
    » https://doi.org/10.1590/s0034-89102011000300007
  • 6.
    Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389(10070): 736-47. https://doi.org/10.1016/S0140-6736(16)30970-9
    » https://doi.org/10.1016/S0140-6736(16)30970-9
  • 7.
    Silva DR, Werneck AO, Malta DC, Romero D, Souza-Júnior PRB, Azevedo LO, et al. Changes in movement behaviors and back pain during the first wave of the COVID-19 pandemic in Brazil. Braz J Phys Ther 2021; 25(6): 819-25. https://doi.org/10.1016/j.bjpt.2021.07.006
    » https://doi.org/10.1016/j.bjpt.2021.07.006
  • 8.
    Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. https://doi.org/10.1590/S1413-81232011001000012
    » https://doi.org/10.1590/S1413-81232011001000012
  • 9.
    Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida e doenças crônicas e saúde bucal. Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020.
  • 10.
    Stopa SR, Szwarcwald CL, Oliveira MM, Gouvea ECDP, Vieira MLFP, Freitas MPS, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude 2020; 29(5): e2020315. https://doi.org/10.1590/s1679-49742020000500004
    » https://doi.org/10.1590/s1679-49742020000500004
  • 11.
    Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal PC. Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study. Rev Bras Fisioter 2011; 15(1): 31-6. https://doi.org/10.1590/S1413-35552011005000001
    » https://doi.org/10.1590/S1413-35552011005000001
  • 12.
    Paula GA. Modelos de regressão com apoio computacional. São Paulo: Universidade de São Paulo, Instituto de Matemática e Estatística; [Internet]. 2013 [acessado em 1 set. 2022]. Disponível em: https://www.ime.usp.br/∼giapaula/texto_2013.pdf
    » https://www.ime.usp.br/∼giapaula/texto_2013.pdf
  • 13.
    Aguiar DP, Souza CPQ, Barbosa WJM, Santos-Júnior FFU, Oliveira AS. Prevalence of chronic pain in Brazil: systematic review. BrJP. São Paulo 2021; 4(3): 257-67. https://doi.org/10.5935/2595-0118.20210041
    » https://doi.org/10.5935/2595-0118.20210041
  • 14.
    Barros MBA, César CLG, Carandina L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. https://doi.org/10.1590/s1413-81232006000400014
    » https://doi.org/10.1590/s1413-81232006000400014
  • 15.
    Garcia JBS, Hernandez-Castro JJ, Nunez RG, Pazos MA, Aguirre JO, Jreige A, et al. Prevalence of low back pain in Latin America: a systematic literature review. Pain Physician 2014; 17(5): 379-91. PMID: 25247896
  • 16.
    Machado GPM, Barreto SM, Passos VMA, Lima-Costa MFF. Health and aging study: prevalence of chronic joint symptoms among the elderly in Bambuí. Rev Assoc Med Bras (1992) 2004; 50(4): 367-72. https://doi.org/10.1590/s0104-42302004000400024
    » https://doi.org/10.1590/s0104-42302004000400024
  • 17.
    Hallal PC, Knuth AG, Reis RS, Rombaldi AJ, Malta DC, Iser BPM, et al. Tendências temporais de atividade física no Brasil (2006-2009). Rev Bras Epidemiol 2011; 14(suppl 1): 53-60. https://doi.org/10.1590/s1415-790x2011000500006
    » https://doi.org/10.1590/s1415-790x2011000500006
  • 18.
    Bento TPF, Genebra CVS, Maciel NM, Cornelio GP, Simeão SFAP, Vitta A. Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther 2020; 24(1): 79-87. https://doi.org/10.1016/j.bjpt.2019.01.012
    » https://doi.org/10.1016/j.bjpt.2019.01.012
  • 19.
    Widanarko B, Legg S, Stevenson M, Devereux J, Eng A, Mannetje A, et al. Gender differences in work-related risk factors associated with low back symptoms. Ergonomics 2012; 55(3): 327-42. https://doi.org/10.1080/00140139.2011.642410
    » https://doi.org/10.1080/00140139.2011.642410
  • 20.
    Meziat Filho N, Silva GA. Invalidez por dor nas costas entre segurados da Previdência Social do Brasil. Rev Saúde Pública 2011; 45(3): 494-502. https://doi.org/10.1590/S0034-89102011000300007
    » https://doi.org/10.1590/S0034-89102011000300007
  • 21.
    Wijnhoven HAH, de Vet HCW, Picavet HSJ. Explaining sex differences in chronic musculoskeletal pain in a general population. Pain 2006; 124(1-2): 158-66. https://doi.org/10.1016/j.pain.2006.04.012
    » https://doi.org/10.1016/j.pain.2006.04.012
  • 22.
    Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Brasília: Ministério da Saúde; 2011.
  • 23.
    World Health Organization. Health topics. Noncommunicable diseases. Geneva: World Health Organization; [Internet]. 2013 [acessado em 1 set. 2022]. Disponível em: https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1
    » https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1
  • 24.
    Malta DC, Bernal RTI, Lima MG, Araújo SSC, Silva MMA, Freitas MIF, et al. Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil. Rev Saúde Pública 2017; 51(suppl 1): 1S-10S. https://doi.org/10.1590/S1518-8787.2017051000090
    » https://doi.org/10.1590/S1518-8787.2017051000090
  • 25.
    Romero DE, Santana D, Borges P, Marques A, Castanheira D, Rodrigues JM, et al. Prevalência, fatores associados e limitações relacionados ao problema crônico de coluna entre adultos e idosos no Brasil. Cad Saúde Pública 2018; 34(2): e00012817. https://doi.org/10.1590/0102-311X00012817
    » https://doi.org/10.1590/0102-311X00012817
  • 26.
    Barreto SM, Figueiredo RC. Doença crônica, auto-avaliação de saúde e comportamento de risco: diferença de gênero. Rev Saúde Pública 2009; 43(suppl 2): 38-47. https://doi.org/10.1590/s0034-89102009000900006
    » https://doi.org/10.1590/s0034-89102009000900006

Publication Dates

  • Publication in this collection
    24 Oct 2022
  • Date of issue
    2022

History

  • Received
    31 May 2022
  • Reviewed
    07 Sept 2022
  • Accepted
    08 Sept 2022
Creative Common - by 4.0
Este é um artigo publicado em acesso aberto sob uma licença Creative Commons
Associação Brasileira de Pós -Graduação em Saúde Coletiva São Paulo - SP - Brazil
E-mail: revbrepi@usp.br
Acompanhe os números deste periódico no seu leitor de RSS