Risk factors associated with back problems

Risk factors increase the chance of developing a chronic condition. Back problems share a number of risk factors with other chronic diseases, such as:

Non-modifiable risk factors

  • age (back problems are more common as people get older)
  • genetic predisposition.

Modifiable risk factors

  • insufficient physical activity
  • smoking
  • overweight/obesity
  • occupational hazards (for example, activities involving repetitive bending and/or lifting, prolonged sitting)
  • joint trauma and injuries (for example, injuries from contact sports or falls, high impact sports)
  • some non-occupational physical activities (for example heavy domestic physical activity, or combination of heavy domestic and recreational physical activity [1].

Other factors such as exposure to whole body vibration [2] and mechanical exposures (such as placing unequal stress on the spine by twisting while lifting heavy objects or poor posture during work activities) [3] may increase the risk of developing back problems, in particular low back pain.

Risk factors can also affect quality of life, and often complicate treatment and management options [4]. Managing these risk factors helps to manage the progression and health burden of back problems, and can reduce the risk of developing further complications and other chronic diseases.

Risk factors are defined in Box 1.

Common risk factors

According to the 2014–15 NHS, people with back problems are more likely to be current daily smokers (although the difference is not statistically significant) and more likely to be physically inactive and obese, compared to those without back problems (see Figure 1 and Table 1).

Figure 1: Prevalence of risk factors in people with and without back problems, 2014–15

Vertical bar chart showing (with back problems, without back problems); risk factors (current daily smoker, physically inactive, obese) on the x axis; per cent (0 to 70) on the y axis.

Note: The thin vertical lines attached at the end of each bar are 95% confidence intervals. We can be 95% confident that the true value is within this confidence interval.

Source: ABS National Health Survey, 2014–15 (see Data table).

Specific risk factors

Smoker status

People with back problems were more likely to be or have been a smoker:

  • 16.2% were current daily smokers (compared with 14.1% of people without back problems), although the difference is not statistically significant
  • 36.3% were ex-smokers (compared with 30.1% of people without back problems).

Current smoking is associated with:

  • increased prevalence of low back pain in the past month and past 12 months
  • seeking care for low back pain
  • chronic low back pain
  • disabling low back pain.

Figure 2: Smoker status of people with and without back problems, 2014–15

Vertical bar chart showing (with back problems, without back problems); smoker status (current daily smoker, occasional smoker, ex-smoker, never smoked) on the x axis; per cent (0 to 60) on the y axis.

Note: The thin vertical lines attached at the end of each bar are 95% confidence intervals. We can be 95% confident that the true value is within this confidence interval.

Source: ABS National Health Survey, 2014–15 (see Data table).

Physical activity

People with back problems were slightly less likely than people without back problems to report engaging in the recommended levels of moderate or vigorous physical activity. For adults with back problems, 57.8% reported being physically inactive (this includes people who are inactive and insufficiently active) compared to 53.7% of those without back problems.

Exercise and physical activity are important for the prevention and management of back problems. The relationship between physical activity and back problems is affected by the nature and intensity of the physical activities undertaken. Both too little and too much activity increases the risk of chronic lower back pain [5]. Moderate to strong risk factors for lower back pain include heavy manual workload and repetitive lifting, with stronger associations for flexed, rotated or awkward positions of the spine [6].

Figure 3: Physical activity in people with and without back problems, 2014–15

Vertical bar chart showing (with back problems, without back problems); physical activity (inactive, insufficiently active, sufficiently active for health) on the x axis; per cent (0 to 50) on the y axis.

Note: The thin vertical lines attached at the end of each bar are 95% confidence intervals. We can be 95% confident that the true value is within this confidence interval.

Source: ABS National Health Survey, 2014–15 (see Data table).

Age differences in risk factors in people with back problems

For people with back problems, the prevalence of risk factors varies by age.

The prevalence of smoking in people with back problems decreased with age. Younger people (aged 18–44) with back problems were more likely to report smoking (22.7%) than those aged 45–64 (19.0%) or 65 and over (7.5%).

There was an increase with age in the prevalence of physical inactivity or overweight and obesity for people with back problems. Physical inactivity increased from 51.1% at age 18–44 to 58.9% at age 45–64 to 66.6% at age 65 and over, although the increase was not significant. Overweight and obesity increased significantly from 58.5% at age 18–44 to 75.9% at ages 45–64 and 65 and over.

A similar pattern is observed in the prevalence of smoking and physical inactivity for people without back problems. In contrast, the prevalence of overweight and obesity for people without back problems increased up to the age of 45–64 but declined for people aged 65 and over, although this decline is not significant.

Figure 5: Prevalence of risk factors in people with back problems, by age, 2014–15

Horizontal bar chart showing age (65 and over, 45 to 64, 18 to 44 years); per cent (0 to 100) on the x axis; risk factor  (overweight/obese, physical inactivity, smoking) on the y axis.

Note: The thin horizontal lines attached at the end of each bar are 95% confidence intervals. We can be 95% confident that the true value is within this confidence interval.

Source: ABS National Health Survey, 2014–15 (see Data table).

Data notes

Risk factors analysis is based on people aged 18 and over. This age group was selected due to the available data in the ABS National Health Survey (NHS) and to ensure consistency with other AIHW risk factor reports [8, 9].

The risk factor data are presented here at one point in time, based on self-reported data from the NHS. When interpreting self-reported data, it is important to recognise that it relies on respondents providing accurate information.

It is not possible to attribute cause and effect to self-reported risk factors and back problems. Risk factors present at the time of the survey may or may not have contributed to the presence of back problems. Similarly, the presence of back problems may not be directly related to the number of risk factors a person has.

Box 1: Risk factors defined

Smoking

Smoker status is defined by the extent of regular smoking of tobacco at the time of interview. This includes manufactured (packet) cigarettes, roll-your-own cigarettes, cigars and pipes, at time of interview. It excludes chewing tobacco and smoking of non-tobacco products. The categories are:

Current daily smoker Regularly smoking one or more cigarettes, cigars or pipes per day
Current smoker (occasional) Smoking cigarettes, cigars or pipes less frequently than daily (weekly or less than weekly)
Ex-smoker Not currently smoking, but smoked daily, or at least 100 cigarettes, or pipes, cigars, etc. at least 20 times in lifetime
Never smoked Never regularly smoked daily, and smoking less than 100 cigarettes in the lifetime and/or smoking pipes, cigars, etc. less than 20 times in the lifetime.

Physical activity

According to the Australian Physical Activity and Sedentary Behaviour Guidelines, physical activity is defined as any bodily movement that requires energy expenditure [10]. This includes walking (for transport, fitness, recreation, or sport). The categories include:

Inactive* Not doing any physical activity (including walking for transport and fitness, and moderate and vigorous activity) in the week before interview
Insufficiently active* Not completely inactive but failing to meet the requirement of at least 150 minutes of physical activity (including walking for transport and fitness, and moderate and vigorous activity) over five separate sessions in a given week. For the purpose of this measure, vigorous activity time is multiplied by a factor of two
Sufficiently active for health Participation in at least 150 minutes of physical activity (including walking for transport and fitness, and moderate and vigorous activity) over five separate sessions in a given week

*Physical inactivity

Not achieving the recommended amounts of physical activity of 150 minutes per week over at least five days. The analysis includes categories of inactive and insufficiently active.

Body weight

Based on body mass. Categories of body mass were derived from the body mass index (BMI)—calculated by dividing a person's weight in kilograms by the square of their height in metres (kg/m2). The standard recommended by the World Health Organization to measure BMI for adults aged 18 and over is:

Underweight Less than 18.50
Normal range 18.50 – 24.99
Overweight 25.00 – 29.99
Obese 30.00 or more

Source: ABS 2014 [11].

References

  1. Hubscher M, Ferreira ML, Junqueira DR et al. 2014. Heavy domestic, but not recreational, physical activity is associated with low back pain: Australian Twin low BACK pain (AUTBACK) study. European Spine Journal 23(10):2083–2089.
  2. Burstrom L, Nilsson T & Wahlstrom J 2015. Whole-body vibration and the risk of low back pain and sciatica: a systematic review and meta-analysis. International Archives of Occupational and Environmental Health 88:403–418.
  3. Griffith LE, Shannon HS, Wells RP et al. 2012. Individual participant data meta-analysis of mechanical workplace risk factors and low back pain. American Journal of Public Health 102:309–318.
  4. Lionel KA 2014. Risk factors for chronic low back pain. Journal of Community Medicine & Health Education 4(2): 271.
  5. Heneweer H, Vanhees L, Susan H et al. 2009. Physical activity and low back pain: A U-shaped relation. Pain 143(1–2):21–25.
  6. Heneweer H, Staes F, Aufdemkampe G et al. 2011. Physical activity and low back pain: a systematic review of recent literature. European Spine Journal 20(6):826–845.
  7. Smuck M, Kao MCJ, Brar N et al. 2014. Does physical activity influence the relationship between low back pain and obesity? The Spine Journal 14:209–216.
  8. Australian Institute of Health & Welfare (AIHW) 2015. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: Risk factors. Cardiovascular, diabetes and chronic kidney disease series no. 4. Cat. no. CDK4. Canberra: AIHW.
  9. AIHW 2013. Risk factors contributing to chronic disease. Cat No. PHE 157. Canberra: AIHW.
  10. Department of Health 2014. Australia’s physical activity and sedentary behaviour guidelines. Canberra: Department of Health. Viewed September 2015.
  11. Australian Bureau of Statistics (ABS) 2014. Australian Health Survey. Viewed on 16 August 2015.