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, 68 (11), 1688-1694

Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey


Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey

Anna Shmagel et al. Arthritis Care Res (Hoboken).


Objective: To describe the epidemiologic characteristics and associations with increased health care utilization in US adults with chronic low back pain (LBP).

Methods: The National Health and Nutrition Examination Survey 2009-2010 was administered to adults ages 20-69 years (n = 5,103). Chronic LBP was defined as pain in the area between the lower posterior margin of the rib cage and the horizontal gluteal fold, with a history of pain lasting almost every day for at least 3 months. Demographic and behavioral characteristics were compared between those with chronic LBP and those without. Factors associated with ≥10 health care visits per year were evaluated in the chronic LBP subgroup (n = 700).

Results: Chronic LBP associations with adjusted odds ratios (ORadj ) ≥2 included age 50-69 years, less than high school education, annual household income <$20,000, income from disability, depression, sleep disturbances, and medical comorbidities. Subjects with chronic LBP were more likely to be covered by government-sponsored insurance plans (ORadj 3.23 [95% confidence interval (95% CI) 2.19-4.75] for Medicaid and ORadj 2.25 [95% CI 1.57-3.22] for Medicare; P < 0.0001), and visited health care providers more frequently (ORadj 3.35 [95% CI 2.40-4.67] for ≥10 health care visits in the past year; P < 0.0001). In the chronic LBP subgroup, adjusted ORs ≥2 were found for associations between ≥10 visits per year and unemployment, income from disability, depression, and sleep disturbances.

Conclusion: US adults with chronic LBP are socioeconomically disadvantaged, make frequent health care visits, and are often covered by government-sponsored health insurance. The clustering of behavioral, psychosocial, and medical issues should be considered in the care of Americans with chronic LBP.

Conflict of interest statement

The authors have no conflicts of interest to disclose.


Figure 1
Figure 1
Health insurance status and healthcare utilization in US adults with cLBP (N = 700). In the cLBP subgroup frequent healthcare users (≥10 healthcare visits per year) were more likely to be insured, than those who had fewer healthcare visits (p = 0.0008), adjusted odds ratio for age, gender, race, education, number of comorbidities (aOR) 2.10 ([95% Confidence interval] 1.03–4.26), p = 0.04. The distribution of health insurance types was significantly different in frequent healthcare users. Among those cLBP subjects, who reported ≥10 healthcare visits in the past year 50.5% were covered by federal or state-subsidized insurance plans (the “other” category includes other government-sponsored plans) vs 34.6% of those who had less frequent healthcare visits (p = 0.006), aOR 2.10 (1.21–3.64) for Medicare, 2.31 (1.35–3.97) for Medicaid, p = 0.001.

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