J Prev Med Public Health.  2018 Sep;51(5):227-233. 10.3961/jpmph.18.038.

Increased Prevalence of Chronic Disease in Back Pain Patients Living in Car-dependent Neighbourhoods in Canada: A Cross-sectional Analysis

• Zeglinski-Spinney A
• Wai DC
• Phan P
• Tsai EC
• Stratton A
• Kingwell S
• Roffey DM
• Wai EK

• KMID: 2424395
• DOI: http://doi.org/10.3961/jpmph.18.038

Abstract

OBJECTIVES
Chronic diseases, including back pain, result in significant patient morbidity and societal burden. Overall improvement in physical fitness is recommended for prevention and treatment. Walking is a convenient modality for achieving initial gains. Our objective was to determine whether neighbourhood walkability, acting as a surrogate measure of physical fitness, was associated with the presence of chronic disease.
METHODS
We conducted a cross-sectional study of prospectively collected data from a prior randomized cohort study of 227 patients referred for tertiary assessment of chronic back pain in Ottawa, ON, Canada. The Charlson Comorbidity Index (CCI) was calculated from patient-completed questionnaires and medical record review. Using patients' postal codes, neighbourhood walkability was determined using the Walk Score, which awards points based on the distance to the closest amenities, yielding a score from 0 to 100 (0-50: car-dependent; 50-100: walkable).
RESULTS
Based on the Walk Score, 134 patients lived in car-dependent neighborhoods and 93 lived in walkable neighborhoods. A multivariate logistic regression model, adjusted for age, gender, rural postal code, body mass index, smoking, median household income, percent employment, pain, and disability, demonstrated an adjusted odds ratio of 2.75 (95% confidence interval, 1.16 to 6.53) times higher prevalence for having a chronic disease for patients living in a car-dependent neighborhood. There was also a significant dose-related association (p=0.01; Mantel-Haenszel chi-square=6.4) between living in car-dependent neighbourhoods and more severe CCI scores.
CONCLUSIONS
Our findings suggest that advocating for improved neighbourhood planning to permit greater walkability may help offset the burden of chronic disease.

Keyword

Chronic disease; Back pain; Walking; Residence characteristics; Comorbidity; Physical fitness

MeSH Terms

Awards and Prizes
Back Pain*
Body Mass Index
Canada*
Chronic Disease*
Cohort Studies
Comorbidity
Cross-Sectional Studies*
Employment
Family Characteristics
Humans
Logistic Models
Medical Records
Odds Ratio
Physical Fitness
Prevalence*
Prospective Studies
Residence Characteristics
Smoke
Smoking
Walking
Smoke