Korean J Pain.  2020 Apr;33(2):153-165. 10.3344/kjp.2020.33.2.153.

A prediction model of low back pain risk: a population based cohort study in Korea

Affiliations
  • 1Complex Diseases & Genome Epidemiology Branch, Division of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea
  • 2Department of Epidemiology, School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea

Abstract

Background
Well-validated risk prediction models help to identify individuals at high risk of diseases and suggest preventive measures. A recent systematic review reported lack of validated prediction models for low back pain (LBP). We aimed to develop prediction models to estimate the 8-year risk of developing LBP and its recurrence.
Methods
A population based prospective cohort study using data from 435,968 participants in the National Health Insurance Service–National Sample Cohort enrolled from 2002 to 2010. We used Cox proportional hazards models.
Results
During median follow-up period of 8.4 years, there were 143,396 (32.9%) first onset LBP cases. The prediction model of first onset consisted of age, sex, income grade, alcohol consumption, physical exercise, body mass index (BMI), total cholesterol, blood pressure, and medical history of diseases. The model of 5-year recurrence risk was comprised of age, sex, income grade, BMI, length of prescription, and medical history of diseases. The Harrell’s C-statistic was 0.812 (95% confidence interval [CI], 0.804-0.820) and 0.916 (95% CI, 0.907-0.924) in validation cohorts of LBP onset and recurrence models, respectively. Age, disc degeneration, and sex conferred the highest risk points for onset, whereas age, spondylolisthesis, and disc degeneration conferred the highest risk for recurrence.
Conclusions
LBP risk prediction models and simplified risk scores have been developed and validated using data from general medical practice. This study also offers an opportunity for external validation and updating of the models by incorporating other risk predictors in other settings, especially in this era of precision medicine.

Keyword

Big Data; Chronic Pain; Intervertebral Disc Degeneration; Low Back Pain; National Health Programs; Proportional Hazards Models; Recurrence; Risk Assessment; Risk Factors; Spondylolisthesis

Figure

  • Fig. 1 Discrimination and calibration plots in the derivation and validation cohorts for low back pain (LBP) primary outcome model. (A, C) Discrimination. (B, D) Calibration.


Reference

1. Koes BW, van Tulder MW, Thomas S. 2006; Diagnosis and treatment of low back pain. BMJ. 332:1430–4. DOI: 10.1136/bmj.332.7555.1430. PMID: 16777886. PMCID: PMC1479671.
Article
2. Lambeek LC, Bosmans JE, Van Royen BJ, Van Tulder MW, Van Mechelen W, Anema JR. 2010; Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial. BMJ. 341:c6414. DOI: 10.1136/bmj.c6414. PMID: 21118874. PMCID: PMC2995018.
Article
3. Andersson GB. 1999; Epidemiological features of chronic low-back pain. Lancet. 354:581–5. DOI: 10.1016/S0140-6736(99)01312-4. PMID: 10470716.
Article
4. Swain MS, Henschke N, Kamper SJ, Gobina I, Ottová-Jordan V, Maher CG. 2014; An international survey of pain in adolescents. BMC Public Health. 14:447. DOI: 10.1186/1471-2458-14-447. PMID: 24885027. PMCID: PMC4046513.
Article
5. Deyo RA, Mirza SK, Martin BI. 2006; Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 31:2724–7. DOI: 10.1097/01.brs.0000244618.06877.cd. PMID: 17077742.
6. Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. 2014; Epidemiology of low back pain in adults. Neuromodulation. 17(Suppl 2):3–10. DOI: 10.1111/ner.12018. PMID: 25395111.
Article
7. Lee S, Nam CM, Yoon DH, Kim KN, Yi S, Shin DA, et al. 2013; Association between low-back pain and lumbar spine bone density: a population-based cross-sectional study. J Neurosurg Spine. 19:307–13. DOI: 10.3171/2013.5.SPINE12473. PMID: 23829289.
Article
8. Bae YH, Shin JS, Lee J, Kim MR, Park KB, Cho JH, et al. 2015; Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: a cross-sectional study. PLoS One. 10:e0138790. DOI: 10.1371/journal.pone.0138790. PMID: 26393797. PMCID: PMC4578861.
Article
9. Ozguler A, Leclerc A, Landre MF, Pietri-Taleb F, Niedhammer I. 2000; Individual and occupational determinants of low back pain according to various definitions of low back pain. J Epidemiol Community Health. 54:215–20. DOI: 10.1136/jech.54.3.215. PMID: 10746116. PMCID: PMC1731646.
Article
10. Jones GT, Macfarlane GJ. 2005; Epidemiology of low back pain in children and adolescents. Arch Dis Child. 90:312–6. DOI: 10.1136/adc.2004.056812. PMID: 15723927. PMCID: PMC1720304.
Article
11. Kamran M, Eeric T. 2008; Epidemiology and natural history of low back pain. Semin Spine Surg. 20:87–92. DOI: 10.1053/j.semss.2008.02.003.
Article
12. Von Korff M. 1994; Studying the natural history of back pain. Spine (Phila Pa 1976). 19(18 Suppl):2041S–6S. DOI: 10.1097/00007632-199409151-00005. PMID: 7801181.
13. Marras WS, Ferguson SA, Burr D, Schabo P, Maronitis A. 2007; Low back pain recurrence in occupational environments. Spine (Phila Pa 1976). 32:2387–97. DOI: 10.1097/BRS.0b013e3181557be9. PMID: 17906584.
Article
14. Stanton TR, Latimer J, Maher CG, Hancock M. 2009; Definitions of recurrence of an episode of low back pain: a systematic review. Spine (Phila Pa 1976). 34:E316–22. DOI: 10.1097/BRS.0b013e318198d073. PMID: 19531986.
15. Global Burden of Disease Study 2013 Collaborators. 2015; Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 386:743–800. DOI: 10.1016/S0140-6736(15)60692-4. PMID: 26063472. PMCID: PMC4561509.
16. Kim YE, Park H, Jo MW, Oh IH, Go DS, Jung J, et al. 2019; Trends and patterns of burden of disease and injuries in Korea using disability-adjusted life years. J Korean Med Sci. 34(Suppl 1):e75. DOI: 10.3346/jkms.2019.34.e75. PMID: 30923488. PMCID: PMC6434149.
Article
17. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. 2014; The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 73:968–74. DOI: 10.1136/annrheumdis-2013-204428. PMID: 24665116.
Article
18. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. 1994; Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 331:69–73. DOI: 10.1056/NEJM199407143310201. PMID: 8208267.
Article
19. Kim HS, Jung KH, Park IH, Ryu JK, Sun KJ, Lim KJ, et al. 2007; Diagnosis and treatment of sacral asymlocation in back pain patients: clinical application of prolotherapy. Korean J Pain. 20:130–7. DOI: 10.3344/kjp.2007.20.2.130.
Article
20. Chou L, Brady SR, Urquhart DM, Teichtahl AJ, Cicuttini FM, Pasco JA, et al. 2016; The association between obesity and low back pain and disability is affected by mood disorders: a population-based, cross-sectional study of men. Medicine (Baltimore). 95:e3367. DOI: 10.1097/MD.0000000000003367. PMID: 27082599. PMCID: PMC4839843.
21. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. 2009; Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 10:447–85. DOI: 10.1016/j.jpain.2008.12.001. PMID: 19411059. PMCID: PMC2677686.
Article
22. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Varonen H, Kalso E, et al. 2007; Cardiovascular and lifestyle risk factors in lumbar radicular pain or clinically defined sciatica: a systematic review. Eur Spine J. 16:2043–54. DOI: 10.1007/s00586-007-0362-6. PMID: 17525856. PMCID: PMC2140143.
Article
23. Paanalahti K, Holm LW, Magnusson C, Carroll L, Nordin M, Skillgate E. 2014; The sex-specific interrelationship between spinal pain and psychological distress across time in the general population. Results from the Stockholm public health study. Spine J. 14:1928–35. DOI: 10.1016/j.spinee.2013.11.017. PMID: 24262854.
Article
24. Pinheiro MB, Ferreira ML, Refshauge K, Ordoñana JR, Machado GC, Prado LR, et al. 2015; Symptoms of depression and risk of new episodes of low back pain: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 67:1591–603. DOI: 10.1002/acr.22619. PMID: 25989342.
Article
25. Suman A, Bostick GP, Schaafsma FG, Anema JR, Gross DP. 2017; Associations between measures of socio-economic status, beliefs about back pain, and exposure to a mass media campaign to improve back beliefs. BMC Public Health. 17:504. DOI: 10.1186/s12889-017-4387-4. PMID: 28545420. PMCID: PMC5445411.
Article
26. Heneweer H, Picavet HS, Staes F, Kiers H, Vanhees L. 2012; Physical fitness, rather than self-reported physical activities, is more strongly associated with low back pain: evidence from a working population. Eur Spine J. 21:1265–72. DOI: 10.1007/s00586-011-2097-7. PMID: 22134487. PMCID: PMC3389121.
Article
27. Fernandez M, Ordoñana JR, Hartvigsen J, Ferreira ML, Refshauge KM, Sánchez-Romera JF, et al. 2016; Is chronic low back pain associated with the prevalence of coronary heart disease when genetic susceptibility is considered? A co-twin control study of Spanish twins. PLoS One. 11:e0155194. DOI: 10.1371/journal.pone.0155194. PMID: 27171210. PMCID: PMC4865187.
Article
28. Leino-Arjas P, Kaila-Kangas L, Solovieva S, Riihimäki H, Kirjonen J, Reunanen A. 2006; Serum lipids and low back pain: an association? A follow-up study of a working population sample. Spine (Phila Pa 1976). 31:1032–7. DOI: 10.1097/01.brs.0000214889.31505.08. PMID: 16641781.
29. Hassoon A, Bydon M, Kerezoudis P, Maloney PR, Rinaldo L, Yeh HC. 2017; Chronic low-back pain in adult with diabetes: NHANES 2009-2010. J Diabetes Complications. 31:38–42. DOI: 10.1016/j.jdiacomp.2016.10.025. PMID: 27838098.
Article
30. Hancock MJ, Maher CM, Petocz P, Lin CW, Steffens D, Luque-Suarez A, et al. 2015; Risk factors for a recurrence of low back pain. Spine J. 15:2360–8. DOI: 10.1016/j.spinee.2015.07.007. PMID: 26169027.
Article
31. Nolet PS, Kristman VL, Côté P, Carroll LJ, Cassidy JD. 2018; The association between a lifetime history of low back injury in a motor vehicle collision and future low back pain: a population-based cohort study. Eur Spine J. 27:136–44. DOI: 10.1007/s00586-017-5090-y. PMID: 28391385.
Article
32. Machado GC, Maher CG, Ferreira PH, Latimer J, Koes BW, Steffens D, et al. 2017; Can recurrence after an acute episode of low back pain be predicted? Phys Ther. 97:889–95. DOI: 10.1093/ptj/pzx067. PMID: 28969347.
Article
33. Manabe T, Takasugi S, Iwamoto Y. 2003; Positive relationship between bone mineral density and low back pain in middle-aged women. Eur Spine J. 12:596–601. DOI: 10.1007/s00586-003-0585-0. PMID: 14564559. PMCID: PMC3467982.
Article
34. Visuri T, Ulaska J, Eskelin M, Pulkkinen P. 2005; Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration: a magnetic resonance imaging study in young Finnish male conscripts. Mil Med. 170:926–30. DOI: 10.7205/MILMED.170.11.926. PMID: 16450819.
Article
35. McIntosh G, Steenstra I, Hogg-Johnson S, Carter T, Hall H. 2018; Lack of prognostic model validation in low back pain prediction studies: a systematic review. Clin J Pain. 34:748–54. DOI: 10.1097/AJP.0000000000000591. PMID: 29406366.
36. Collins GS, Reitsma JB, Altman DG, Moons KG. 2015; Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med. 162:55–63. DOI: 10.7326/M14-0697. PMID: 25560714.
Article
37. Song SO, Jung CH, Song YD, Park CY, Kwon HS, Cha BS, et al. 2014; Background and data configuration process of a nationwide population-based study using the Korean National Health Insurance System. Diabetes Metab J. 38:395–403. DOI: 10.4093/dmj.2014.38.5.395. PMID: 25349827. PMCID: PMC4209354.
Article
38. Lee J, Lee JS, Park SH, Shin SA, Kim K. 2017; Cohort profile: the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. 46:e15. DOI: 10.1093/ije/dyv319. PMID: 26822938.
Article
39. Dobbin KK, Simon RM. 2011; Optimally splitting cases for training and testing high dimensional classifiers. BMC Med Genomics. 4:31. DOI: 10.1186/1755-8794-4-31. PMID: 21477282. PMCID: PMC3090739.
Article
40. MacGregor AJ, Dougherty AL, Mayo JA, Rauh MJ, Galarneau MR. 2012; Occupational correlates of low back pain among U.S. Marines following combat deployment. Mil Med. 177:845–9. DOI: 10.7205/MILMED-D-12-00021. PMID: 22808893.
Article
41. Jöud A, Petersson IF, Englund M. 2012; Low back pain: epidemiology of consultations. Arthritis Care Res (Hoboken). 64:1084–8. DOI: 10.1002/acr.21642. PMID: 22337573.
42. Bosman LC, Dijkstra L, Oling CI, Heymans MW, Twisk JW, Roelen CA. 2018; Prediction models to identify workers at risk of sick leave due to low-back pain in the Dutch construction industry. Scand J Work Environ Health. 44:156–62. DOI: 10.5271/sjweh.3703. PMID: 29306961.
43. D’Agostino RB, Nam BH. 2003; Evaluation of the performance of survival analysis models: discrimination and calibration measures. Handb Stat. 23:1–25. DOI: 10.1016/S0169-7161(03)23001-7.
44. Pencina MJ, D’Agostino RB. 2004; Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med. 23:2109–23. DOI: 10.1002/sim.1802. PMID: 15211606.
45. 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:e93671. DOI: 10.1371/journal.pone.0093671. PMID: 24751659. PMCID: PMC3994023.
Article
46. Hippisley-Cox J, Coupland C. 2017; Development and validation of QMortality risk prediction algorithm to estimate short term risk of death and assess frailty: cohort study. BMJ. 358:j4208. DOI: 10.1136/bmj.j4208. PMID: 28931509. PMCID: PMC5606253.
Article
47. Traeger AC, Henschke N, Hübscher M, Williams CM, Kamper SJ, Maher CG, et al. 2016; Estimating the risk of chronic pain: development and validation of a prognostic model (PICKUP) for patients with acute low back pain. PLoS Med. 13:e1002019. DOI: 10.1371/journal.pmed.1002019. PMID: 27187782. PMCID: PMC4871494.
Article
48. Panken G, Hoekstra T, Verhagen A, van Tulder M, Twisk J, Heymans MW. 2016; Predicting chronic low-back pain based on pain trajectories in patients in an occupational setting: an exploratory analysis. Scand J Work Environ Health. 42:520–7. DOI: 10.5271/sjweh.3584. PMID: 27537989.
Article
49. Park BJ, Sung J, Park K, Seo SW, Kim SH. 2003. Studying on diagnosis accuracy for health insurance claims data in Korea. Seoul National University;Seoul: p. 17–29.
50. Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ. 2010; Factors defining care-seeking in low back pain--a meta-analysis of population based surveys. Eur J Pain. 14:747.e1–-77. DOI: 10.1016/j.ejpain.2009.11.005. PMID: 20036168.
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