Recurrent Low Back Pain Prevalence in a Canadian Population
Recurrent Low Back Pain Prevalence in a Canadian Population
Low back pain (LBP) is a common and costly health condition. Lifetime prevalence has an average of 39% (+/- SD 24%), with a large variability depending on the surveyed population and the LBP definition. In a lifetime, recurrent episodes will affect a large subset of the LBP population. One patient out of four presenting with an acute LBP episode is likely to experience a LBP recurrence within one year. Approximately 10% of the LBP-presenting individuals will suffer from chronic LBP. These recurrent episodes and chronic cases are responsible for most of the health expenses related to LBP.
An overview of the extensive literature on low back pain led us to the following observations: 1) only 38% of prevalence studies that were reviewed provide definitions for recurrent LBP, thus making comparisons difficult; 2) LBP is often reported as a point prevalence but its longitudinal progression is seldom investigated; 3) sex and age variables are often aggregated, which limits descriptive and categorical analyses of the data.
International experts recently used a consensus approach to propose definitions for back pain or recurrent low back pain. This issue has been examined frequently in recent years, and the community is already adopting these standards. Regarding the prevalence of low back pain over time, the use of survey- or questionnaire-based designs is not optimal. Recall biases, small sample sizes and costs are drawbacks to longitudinal studies. While national surveys allow repeated measurements of the prevalence over time, definitions regarding low back pain are not always specific, and the accuracy of LBP estimates generated with large population surveys remains debatable with regards to the variations reported. To complement the results obtained with surveys, the frequency of a health condition can be estimated based on the secondary analysis of administrative healthcare databases. Administrative databases are often developed for preparing healthcare economic evaluations. Recall biases are avoided and data is homogeneously extracted. In a universal healthcare system based on a centralized fee-for-service, the specificity of the administrative databases is high, in part because physicians promptly submit claims for the services provided to patients.
Therefore, by analyzing large data sets such as those found in administrative health care databases, prevalence can be determined over a longer period than in other designs. Also, the sample size is larger; therefore, categorical analyses by sex and age can be performed allowing for a better understanding of the LBP condition in different subpopulations over time.
The objective of our study was to evaluate the prevalence of claims-based recurrent low back pain in a universal health care system for the population of the province of Quebec over an 8-year period starting in 2000. By performing secondary analyses on this extensive administrative database, we provide a descriptive portrait of the longitudinal progression of the annual prevalence of recurrent LBP cases in specific age and sex categories.
Background
Low back pain (LBP) is a common and costly health condition. Lifetime prevalence has an average of 39% (+/- SD 24%), with a large variability depending on the surveyed population and the LBP definition. In a lifetime, recurrent episodes will affect a large subset of the LBP population. One patient out of four presenting with an acute LBP episode is likely to experience a LBP recurrence within one year. Approximately 10% of the LBP-presenting individuals will suffer from chronic LBP. These recurrent episodes and chronic cases are responsible for most of the health expenses related to LBP.
An overview of the extensive literature on low back pain led us to the following observations: 1) only 38% of prevalence studies that were reviewed provide definitions for recurrent LBP, thus making comparisons difficult; 2) LBP is often reported as a point prevalence but its longitudinal progression is seldom investigated; 3) sex and age variables are often aggregated, which limits descriptive and categorical analyses of the data.
International experts recently used a consensus approach to propose definitions for back pain or recurrent low back pain. This issue has been examined frequently in recent years, and the community is already adopting these standards. Regarding the prevalence of low back pain over time, the use of survey- or questionnaire-based designs is not optimal. Recall biases, small sample sizes and costs are drawbacks to longitudinal studies. While national surveys allow repeated measurements of the prevalence over time, definitions regarding low back pain are not always specific, and the accuracy of LBP estimates generated with large population surveys remains debatable with regards to the variations reported. To complement the results obtained with surveys, the frequency of a health condition can be estimated based on the secondary analysis of administrative healthcare databases. Administrative databases are often developed for preparing healthcare economic evaluations. Recall biases are avoided and data is homogeneously extracted. In a universal healthcare system based on a centralized fee-for-service, the specificity of the administrative databases is high, in part because physicians promptly submit claims for the services provided to patients.
Therefore, by analyzing large data sets such as those found in administrative health care databases, prevalence can be determined over a longer period than in other designs. Also, the sample size is larger; therefore, categorical analyses by sex and age can be performed allowing for a better understanding of the LBP condition in different subpopulations over time.
The objective of our study was to evaluate the prevalence of claims-based recurrent low back pain in a universal health care system for the population of the province of Quebec over an 8-year period starting in 2000. By performing secondary analyses on this extensive administrative database, we provide a descriptive portrait of the longitudinal progression of the annual prevalence of recurrent LBP cases in specific age and sex categories.