Association of back pain with all-cause and cause-specific mortality among older men: a cohort study

Eric J Roseen; David T McNaughton; Stephanie Harrison; Aron S Downie; Cecilie K Øverås; Casper G Nim; Hazel J Jenkins; James J Young; Jan Hartvigsen; Katie L Stone; Kristine E Ensrud; Soomi Lee; Peggy M Cawthon; Howard A Fink; Osteoporotic Fractures in Men (MrOS) research group

doi:10.1093/pm/pnae040

Association of back pain with all-cause and cause-specific mortality among older men: a cohort study

Pain Med. 2024 May 13:pnae040. doi: 10.1093/pm/pnae040. Online ahead of print.

Authors

Eric J Roseen^{1

2}, David T McNaughton³, Stephanie Harrison⁴, Aron S Downie⁵, Cecilie K Øverås⁶, Casper G Nim^{7

8

9}, Hazel J Jenkins⁵, James J Young^{10

11}, Jan Hartvigsen^{11

12}, Katie L Stone^{4

13}, Kristine E Ensrud^{14

15}, Soomi Lee¹⁶, Peggy M Cawthon⁴, Howard A Fink^{14

15

17}; Osteoporotic Fractures in Men (MrOS) research group

Affiliations

¹ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.
² Department of Physical Medicine & Rehabilitation and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Jamaica Plain Campus, Boston, Massachusetts, USA.
³ School of Psychological Sciences, Macquarie University, Sydney, Australia.
⁴ Research Institute, California Pacific Medical Center, San Francisco, California, USA.
⁵ Department of Chiropractic, Macquarie University, Sydney, Australia.
⁶ Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
⁷ Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark.
⁸ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
⁹ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
¹⁰ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
¹¹ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
¹² The Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark.
¹³ Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
¹⁴ Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
¹⁵ Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.
¹⁶ Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA.
¹⁷ Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.

PMID: 38741219
DOI: 10.1093/pm/pnae040

Abstract

Objective: We evaluated whether more severe back pain phenotypes-persistent, frequent or disabling back pain-are associated with higher mortality among older men.

Methods: In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from six U.S. sites. The primary back pain measure used baseline and year five back pain questionnaire data to characterize participants as having: no back pain; non-persistent back pain; infrequent persistent back pain; or frequent persistent back pain. Secondary measures of back pain from year five questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific mortality.

Results: After the year five exam, during up to 18 years of follow-up (mean follow-up=10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95%CI=1.11-1.45). No association was evident after further adjusting for health-related factors such as self-reported general health and comorbid chronic health conditions (fully-adjusted HR = 1.00; 95%CI=0.86-1.15). Results were similar for cardiovascular mortality and other mortality, but we observed no association of back pain with cancer mortality. Secondary back pain measures including back-related disability were associated with increased mortality risk that remained statistically significant in fully-adjusted models.

Conclusion: While frequent persistent back pain was not independently associated with mortality in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality. Future investigations should evaluate whether improvements in disabling back pain effect general health and well-being or mortality.

Keywords: back pain; chronic disease; disability; general health; mortality; multimorbidity.