Risk factors associated with back problems

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
  • 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 self-reported data from the 2017–18 National Health Survey (NHS), people with back problems are more likely to be current daily smokers, insufficiently physically active and obese, compared with those without back problems (Figure 1).

Figure 1: Prevalence of risk factors in people with and without back problems, 2017–18

Vertical bar chart showing the percentage of people aged 18 and over with back problems who are current daily smokers (18%25), physically inactive (60%25) or obese (40%25) compared with people without back problems (13%25, 53%25, and 29%25, respectively).

Notes:

  1. Insufficient physical activity refers to adults aged 18–64 who did not complete 150 minutes of moderate to vigorous physical activity across 5 or more days in the last week and adults aged 65 and over who did not complete at least 30 minutes of physical activity per day on 5 or more days in the last week. Data does not include people for whom this measure was not known or not applicable.
  2. Obesity is based on Body Mass Index (BMI) for persons whose height and weight was measured and imputed. In 2017–18, 33.8% of respondents aged 18 years and over did not have a measured Body Mass Index (BMI). For these respondents, imputation was used to obtain BMI. For more information see Appendix 2: Physical measurements in the 2017–18 National Health Survey [5].

Source: AIHW analysis of (ABS 2019) [6] (Data table).

Selected risk factors

Smoker status

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

  • 18% were current daily smokers (compared with 13% of people without back problems)
  • 35% were ex-smokers (compared with 29% of people without back problems) (Figure 2).

Figure 2: Smoker status of people with and without back problems, 2017–18

Source: AIHW analysis of (ABS 2019) [6] (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, 60% were insufficiently physically active compared with 53% of those without back problems (Figure 3).

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 [7]. 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 [8].

Figure 3: Physical activity in people with and without back problems, 2017–18

Vertical bar chart showing the percentage of people with and without back problems who were classified as sufficiently or insufficiently physically active.

Source: AIHW analysis of (ABS 2019) [6] (Data table).

Body weight

People with back problems were more likely to be obese (40%) compared with people without back problems (29%).  People with back problems were less likely to be overweight, or underweight/in the normal range compared with people without back problems (Figure 4).

Figure 4: Body weight category of people with and without back problems, 2017–18

Vertical bar chart showing the percentage of people with and without back problems who were classified as underweight/normal range, overweight, or obese.

Note: Body weight category is based on Body Mass Index (BMI) for persons whose height and weight was measured and imputed. In 2017–18, 33.8% of respondents aged 18 years and over did not have a measured Body Mass Index (BMI). For these respondents, imputation was used to obtain BMI. For more information see Appendix 2: Physical measurements in the 2017–18 National Health Survey [5].

Source: AIHW analysis of (ABS 2019) [6] (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 among people with back problems decreased with increasing age. Older people (aged 65 and over) with back problems were less likely to report current daily smoking (9%) than those aged 45–64 (20%) or 18–44 (21%).

There was an increase with increasing age in the prevalence of insufficient physical activity or obesity for people with back problems. Insufficient physical activity increased significantly from 51% at age 18–44 to 60% at age 45–64 and 75% at age 65 and over. Obesity increased significantly from 32% at age 18–44 to 45% at ages 45–64 and 43% at 65 and over (Figure 4).

A similar pattern is observed in the prevalence of smoking, insufficient physical inactivity and obesity for people without back problems.

Figure 5: Prevalence of risk factors in people with back problems, by age, 2017–18

Horizontal bar chart showing the percentage of people with back problems who were obese, insufficiently physically active, or daily smokers for three age groups; 18–44, 45–64, and 65 and over.

Source: AIHW analysis of (ABS 2019) [6] (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 [9, 10].

The risk factor data presented here were obtained at one point in time, based on self‑reported data from the NHS (with the exception of BMI, which was measured). 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.

The risk factor definitions used in the ABS 2017–18 National Health Survey are described below in Box 1.

Box 1: Definitions for risk factors in the National Health Survey

Smoker status

Refers to the frequency of smoking of tobacco, including manufactured (packet) cigarettes, roll-your-own cigarettes, cigars and pipes, but excluding chewing tobacco, electronic cigarettes (and similar) and smoking of non-tobacco products. Categorised as:

Current daily smoker A respondent who reported at the time of interview that they regularly smoked one or more cigarettes, cigars or pipes per day.
Current smoker (occasional)

A respondent who reported at the time of interview that they smoked cigarettes, cigars or pipes, less frequently than daily.

Ex-smoker A respondent who reported that they did not currently smoke, but had regularly smoked daily, or had smoked at least 100 cigarettes, or smoked pipes, cigars, etc. at least 20 times in their lifetime; and
Never smoked A respondent who reported they had never regularly smoked daily, and had smoked less than 100 cigarettes in their lifetime and had smoked pipes, cigars, etc. less than 20 times.

Source: (ABS 2018) National Health Survey: Glossary, 2017–18 [11].

Physical activity

Australia’s Physical Activity and Sedentary Behaviour Guidelines (the Guidelines) are a set of recommendations outlining the minimum levels of physical activity required for health benefits, as well as the maximum amount of time one should spend on sedentary behaviours to achieve optimal health outcomes [12]. Please see the Physical activity web topic page for more information.

In 2017–18, the ABS National Health Survey collected information for the first time on physical activity at work. Therefore all results for adults include physical activity at work.

Based on the guidelines, insufficient physical activity is defined as:

 

  • Adults aged 18–64 who did not complete 150 minutes of moderate to vigorous physical activity across 5 or more days in the last week.
  • Adults aged 65 and over who did not complete at least 30 minutes of physical activity per day on 5 or more days in the last week.

For the purpose of calculating activity time, vigorous activity time is multiplied by a factor of two.

Muscle strengthening activities are not included in this analysis.

Source: (AIHW 2019) Insufficient activity report [13].

Body mass index

Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, normal weight, overweight and obesity. It is calculated from height and weight information, using the formula weight (kg) divided by the square of height (m). To produce a measure of the prevalence of underweight, normal weight, overweight or obesity in adults, BMI values are grouped according to the table below.

Category Range
Underweight Less than 18.50
Normal range 18.50 – 24.99
Overweight 25.00 – 29.99
Obese

30.00 – 34.99

Obesity class II 35.00 – 39.99
Obesity class III 40.00 or more

In 2017–18, 33.8% of respondents aged 18 years and over did not have a measured Body Mass Index (BMI). For these respondents, imputation was used to obtain BMI [14].

Source: (ABS 2018) National Health Survey: Glossary, 2017–18 [11]; (ABS 2019) National Health Survey: Users’ Guide, 2017–18 [14].

References

  1. Hubscher M, Ferreira ML, Junqueira DR, Refshauge KM, Maher CG, Hopper JL 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, Walter SD, Cole DC, Côté P 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.  ABS (Australian Bureau of Statistics) 2018. National Health Survey: First Results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.
  6. ABS 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.
  7. Heneweer H, Vanhees L & Susan H 2009. Physical activity and low back pain: A U-shaped relation. Pain 143(1–2):21–25.
  8. Heneweer H, Staes F, Aufdemkampe G, van Rijn M & Vanhees L 2011. Physical activity and low back pain: a systematic review of recent literature. European Spine Journal 20(6):826–845.
  9. AIHW (Australian Institute of Health and Welfare) 2015. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: Risk factors. Cardiovascular, diabetes and chronic kidney disease series no. 4. Cat. no. CDK 4. Canberra: AIHW.
  10. AIHW 2013. Risk factors contributing to chronic disease. Cat no. PHE 157. Canberra: AIHW.
  11. ABS 2018. National Health Survey: Glossary, 2017–18. Canberra: ABS. Viewed 1 May 2019.
  12. DoH (Department of Health) 2019. Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines. Canberra: DoH. Viewed 5 June 2019.
  13. AIHW 2019. Insufficient physical inactivity. Cat. no. PHE 248. Canberra: AIHW.
  14. ABS 2018. National Health Survey: Users’ Guide, 2017–18. ABS cat. no. 4363.0.55.001. Canberra: ABS. Viewed 1 May 2019.