Impact of back problems

Back problems often lead to poorer quality of life, psychological distress, bodily pain, and disability.

Burden of disease

Back pain and problems are a large contributor to illness, pain, and disability in Australia. Based on data from the Australian Burden of Disease Study 2015, back pain and problems were the second leading cause of burden overall, accounting for 4.1% of Australia’s total disease burden.

Back pain and problems were the third leading cause of disease burden for both males and females, representing 3.9% and 4.4% of total disease burden, respectively (AIHW 2019a).

Among males, back pain and problems were the second leading cause of disease burden for those aged 25–44 and 45–54 and the third leading cause for those aged 55–64. Among females, they were the leading cause for those aged 45–54 and the second leading cause for those aged 25–44.

Almost all of the burden caused by back pain and problems was non-fatal burden, where back pain and problems were the number one leading cause of non-fatal disease burden among males, females and overall, accounting for 8.1% of total non-fatal disease burden in Australia.

Additionally, in 2015–16, Back pain and problems cost the Australian health system an estimated $2.8 billion, representing 23% of disease expenditure on musculoskeletal conditions and 2.4% of total health expenditure (AIHW 2019b).

Perceived health status

People aged 15 and over with back problems were less likely to perceive their health as excellent compared with those without the condition according to the 2017–18 National Health Survey (NHS). After adjusting for age, people with back problems were 2.4 times as likely to rate their health as poor (6.5%) compared with those without back problems (2.7%) (Figure 1).

Figure 1: Self-assessed health of people aged 15 and over with and without back problems, 2017–18

The vertical bar chart shows that people aged 15 and over with back problems are less likely to perceive their health as excellent (10%25) or very good (33%25) compared with people without back problems (24%25 and 37%25 respectively). People with back problems were more likely to rate their health as good (34%25), fair (16%25) or poor (7%25), compared with people without back problems (28%25, 9%25, and 3%25 respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

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

Pain

People with back problems were 2.6 times as likely to experience severe (11%) and very severe (3.1%) bodily pain compared with those without the condition (4.6% and 1.0%, respectively) according to self-reported data from the 2017–18 NHS (Figure 2).

Figure 2: Pain(a) experienced by people aged 18 and over with and without back problems, 2017–18

The vertical bar chart shows that people aged 18 and over with back problems were more likely to report levels of psychological distress that were moderate (28%25), high (16%25) or very high (8%25) compared with people without back problems (22%25, 8%25, and 3%25 respectively). People with back problems were less likely to report low levels of psychological distress (48%25) compared with people without back problems (67%25).

(a) Bodily pain experienced in the 4 weeks prior to interview.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

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

Impact on activity

In 2017–18, 38% of people with back problems said that bodily pain interfered with their daily activities at least 'moderately', compared with 17% of people without back problems. Of people with back problems, 5.8% said bodily pain had an 'extreme' impact on their activity, compared with 2.4% of people without back problems (Figure 3).

Figure 3: Extent that bodily pain interferes in daily activities in people with and without back problems, 2017–18

The vertical bar chart shows that people aged 18 and over with back problems were more than twice as likely to report moderate (34%25) or severe (11%25) bodily pain and three times as likely to report very severe (3%25) bodily pain compared with those without the condition (15%25, 5%25 and 1.0%25 respectively). People with back problems were less likely to report their levels of bodily pain as very mild (20%25) or none (11%25) compared with people without back problems (26%25 and 37%25 respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

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

Psychological distress

Overall, people aged 18 and over with back problems were 2.5 times as likely to report experiencing very high levels of psychological distress (8.1%) than those without the condition (3.2%) after adjusting for age (Figure 4).

Figure 4: Psychological distress(a) experienced by people aged 18 and over with and without back problems, 2017–18

The vertical bar chart shows that people with back problems were more likely to describe their bodily pain as interfering with their daily activities ‘a little bit’ (29%25), ‘moderately’ (20%25), ‘quite a bit’ (13%25), and ‘extremely’ (5.8%25) compared with people without back problems (19%25, 9.6%25, 4.6%25 and 2.4%25, respectively). People with back problems were less likely to describe no interference in daily activities (22%25) or no bodily pain (11%25) compared with people without back problems (27%25 and 37%25, respectively).

(a) Psychological distress is measured using the Kessler Psychological Distress Scale (K10), which involves 10 questions about negative emotional states experienced in the previous 4 weeks. The scores are grouped into Low: K10 score 10–15, Moderate: 16–21, High: 22–29, Very high: 30–50.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

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

Workforce participation

According to self-reported data from the 2017–18 NHS, people aged 15–64 with back problems are less likely to be employed (73%) compared with people without back problems (77%) and more likely to not be in the labour force (22% compared with 19%). There is little difference in the proportion of people who were unemployed with (5%) and without (4%) back problems (Figure 5).   

Figure 5: Workforce participation of people aged 15–64 with and without back problems, 2017–18

The vertical bar chart shows that there was very little difference in the workforce participation of 15–64 year olds with and without back problems. Slightly less people with back problems were employed (73%25) compared with people without back problems (77%25), and a similar proportion of people with back problems were unemployed (5%25) or not in the labour force (22%25) compared with people without back problems (4%25 and 19%25 respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

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

Comorbidities of back problems

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 may interact to determine the health status of individuals. As people age, they are more likely to develop more than one chronic condition.

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 6):

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

In addition, almost 1 in 2 (46%) have two or more other chronic conditions (Figure 6).

Figure 6: 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 (Data table).

Types of comorbid chronic conditions in people with back problems

Among people aged 45 years and over with back problems:

  • 48% have arthritis, compared with 29% without back problems
  • 34% 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 (Data tables - Table 5.2).

These proportions remained similar even after accounting for differences in the age structure of the populations (Figure 7; Data tables - Table 5.2).

Figure 7: 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).

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Proportions do not total 100% as one person may have more than one additional diagnosis.

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

Data notes

The National Health Survey (NHS) uses three factors to determine whether or not a person is counted as having a particular condition: whether the condition is current, whether it is long term and whether it was medically diagnosed. The combination of these factors required for a person to count as having the condition varies according to the nature of the condition. For example, some conditions, such as diabetes and HSVD, once diagnosed, are seen to be lifelong. Even if a person no longer reports symptoms, they still count as having the condition. While other conditions, such as depression, asthma, cancer or back problems, can be lifelong, episodic or in complete remission.

Most conditions do not need the respondent to have been diagnosed by a doctor or nurse. The respondent is counted if they said they have the condition. However, in cases where the respondent said they had diabetes or HSVD and that the condition was not current, they need to have received a diagnosis to be counted.

Table 1: Definitions used for chronic conditions

Condition

Current

Long term

Has the condition been diagnosed by a doctor or nurse?

Arthritis

current

long term

no diagnosis required

Asthma

current

long term

no diagnosis required

Back problems

current

long term

no diagnosis required

Cancer

current

long term

no diagnosis required

COPD

current

long term

no diagnosis required

Diabetes

(2 combinations)

current

long term

no diagnosis required

ever had

not long term

diagnosis required

Heart, stroke and vascular disease (HSVD)

(2 combinations)

current

long term

no diagnosis required

ever had

not long term

diagnosis required

Kidney disease

current

long term

no diagnosis required

Mental and behavioural conditions

current

long term

no diagnosis required

Osteoporosis

current

long term

no diagnosis required

Osteoarthritis

current

long term

no diagnosis required

Rheumatoid arthritis

current

long term

no diagnosis required

Note: Please see the 2017-18 NHS User Guide for more information on the definitions of the conditions.