The effect of comorbidity on care seeking for back problems in the United States

Ann Epidemiol. 1999 May;9(4):262-70. doi: 10.1016/s1047-2797(98)00059-3.


Purpose: We assess the effect of comorbidity on self-reported use of health care for back problems in the United States.

Methods: Data from the 1989 National Health Interview Survey (NHIS) were used to perform cross-sectional analyses of adults who reported a back-related condition. The presence of one or more nonback-related conditions (and associated disability and health care) were the primary predictor variables. Weighted logistic regression modeling was performed to estimate odds ratios (ORs) adjusted for the effects of covariates.

Results: The 1989 NHIS included 84,572 adults, of which 4790 (5.7%) reported at least one back-related condition. Of these, 931 (19.6%) sought health care for their back condition during the 2-week reference period. Among all adults with reported back problems, those with disabling comorbidities and those who sought care for their comorbidities during the reference period were less likely to have sought back care than were those with no comorbidities. Subjects with back-related disabilities who reported nondisabling comorbidities without associated health care were much more likely to have sought back care than were similar subjects without any comorbidities.

Conclusions: The decision to seek care for a back problem is a complex process that depends upon the presence and impact of other conditions and the use of care for these conditions. Comorbid back problem sufferers may not seek back care when afflicted with other disabling conditions or conditions that may be perceived to be more amenable to care.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Comorbidity
  • Cross-Sectional Studies
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Acceptance of Health Care*
  • Socioeconomic Factors
  • Spinal Diseases / epidemiology*
  • Spinal Diseases / therapy
  • Spinal Injuries / epidemiology*
  • Spinal Injuries / therapy
  • United States / epidemiology