Back problems and associated comorbidities

People with back problems often have other chronic diseases and long-term conditions. These are referred to as 'comorbidities'—two or more health problems occurring at the same time. Comorbidities often share common risk factors, and are increasingly seen as acting together to determine the health status of individuals.

As people age, they are more likely to develop more than one chronic condition. Various studies show that cardiovascular diseases [1, 2], arthritis [3], mental health problems [4, 5] and respiratory conditions [6] are common comorbidities with back problems.

In this context, 'back problems' include:

  • Disc disorders (such as a herniated disc or disc degeneration)
  • Sciatica and curvature of the spine, and
  • Back pain/problems not elsewhere classified.

Note, if back problems are caused by another condition such as osteoporosis or osteoarthritis they will be classified as that condition and not included here. As such, the true prevalence of back problems presented here may be an underestimate.

This information is based on self-reported data from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (NHS), and was last updated in March 2019.

Selected comorbidities

An estimated 2.5 million Australians aged 45 and over have back problems, based on self-reported data from the 2017–18 National Health Survey. Of these, almost 3 in 4 of those people (74% of the total population of people with back problems) report also having one or more of the following selected chronic conditions (Figure 1):

  • heart, stroke and vascular disease
  • kidney disease
  • arthritis
  • mental land behavioural conditions
  • asthma
  • diabetes
  • chronic obstructive pulmonary disease (COPD)
  • osteoporosis
  • cancer.

These 9 chronic conditions have been selected because they are common, pose significant health problems, have been the focus of ongoing national surveillance efforts, and action can be taken to prevent their occurrence.

In addition, more than 2 in 5 (46%) have two or more other chronic conditions (Figure 1).

Figure 1: Number of selected chronic conditions in people aged 45 years and over with back problems, 2017–18

The vertical bar chart shows the percentage of people aged 45 years and over with back problems only (26%25), with one other chronic condition (28%25), or with 2 or more other chronic conditions (46%25).

Note: the 9 other selected chronic conditions are heart, stroke and vascular disease, asthma, arthritis, cancer, COPD, diabetes, kidney disease, mental and behavioural conditions, and osteoporosis.

Source: AIHW analysis of ABS 2019 [7] (Data table).

Types of comorbid chronic conditions in people with back problems

Figure 2 shows that among people aged 45 years and over with back problems:

  • 48% have arthritis, compared with  29% without back problems
  • 33% have mental and behavioural conditions, compared with 18% without back problems.
  • 17% have asthma, compared with 11% without back problems
  • 16% have heart, stroke and vascular disease, compared with 10% without back problems.

These proportions remained similar even after accounting for difference in the age structure of the populations (Table 5.2).

Figure 2: Prevalence of other chronic conditions in people aged 45 years and over with and without back problems, 2017–18

Vertical bar chart showing the percentage of people with and without back problems who also experience other chronic conditions (arthritis, mental and behavioural conditions, asthma, heart, stroke and vascular disease, osteoporosis, diabetes, COPD, cancer, and kidney disease).

Source: AIHW analysis of ABS 2019 [7] (Data table).

Note: These components do not total 100% as one person may have more than one comorbidity.

Data notes

The comorbidity data presented here are based on self-reported data from the Australian Bureau of Statistics National Health Survey (NHS). When interpreting self-reported data, it is important to recognise that because we rely on respondents providing accurate information, the outputs may not always be a true reflection of the situation.

In the 2017–18 NHS, the number and proportion of persons with long-term health conditions is presented as those who have 'a current medical condition which has lasted, or is expected to last, for 6 months or more, unless otherwise stated' [8]. For the conditions arthritis, asthma, cancer, heart, stroke and vascular disease (HSVD), diabetes, kidney disease and mental and behavioural conditions, the estimates are based on: persons who reported having been told by a doctor or nurse that they had the condition/s and whether they reported that their condition was current and long-term; that is, their condition was current at the time of interview and had lasted, or was expected to last, 6 months or more. 

For HSVD and diabetes, estimates also included persons who reported they had had the conditions, but that these conditions were not current and long-term at the time of interview.

The conditions data collected for back problems and COPD are 'as reported' by respondents and do not necessarily represent conditions as medically diagnosed. However, as the data relate to conditions which had lasted, or were expected to last, for six months or more, there is considered to be a reasonable likelihood that medical diagnoses would have been made in most cases. The degree to which conditions have been medically diagnosed is likely to differ across condition types. See the National Health Survey: Users’ Guide, 2017─18 [9] for more information.

References

  1. Ha IH, Lee J, Kim MR, Kim H & Shin JS 2014. The association between the history of cardiovascular diseases and chronic low back pain in South Koreans: a cross-sectional study. PLOS ONE 9(4):e93671.
  2. Schofield DJ, Callander EJ, Shrestha RN, Passey ME, Percival R & Kelly SJ 2012. Association between comorbidities and labour force participation amongst persons with back problems. Pain 153:2058–2072.
  3. Bollegala D, Perruccio AV & Badley EM 2011. Combined impact of concomitant arthritis and back problems on health status: Results from a nationally representative health survey. Arthritis Care & Research 63(11):1584–1591.
  4. Gore M, Sadosky A, Stacey BR, Tai KS & Leslie D 2012. The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings. Spine (Phila Pa 1976) 37(11):E668–E677.
  5. Gerhardt A, Hartmann M, Schuller-Roma B, Blumenstiel K, Bieber C, Eich W et al. 2011. The prevalence and type of Axis-I and Axis-II mental disorders in subjects with non-specific chronic back pain: results from a population-based study. Pain Medicine 12:1231–1240.
  6. Bartholomeeusen S, Van Zundert J, Truyers C, Buntinx F & Paulus D 2012. Higher incidence of common diagnoses in patients with low back pain in primary care. Pain Practice 12:1–6.
  7. ABS (Australian Bureau of Statistics) 2019. Microdata: National Health Survey, 2017–18, detailed microdata, DataLab. ABS cat. no. 4324.0.55.001. Canberra: ABS. Findings based on AIHW analysis of ABS microdata.
  8. ABS 2018. National Health Survey: First Results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.
  9. ABS 2018. National Health Survey: Users’ Guide, 2017–18. Viewed 1 May 2019. Canberra: ABS.