Back pain in seniors: the Back pain Outcomes using Longitudinal Data (BOLD) cohort baseline data

Abstract

Background: Back pain represents a substantial burden globally, ranking first in a recent assessment among causes of years lived with disability. Though back pain is widely studied among working age adults, there are gaps with respect to basic descriptive epidemiology among seniors, especially in the United States. Our goal was to describe how pain, function and health-related quality of life vary by demographic and geographic factors among seniors presenting to primary care providers with new episodes of care for back pain.

Methods: We examined baseline data from the Back pain Outcomes using Longitudinal Data (BOLD) registry, the largest inception cohort to date of seniors presenting to a primary care provider for back pain. The sample included 5,239 patients ≥ 65 years old with a new primary care visit for back pain at three integrated health systems (Northern California Kaiser-Permanente, Henry Ford Health System [Detroit], and Harvard Vanguard Medical Associates [Boston]). We examined differences in patient characteristics across healthcare sites and associations of patient sociodemographic and clinical characteristics with baseline patient-reported measures of pain, function, and health-related quality of life.

Results: Patients differed across sites in demographic and other characteristics. The Detroit site had more African-American patients (50%) compared with the other sites (7-8%). The Boston site had more college graduates (68%) compared with Detroit (20%). Female sex, lower educational status, African-American race, and older age were associated with worse functional disability as measured by the Roland-Morris Disability Questionnaire. Except for age, these factors were also associated with worse pain.

Conclusions: Baseline pain and functional impairment varied substantially with a number of factors in the BOLD cohort. Healthcare site was an important factor. After controlling for healthcare site, lower education, female sex, African-American race, and older age were associated with worse physical disability and all of these factors except age were associated with worse pain.

Trial registration: Clinical Trials.gov NCT01776242; Registration date: June 13, 2012.

Figures

Figure 1

Consort diagram depicting patient flow from initial screening through enrollment.

Figure 2

Roland-Morris Disability Questionnaire (RMDQ) and average back pain intensity in past week by age, race, sex and education stratified by site. a, c, e, and g display the baseline measure of back-related physical disability (the Roland-Morris disability questionnaire) and b, d, f, h display the baseline measure of pain (a numerical rating scale of average back pain in past week), stratified by site and compared with key demographic variables. a and b depict baseline measures by age; c and d depict baseline measures by race; e and f depict baseline measures by sex; and g and h depict baseline measures by education. Each outcome by demographic boxplot displays the within-group mean (horizontal in the center of the box) +/- the within-group standard deviation (upper and lower edges of the box). The vertical lines display the within-group range of scores.

Figure 3

RMDQ and back pain intensity by ICD-9-CM code stratified by site. a displays the baseline measure of back-related physical disability (the Roland-Morris disability questionnaire) and b displays the baseline measure of pain (a numerical rating scale of average back pain in past week), stratified by site and compared with primary diagnosis code for the index visit using ICD-9-CM. Each outcome by demographic boxplot displays the within-group mean (horizontal in the center of the box) +/- the within-group standard deviation (upper and lower edges of the box). The vertical lines display the within-group range of scores.