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Roseen EJ, McNaughton DT, Harrison S, Downie AS, Øverås CK, Nim CG, Jenkins HJ, Young JJ, Hartvigsen J, Stone KL, Ensrud KE, Lee S, Cawthon PM, Fink HA. Association of back pain with all-cause and cause-specific mortality among older men: a cohort study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:505-513. [PMID: 38741219 PMCID: PMC11292054 DOI: 10.1093/pm/pnae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE We evaluated whether more severe back pain phenotypes-persistent, frequent, or disabling back pain-are associated with higher mortality rate among older men. METHODS In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. RESULTS After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95% CI = 1.11-1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95% CI = 0.86-1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. CONCLUSION Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA 02131, United States
- Department of Physical Medicine & Rehabilitation and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA 02130, United States
| | - David T McNaughton
- School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Stephanie Harrison
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
| | - Aron S Downie
- Department of Chiropractic, Macquarie University, Sydney, 2109, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, 7034, Norway
| | - Casper G Nim
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, 5000, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5000, Denmark
| | - Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, 2109, Australia
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5000, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, M5T 0S8, Canada
| | - Jan Hartvigsen
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, M5T 0S8, Canada
- The Chiropractic Knowledge Hub, University of Southern Denmark, Odense, 5000, Denmark
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, United States
| | - Kristine E Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55415, United States
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, United States
| | - Soomi Lee
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, United States
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
| | - Howard A Fink
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55415, United States
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, United States
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN 55417, United States
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Sex and gender differences in pain: past, present, and future. Pain 2022; 163:S108-S116. [PMID: 36099334 DOI: 10.1097/j.pain.0000000000002738] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/18/2022] [Indexed: 12/30/2022]
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Lu YM, Chen CH, Lue YJ. A cross-sectional study of disability and quality of life in patients with low back pain: Focus on sex and gender. J Back Musculoskelet Rehabil 2022; 35:177-184. [PMID: 34092600 DOI: 10.3233/bmr-200319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sex and gender affect responses to pain, but little is known about disability and quality of life. OBJECTIVES To investigate the effects of sex and gender on disability and health-related quality of life (HRQOL) in patients with low back pain. METHODS Ninety-three patients with low back pain were included in this cross-sectional survey study. Disability, HRQOL and gender identity were respectively assessed with the Oswestry Disability Index, Short Form-36 and Bem Sex Role Inventory. The participants were classified into four gender role orientations (masculinity, femininity, androgyny and undifferentiated). One-way analysis of variance was used to analyze both the sex and the gender role orientation. RESULTS Females had higher disability than males (p< 0.05), but in gender identity, no significant difference was found. Seven domains of HRQOL were lower than the healthy norms. Males experienced greater impacts than females on vitality and mental health (p< 0.05). For gender identity, five domains of HRQOL had significant differences (p< 0.05). Masculinity orientation had the least impact on four domains (p< 0.05), while undifferentiated orientation had the largest impact on all domains. CONCLUSION Sex and gender effects can be used to analyze disability and HRQOL in patients with low back pain. Females have higher disability, while HRQOL is greatly influenced by different gender role orientations.
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Affiliation(s)
- Yen-Mou Lu
- Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Jing Lue
- Department of Physical Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Roseen EJ, Rajendran I, Stein P, Fredman L, Fink HA, LaValley MP, Saper RB. Association of Back Pain with Mortality: a Systematic Review and Meta-analysis of Cohort Studies. J Gen Intern Med 2021; 36:3148-3158. [PMID: 33876379 PMCID: PMC8481518 DOI: 10.1007/s11606-021-06732-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Back pain is the most common cause of disability worldwide. While disability generally is associated with greater mortality, the association between back pain and mortality is unclear. Our objective was to examine whether back pain is associated with increased mortality risk and whether this association varies by age, sex, and back pain severity. METHODS A systematic search of published literature was conducted using PubMed, Web of Science, and Embase databases from inception through March 2019. We included English-language prospective cohort studies evaluating the association of back pain with all-cause mortality with follow-up periods >5 years. Three reviewers independently screened studies, abstracted data, and appraised risk of bias using the Quality in Prognosis Studies (QUIPS) tool. A random-effects meta-analysis estimated combined odds ratios (OR) and 95% confidence intervals (CI), using the most adjusted model from each study. Potential effect modification by a priori hypothesized factors (age, sex, and back pain severity) was evaluated with meta-regression and stratified estimates. RESULTS We identified eleven studies with 81,337 participants. Follow-up periods ranged from 5 to 23 years. The presence of any back pain, compared to none, was not associated with an increase in mortality (OR, 1.06; 95% CI, 0.97 to 1.16). However, back pain was associated with mortality in studies of women (OR, 1.22; 95% CI, 1.02 to 1.46) and among adults with more severe back pain (OR, 1.26; 95% CI, 1.14 to 1.40). CONCLUSION Back pain was associated with a modest increase in all-cause mortality among women and those with more severe back pain.
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Affiliation(s)
- Eric J Roseen
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA. .,Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA. .,New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.
| | - Iniya Rajendran
- Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Peter Stein
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Howard A Fink
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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Holmberg T, Davidsen M, Thygesen LC, Krøll MJ, Tolstrup JS. Mortality among persons experiencing musculoskeletal pain: a prospective study among Danish men and women. BMC Musculoskelet Disord 2020; 21:666. [PMID: 33032563 PMCID: PMC7545937 DOI: 10.1186/s12891-020-03620-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
Background Musculoskeletal (MSK) pain affects many people worldwide and has a great impact on general health and quality of life. However, the relationship between MSK pain and mortality is not clear. This study aimed to investigate all-cause and cause-specific mortality in relation to self-reported MSK pain within the last 14 days, including spread of pain and pain intensity. Methods This prospective cohort study included a representative cohort of 4806 men and women aged 16+ years, who participated in a Danish MSK survey 1990–1991. The survey comprised questions on MSK pain, including spread of pain and pain intensity. These data were linked with the Danish Register of Causes of Death to obtain information on cause of death. Mean follow-up was 19.1 years. Cox regression analyses were performed with adjustment for potential confounders. Results In the study population (mean age 44.5 years; 47.9% men), 41.0% had experienced MSK pain within the last 14 days and 1372 persons died during follow-up. For both sexes, increased all-cause mortality with higher spread and intensity of MSK pain was observed; a high risk was observed especially for men with strong pain (HR = 1.66; 95% CI:1.09–2.53) and women with widespread pain (HR = 1.49; 95% CI:1.16–1.92). MSK pain within last 14 days yielded c-statistics of 0.544 and 0.887 with age added. Moreover, persons with strong MSK pain had an increased cardiovascular mortality, persons with moderate pain and pain in two areas had an increased risk of cancer mortality, and persons with widespread pain had an increased risk of respiratory mortality. Conclusions Overall, persons experiencing MSK pain had a higher risk of mortality. The increased mortality was not accounted for by potential confounders. However, when evaluating these results, it is important to take the possibility of unmeasured confounders into account as we had no information on e.g. BMI etc. Significance The present study provides new insights into the long-term consequences of MSK pain. However, the discriminatory accuracy of MSK pain was low, which indicates that this information cannot stand alone when predicting mortality risk.
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Affiliation(s)
- Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark.
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
| | | | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
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Long-term mortality in older adults with chronic pain: a nationwide population-based study in Taiwan. Eur Geriatr Med 2019; 10:777-784. [PMID: 34652710 DOI: 10.1007/s41999-019-00228-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was conducted to clarify the long-term mortality in the older population with chronic pain (CP), which is still unclear. METHODS We identified 17,568 older participants (aged ≥ 65 years) with CP and an identical number of comparison cohort without CP matched 1:1 by age and sex between 1996 and 2000 from the Taiwan National Health Insurance Research Database. Causes of CP, underlying comorbidities, living areas, and mortality were collected for analyses. The long-term mortality and the causes of mortality were compared between the two cohorts through follow-up since 2000 until 2015. RESULTS The mean age (± standard deviation) was 73.5 ± 5.7 years, and female participants comprised 55.1% in both cohorts. The most common causes of CP were osteoarthritis (24.2%), spinal disorders (22.4%), peripheral vascular diseases (14.0%), and osteoporosis (9.5%). Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP (adjusted hazard ratio [AHR]: 1.18; 95% confidence interval [CI] 1.14-1.21). The increased mortality rate was observed even after the follow-up of 6 years (AHR 1.15; 95% CI 1.10-1.20). No significant difference was observed in the causes of mortality between the two cohorts. The most common cause of mortality was malignancy, followed by cardiovascular and cerebrovascular diseases. CONCLUSIONS Chronic pain was associated with an increased rate of long-term mortality in the older population. Early detection and intervention for treating CP are suggested for this population.
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Muscari A, Bianchi G, Forti P, Magalotti D, Pandolfi P, Zoli M. Inverse Association Between Neck Pain and All-Cause Mortality in Community-Dwelling Older Adults. PAIN MEDICINE 2019; 19:2377-2386. [PMID: 29220527 DOI: 10.1093/pm/pnx306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective In a previous study, we found an apparent protective effect of neck pain on all-cause mortality in subjects older than age 85 years. The present longitudinal investigation was performed to verify this unexpected finding in a larger sample and to establish its significance. Design Population follow-up study. Setting Three towns of Northern Italy. Subjects We examined 5,253 community-dwelling residents age 65-102 years (55% female). Methods Through a postal questionnaire, baseline information was obtained concerning cardiovascular risk factors, self-rated health, physical activity, cardiovascular events, medical therapy, and presence of pain in the main joints. Seven-year all-cause mortality was the end point. Results During follow-up, 1,250 people died. After adjustment for age, sex, anti-inflammatory drugs, physical activity, and main risk factors, neck pain was inversely associated with mortality (hazard ratio = 0.74, 95% confidence interval = 0.64-0.86, P < 0.001). This association was present, with high significance, in each of the eight following subgroups: men, women, age 65-74 years, age 75-84 years, age ≥85 years and residents of each of the three towns. The subjects without neck pain (N = 3,158) were older, more often men, less often hypercholesterolemic, less physically active, and had more frequently had a stroke than the subjects with neck pain (N = 2,095). There were no differences in the causes of death between subjects with or without neck pain. Conclusion This study has confirmed the existence of an independent inverse association between neck pain and mortality in the elderly, suggesting that reduced sensitivity to neck pain may be a new marker of frailty.
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Affiliation(s)
- Antonio Muscari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Donatella Magalotti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Pandolfi
- Department of Public Health, AUSL Bologna, Epidemiological and Health Promotion Unit, Bologna, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Abstract
Global burden of disease studies measure the impact of disability and premature death resulting from specific diseases and injuries. Recently, these studies have highlighted the leading contribution of regional pain conditions (low back pain and neck pain in particular) to the global burden of disability. However, to date, there has not been a systematic approach to measuring the global burden of disease attributable to neuropathic pain (NP) conditions. This article gives a brief overview of the concept of burden of disease, the underlying drivers, and dynamics of disease burden at a population level and proposes an agenda in relation to NP for developing the conceptual and empirical evidence base necessary for estimating the global burden of NP.
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Roseen EJ, LaValley MP, Li S, Saper RB, Felson DT, Fredman L. Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study. J Gen Intern Med 2019; 34:90-97. [PMID: 30350028 PMCID: PMC6318166 DOI: 10.1007/s11606-018-4680-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear. OBJECTIVE To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability. DESIGN Prospective cohort study. SETTING The Study of Osteoporotic Fractures. PARTICIPANTS Women aged 65 or older. MEASUREMENT Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators. RESULTS Of 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively. LIMITATIONS Only white women were included. CONCLUSION Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.
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Affiliation(s)
- Eric J. Roseen
- Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA USA
| | - Michael P. LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Shanshan Li
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA USA
| | - Robert B. Saper
- Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA USA
| | - David T. Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA USA
| | - Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - For the Study of Osteoporotic Fractures
- Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
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Åsberg AN, Hagen K, Stovner LJ, Heuch I, Zwart JA, Winsvold BS. Do incident musculoskeletal complaints influence mortality? The Nord-Trøndelag Health study. PLoS One 2018; 13:e0203925. [PMID: 30265708 PMCID: PMC6161841 DOI: 10.1371/journal.pone.0203925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Musculoskeletal complaints (MSC) are common in the general population, causing a major disease burden to the individual and society. The association between MSC and mortality is still unclear. To our knowledge, no study has hitherto evaluated the association between MSC onset within the last month (incident MSC) on the one hand, and all-cause and cause-specific mortality on the other. Methods This prospective population-based cohort study was done using data from the second Nord-Trøndelag Health Study (HUNT2) linked with data from a comprehensive national registry of cause of death. A total of 25,931 participants at risk for incident MSC were included. Hazard ratios (HR) of mortality were estimated for participants with incident MSC using Cox regression based on a mean of 14.1 years of follow-up. Results Participants who reported incident MSC did not have an excess mortality compared to those with no MSC in the analyses of all-cause mortality (HR 0.99, 95% CI 0.89–1.10) and cause specific mortality. This was true also after adjustment for several potential confounding factors. No clear association between the number of MSC body sites and mortality was found. Conclusion Incident MSC were not associated with an increased mortality, neither for all-cause mortality, nor cause-specific mortality.
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Affiliation(s)
- Anders Nikolai Åsberg
- Department of Neuroscience, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Knut Hagen
- Department of Neuroscience, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headache, St. Olavs University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headache, St. Olavs University Hospital, Trondheim, Norway
| | - Ingrid Heuch
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology and FORMI; Oslo University Hospital, Oslo, Norway
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Cimas M, Ayala A, Sanz B, Agulló-Tomás MS, Escobar A, Forjaz MJ. Chronic musculoskeletal pain in European older adults: Cross-national and gender differences. Eur J Pain 2017; 22:333-345. [PMID: 29235193 DOI: 10.1002/ejp.1123] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND In an ageing Europe, chronic pain is a major public health problem, but robust epidemiological data are scarce. This study aimed to analyse the prevalence of and factors associated with chronic musculoskeletal pain by gender in older adults of 14 European countries. METHODS A cross-sectional study was performed from wave 5 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The study included people ≥50 years residing in Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, the Netherlands, Slovenia, Spain, Sweden and Switzerland. Chronic pain was defined as being bothered by joint and/or back pain for the previous 6 months. Multivariable Poisson regression models with robust variance were performed to analyse prevalence ratio by covariates, stratified by sex. RESULTS A total of 61,157 participants were included. Overall prevalence of chronic musculoskeletal pain was 35.7% (28.8-31.7), ranging from 18.6% (17.1-20.1) for Switzerland to 45.6% (43.3-47.8) for France. Prevalence was higher in women than in men: 41.3% (40.2-42.4) versus 29.1% (28.0-30.3). Chronic musculoskeletal pain was lower in men aged >75 years (PR = 0.82; 0.72-0.92) than the younger (50-59) group. Separated/divorced status presented opposite effects among men (PR = 0.85; 0.76-0.96) and women (PR = 1.12; 1.03-1.21) compared with married, and unemployment was a significant factor in men (PR = 1.21; 95% CI 1.02-1.43) compared with employed. CONCLUSIONS Musculoskeletal pain in older European adults is very frequent, especially in women, with large differences depending on the country of residence. Health policy makers should prioritize strategies aimed at improving the prevention and management of chronic musculoskeletal pain in Europe. SIGNIFICANCE This study provides epidemiological data of chronic musculoskeletal pain in older adults. Reported differences contribute to highlight the relevance of considering a gender perspective in chronic musculoskeletal pain research. Cross-national comparison also offers a map of differences that improves the knowledge of this chronic condition in Europe.
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Affiliation(s)
- M Cimas
- National School of Health, Institute of Health Carlos III, Madrid, Spain
| | - A Ayala
- National School of Health, Institute of Health Carlos III, Madrid, Spain.,Red de Investigación en Servicios, Red de Servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, Spain
| | - B Sanz
- National School of Health, Institute of Health Carlos III, Madrid, Spain
| | - M S Agulló-Tomás
- Instituto Universitario de Estudios de Género y Departamento de Análisis Social, Universidad Carlos III, Madrid, Spain
| | - A Escobar
- Red de Investigación en Servicios, Red de Servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, Spain
| | - M J Forjaz
- National School of Health, Institute of Health Carlos III, Madrid, Spain.,Red de Investigación en Servicios, Red de Servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, Spain
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Makris UE, Weinreich MA, Fraenkel L, Han L, Leo-Summers L, Gill TM. Restricting Back Pain and Subsequent Disability in Activities of Daily Living Among Community-Living Older Adults. J Aging Health 2017; 30:1482-1494. [PMID: 28863724 DOI: 10.1177/0898264317721555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent disability in essential (e) and instrumental (i) activities of daily living (ADL) among community-living older adults. METHOD In this prospective cohort study, we evaluated 754 adults, aged ≥70 years who were initially nondisabled in eADL. Restricting back pain and disability were assessed during monthly interviews for up to 159 months. Associations between restricting back pain and subsequent eADL and iADL disability were evaluated using recurrent events Cox models, adjusted for fixed-in-time and time-varying covariates. RESULTS Strong associations were found between restricting back pain and eADL and iADL disability, with hazard ratios (95% confidence intervals) of 3.47 [3.01, 3.90] and 2.33 [2.08, 2.61], respectively. DISCUSSION Restricting back pain was independently associated with subsequent disability in eADL and iADL. Interventions focused on decreasing restricting back pain in older adults may have the potential to reduce the subsequent burden of disability.
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Affiliation(s)
- Una E Makris
- 1 VA North Texas Health Care System, Dallas, USA.,2 UT Southwestern Medical Center, Dallas, USA
| | | | - Liana Fraenkel
- 3 Yale School of Medicine, New Haven, CT, USA.,4 Veterans Administration Medical Center, West Haven, CT, USA
| | - Ling Han
- 3 Yale School of Medicine, New Haven, CT, USA
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Fernandez M, Boyle E, Hartvigsen J, Ferreira M, Refshauge K, Maher C, Christensen K, Hopper J, Ferreira P. Is this back pain killing me? All‐cause and cardiovascular‐specific mortality in older Danish twins with spinal pain. Eur J Pain 2017; 21:938-948. [DOI: 10.1002/ejp.996] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 01/21/2023]
Affiliation(s)
- M. Fernandez
- Faculty of Health Sciences The University of Sydney NSW Australia
| | - E. Boyle
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense M Denmark
- Dalla Lana School of Public Health University of Toronto ON Canada
| | - J. Hartvigsen
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense M Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics University of Southern Denmark Odense M Denmark
| | - M.L. Ferreira
- The George Institute for Global Health Sydney Medical School The University of Sydney NSW Australia
- Institute of Bone and Joint Research The Kolling Institute Sydney Medical School The University of Sydney NSW Australia
| | - K.M. Refshauge
- Faculty of Health Sciences The University of Sydney NSW Australia
| | - C.G. Maher
- The George Institute for Global Health Sydney Medical School The University of Sydney NSW Australia
| | - K. Christensen
- Danish Aging Research Center Institute of Public Health, Epidemiology University of Southern Denmark Odense C Denmark
| | - J.L. Hopper
- Australian Twin Registry Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology The University of Melbourne Vic. Australia
| | - P.H. Ferreira
- Faculty of Health Sciences The University of Sydney NSW Australia
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15
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Pan CW, Wang X, Ma Q, Sun HP, Xu Y, Wang P. Cognitive dysfunction and health-related quality of life among older Chinese. Sci Rep 2015; 5:17301. [PMID: 26601612 PMCID: PMC4658548 DOI: 10.1038/srep17301] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/28/2015] [Indexed: 11/09/2022] Open
Abstract
We aimed to assess the association of cognitive dysfunction with health-related quality of life (HRQOL) among older adults in China. We analyzed community-based cross-sectional data of 5,557 Chinese individuals aged 60 years and above in the Weitang Geriatric Diseases Study. Cognitive dysfunction and HRQOL were assessed using the Abbreviated Mental Test (AMT) and the European Quality of Life-5 dimensions (EQ-5D), respectively. We estimated the impacts of cognitive dysfunction on the EQ-5D index and visual analogue scale (VAS) scores using linear regression models, and the association between cognitive dysfunction and self-reported EQ-5D health problems using logistic regression models. The EQ-5D index and VAS scores were significantly lower for individuals with cognitive dysfunction than their counterparts. After controlling for covariates, the differences in EQ-5D index and VAS scores between individuals with and without cognitive dysfunction were −0.016 (95% confidence interval [CI]: −0.024, −0.008), and −3.4 (95% CI: −4.5, −2.4), respectively. Cognitive dysfunction was associated with reporting of problems in pain/discomfort (odds ration [OR]: 1.37; 95% CI: 1.12, 1.69), and anxiety/depression (OR: 2.13; 95% CI: 1.41, 3.23). The negative impact on HRQOL increased with the severity of cognitive dysfunction. The results indicate cognitive dysfunction was associated with worse HRQOL in older adults.
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Affiliation(s)
- Chen-Wei Pan
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Xingzhi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Qinghua Ma
- The 3rd People's Hospital of Xiangcheng District, Suzhou, China
| | - Hong-Peng Sun
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yong Xu
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Pei Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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