Very little is known about the association of back pain with subjective health and well-being and sleep problems among the older population in middle-income countries. In this study, we examine the association of back pain with four health outcomes — poor self-rated health, impairments in activities of daily living (1+ADL), sleep problems and World Health Organization Quality of Life score (WHOQOL) — and to study what extent the association differs by age group.
Nationally representative data from World Health Organization’s Study on global AGEing and adult health (WHO-SAGE) consisting of 33,878 older adults aged 50 or above were analyzed. The linkages of back pain with poor self-rated health, impairments in activities of daily living (1+ADL), and sleep problems were examined using multivariate logistic regression analysis. Multivariate linear regression was used to assess the association between back pain and quality of life.
In the pooled analysis, the association of back pain with four health outcomes were significant. Older adults who reported low back pain were more likely to report poor self-rated health (OR=1.91; p < .001), impairments in activities of dailiy living (ADL) (OR=2.06; p < .001), and sleep problems (OR=2.04; p < .001), and had lower quality of life score (β = −3.23, p < .001). Furthermore, the association of back pain and poor self-rated health, impairments in ADL, and sleep problems was stronger for the 50–59 age group than the 80 or above age group, suggesting significant age interaction in the association.
This study suggested the significant role of back pain in determining subjective health, wellbeing, and sleep problems. Measures to prevent back pain, particularly among those in the 50–59 age group, are important to enhance overall wellbeing of the growing older population in low- and middle-income countries.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The data can be freely downloaded from the WHO’s website through the following link: http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/sage
Akpan A, Roberts C, Bandeen-Roche K, Batty B, Bausewein C, Bell D, Ekdahl A (2018) Standard set of health outcome measures for older persons. BMC Geriatr 18(1):36. https://doi.org/10.1186/s12877-017-0701-3
Alsaadi SM, McAuley JH, Hush JM, Maher CG (2011) Prevalence of sleep disturbance in patients with low back pain. Eur Spine J 20(5):737–743. https://doi.org/10.1007/s00586-010-1661-x
Andersson HI, Ejlertsson G, Leden I, Rosenberg C (1993) Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain 9(3):174–182. https://doi.org/10.1097/00002508-199309000-00004
Bahouq H, Allali F, Rkain H, Hmamouchi I, Hajjaj-Hassouni N (2013) Prevalence and severity of insomnia in chronic low back pain patients. Rheumatol Int 33(5):1277–1281. https://doi.org/10.1007/s00296-012-2550-x
Bressler HB, Keyes WJ, Rochon PA, Badley E (1999) The prevalence of low back pain in the elderly: a systematic review of the literature. Spine 24(17):1813. https://doi.org/10.1097/00007632-199909010-00011
Brooks PM (2006) The burden of musculoskeletal disease—a global perspective. Clin Rheumatol 25(6):778–781. https://doi.org/10.1007/s10067-006-0240-3
Cano A, Leong LE, Williams AM, May DK, Lutz JR (2012) Correlates and consequences of the disclosure of pain-related distress to one’s spouse. Pain 153(12):2441–2447. https://doi.org/10.1016/j.pain.2012.08.015
Case A, Deaton A (2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci 112(49):15078–15083. https://doi.org/10.1073/pnas.1518393112
Cho NH, Jung YO, Lim SH, Chung CK, Kim HA (2012) The prevalence and risk factors of low back pain in rural community residents of Korea. Spine 37(24):2001–2010. https://doi.org/10.1097/BRS.0b013e31825d1fa8
Cole LJ, Farrell MJ, Gibson SJ, Egan GF (2010) Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging 31(3):494–503. https://doi.org/10.1016/j.neurobiolaging.2008.04.012
de Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do Espírito-Santo ADS et al (2019) Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo)74:e789. https://doi.org/10.6061/clinics/2019/e789
Edwards RR, Fillingim RB, Ness TJ (2003) Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults. Pain 101(1-2):155–165. https://doi.org/10.1016/s0304-3959(02)00324-x
Fernández-de-las-Peñas C, Hernández-Barrera V, Alonso-Blanco C, Palacios-Ceña D, Carrasco-Garrido P et al (2011) Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine 36(3):E213–E219. https://doi.org/10.1007/s00586-014-3567-5
Fernández-de-las-Peñas C, Alonso-Blanco C, Hernández-Barrera V, Palacios-Ceña D, Jiménez-García R et al (2013) Has the prevalence of neck pain and low back pain changed over the last 5 years? A population-based national study in Spain. Spine J 13(9):1069–1076. https://doi.org/10.1016/j.spinee.2013.02.064
Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK (2014) Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 62(12):2261–2272. https://doi.org/10.1111/jgs.13153
Gilgil E, Kaçar C, Bütün B, Tuncer T, Urhan S et al (2005) Prevalence of low back pain in a developing urban setting. Spine 30(9):1093–1098. https://doi.org/10.1097/01.brs.0000161007.46849.4c
Hoy D, March L, Brooks P, Woolf A, Blyth et al (2010a) Measuring the global burden of low back pain. Best Prac Res Clin Rheumatol 24(2):155–165. https://doi.org/10.1016/j.berh.2009.11.002
Hoy D, Brooks P, Blyth F, Buchbinder R (2010b) The epidemiology of low back pain. Best Pract Res Clin Rheumatol 24(6):769–781. https://doi.org/10.1016/j.berh.2010.10.002
Hoy D, March L, Brooks P, Blyth F, Woolf A et al (2014) The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73(6):968–974. https://doi.org/10.1136/annrheumdis-2013-204428
Hugo J, Ganguli M (2014) Dementia and cognitive impairment: epidemiology, diagnosis, and treatment. Clin Geriatr Med 30(3):421–442. https://doi.org/10.1016/j.cger.2014.04.001
Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38(1):21–37. https://doi.org/10.2307/2955359
Kelly GA, Blake C, Power CK, O’Keeffe D, Fullen BM (2011) The association between chronic low back pain and sleep: a systematic review. Clin J Pain 27(2):169–181. https://doi.org/10.1002/14651858.CD011279.pub3
Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W et al (2012) Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol 41(6):1639–1649. https://doi.org/10.1093/ije/dys210
Marin R, Cyhan T, Miklos W (2006) Sleep disturbance in patients with chronic low back pain. Am J Phys Med Rehabil 85(5):430–435.
Marty M, Rozenberg S, Duplan B, Thomas P, Duquesnoy B et al (2008) Quality of sleep in patients with chronic low back pain: a case-control study. Eur Spine J 17(6):839–844. https://doi.org/10.1007/s00586-008-0660-7
McDaid O, Hanly MJ, Richardson K, Kee F, Kenny RA et al (2013) The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. BMJ Open 3(6):e002571. https://doi.org/10.1136/bmjopen-2013-002571
Murray C J, Vos T, Lozano R, Naghavi M, Flaxman AD et al. (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet 380(9859):2197–2223. https://doi.org/10.1016/S0140-6736(12)61689-4
O’Donoghue GM, Fox N, Heneghan C, Hurley DA (2009) Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC Musculoskelet Disord 10(1):122. https://doi.org/10.1186/1471-2474-10-122
Patel KV, Guralnik JM, Dansie EJ, Turk DC (2013) Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and aging trends study. Pain 154(12):2649–2657. https://doi.org/10.1016/j.pain.2013.07.029
Petrosky E, Harpaz R, Fowler KA, Bohm MK, Helmick CG et al (2018) Chronic pain among suicide decedents, 2003 to 2014: findings from the National Violent Death Reporting System. Ann Intern Med 169(7):448–455. https://doi.org/10.7326/M18-0830
Podichetty VK, Mazanec DJ, Biscup RS (2003) Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J 79(937):627–633. https://doi.org/10.1136/pmj.79.937.627
Prince MJ, Wu F, Guo Y, Robledo LMG, O’Donnell M et al (2015) The burden of disease in older people and implications for health policy and practice. Lancet 385(9967):549–562. https://doi.org/10.1016/S0140-6736(14)61347-7
Rives PA, Douglass AB (2004) Evaluation and treatment of low back pain in family practice. J Am Board Fam Pract 17(suppl 1):S23–S31. https://doi.org/10.3122/jabfm.17.suppl_1.s23
Robinson CL (2007) Relieving pain in the elderly. Health Progress (Saint Louis, Mo) 88(1):48–53.
Schmidt S, Mühlan H, Power M (2006) The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Eur J Pub Health 16(4):420–428. https://doi.org/10.1093/eurpub/cki155
Sen A (2002) Health: perception versus observation: self reported morbidity has severe limitations and can be extremely misleading. BMJ: British Medical Journal 324(7342):860
Smith MT, Perlis ML, Carmody TP, Smith MS, Giles DE (2001) Presleep cognitions in patients with insomnia secondary to chronic pain. J Behav Med 24(1):93–114. https://doi.org/10.1023/a:1005690505632
Stamm TA, Pieber K, Crevenna R, Dorner TE (2016) Impairment in the activities of daily living in older adults with and without osteoporosis, osteoarthritis and chronic back pain: a secondary analysis of population-based health survey data. BMC Musculoskelet Disord 17(1):139. https://doi.org/10.1186/s12891-016-0994-y
Tang NK, Wright KJ, Salkovskis PM (2007) Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res 16(1):85–95. https://doi.org/10.1111/j.1365-2869.2007.00571.x
Thomas E, Peat G, Harris L, Wilkie R, Croft PR (2004) The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain 110(1-2):361–368. https://doi.org/10.1016/j.pain.2004.04.017
Tsang A, Von Korff M, Lee S, Alonso J, Karam E et al (2008) Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 9(10):883–891. https://doi.org/10.1016/j.jpain.2008.05.005
Turk DC, Okifuji A (1999) Assessment of patients’ reporting of pain: an integrated perspective. Lancet 353(9166), 1784-1788.
United Nations, Department of Economic and Social Affairs, Division P (2015) World population prospects: the 2015 revision key findings and advance tables. United Nations, New York
Volinn E (1997) The epidemiology of low back pain in the rest of the world: a review of surveys in low-and middle-income countries. Spine 22(15):1747–1754. https://doi.org/10.1097/00007632-199708010-00013
Wang C, Pu R, Ghose B, Tang S (2018) Chronic musculoskeletal pain, self-reported health and quality of life among older populations in South Africa and Uganda. Int J Environ Res Public Health 15(12):2806. https://doi.org/10.3390/ijerph15122806
Weiner DK, Sakamoto S, Perera S, Breuer P (2006) Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings. J Am Geriatr Soc 54(1):11–20. https://doi.org/10.1111/j.1532-5415.2005.00534.x
WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium (2003) The burden of musculoskeletal conditions at the start of the new millennium: WHO Technical Services Report (no. 919). World Health Organization, Geneva.
Williams JS, Ng N, Peltzer K, Yawson A, Biritwum R et al (2015) Risk factors and disability associated with low back pain in older adults in low-and middle-income countries. Results from the WHO study on global AGEing and adult health (SAGE). PLoS One 10(6):e0127880
Wong WS, Fielding R (2011) Prevalence and characteristics of chronic pain in the general population of Hong Kong. J Pain 12(2):236–245
Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656
World Health Organization (2016) World health statistics 2016: monitoring health for the SDGs, sustainable development goals. World Health Organization, Geneva
No funding was received to support the writing of this paper.
The SAGE study was approved by the Ethics Review Committee (RPC146), World Health Organization, Geneva, Switzerland.
Consent to participate
Informed written consent was obtained from each participant, who were assured that data would remain confidential and used for research purposes only
Consent to publish
The authors have no competing or conflicting Interest
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chaudhary, M., Selvamani, Y. Association between back pain and subjective health, wellbeing and sleep problems among older adults in six middle-income countries: a cross-sectional study. J Public Health (Berl.) (2021). https://doi.org/10.1007/s10389-020-01474-x
- Back pain
- Self-rated health
- Sleep problems
- Older adults
- SAGE countries