Der Schmerz

, Volume 25, Issue 3, pp 306–314

Rückenschmerz und Sozialschicht bei Berufstätigen

Ergebnisse einer deutschen Bevölkerungsstichprobe
  • C.O. Schmidt
  • J. Moock
  • R.A. Fahland
  • Y.Y.-S. Feng
  • T. Kohlmann
Originalien

Zusammenfassung

Hintergrund

Wenig Evidenz besteht in Deutschland für den differenziellen Einfluss von Sozialschichtindikatoren auf Rückenschmerzen. Diese Arbeit geht daher der Frage nach, welche Sozialschichtindikatoren bei Berufstätigen mit welchen Rückenschmerzindikatoren am engsten assoziiert sind.

Material und Methoden

Insgesamt 4412 berufstätige Erwachsene aus 5 deutschen Städten im Alter zwischen 18 und 65 Jahren nahmen an einem postalischen Rückenschmerzsurvey teil. Erfasst wurden die Punkt- und Jahresprävalenz der Rückenschmerzen sowie deren Schweregrad. Als Sozialschichtindikatoren wurden das Bildungsniveau, die berufliche Position und das Äquivalenzeinkommen herangezogen. Assoziationen wurden mittels Poisson-Regression im Querschnitt untersucht.

Ergebnisse

Das Bildungsniveau war der beste Prädiktor für Rückenschmerzen. Personen mit Hauptschulabschluss hatten im Vergleich zu Teilnehmern mit Fachabitur oder Abitur ein fast 4-fach erhöhtes Risiko, schwergradige Rückenschmerzen aufzuweisen. Vom Rückenschmerzschweregrad über die Punkt- hin zur Jahresprävalenz nahm der Grad der Assoziation mit den Sozialschichtindikatoren erheblich ab.

Schlussfolgerung

Rückenschmerz kann nicht generell als Symptom eines niedrigen Sozialstatus aufgefasst werden. Soziale Ungleichheit spielt jedoch eine große Rolle bei der Vorhersage starker und beeinträchtigender Rückenschmerzen. Die zukünftige Analyse zugrundeliegender Wirkmechanismen ist für präventive und therapeutische Ansätze von großer Relevanz.

Schlüsselwörter

Rückenschmerz Sozialschicht Bildung Einkommen Geschlecht 

Back pain and social status among the working population

What is the association? Results from a German general population survey

Abstract

Background

Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain.

Methods

In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression.

Results

Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence.

Discussion

Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.

Keywords

Back pain Social class Status, educational Income Gender 

Literatur

  1. 1.
    Astrand NE (1987) Medical, psychological, and social factors associated with back abnormalities and self reported back pain: a cross sectional study of male employees in a Swedish pulp and paper industry. Br J Ind Med 44:327–336PubMedGoogle Scholar
  2. 2.
    Bortz J, Schuster C (2010) Statistik für Human- und Sozialwissenschaftler Springer, BerlinGoogle Scholar
  3. 3.
    Bundesministerium für Gesundheit und Soziales (2005) 2. Armuts- und Reichtumsbericht der Bundesregierung. Eigenverlag, Bonn, BerlinGoogle Scholar
  4. 4.
    Cole DC, Ibrahim SA, Shannon HS et al (2001) Work correlates of back problems and activity restriction due to musculoskeletal disorders in the Canadian national population health survey (NPHS) 1994–5 data. Occup Environ Med 58:728–734PubMedCrossRefGoogle Scholar
  5. 5.
    Croft PR, Rigby AS (1994) Socioeconomic influences on back problems in the community in Britain. J Epidemiol Community Health 48:166–170PubMedCrossRefGoogle Scholar
  6. 6.
    Cunningham LS, Kelsey JL (1984) Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 74:574–579PubMedCrossRefGoogle Scholar
  7. 7.
    Deck R, Röckelein E (1999) Zur Erhebung soziodemographischer und sozialmedizinischer Indikatoren in den rehabilitationswissenschaftlichen Forschungsverbünden. In, S 84–102Google Scholar
  8. 8.
    Deyo RA, Tsui-Wu YJ (1987) Functional disability due to back pain. A population-based study indicating the importance of socioeconomic factors. Arthritis Rheum 30:1247–1253PubMedCrossRefGoogle Scholar
  9. 9.
    Dionne CE, Von Korff M, Koepsell TD et al (2001) Formal education and back pain: a review. J Epidemiol Community Health 55 455–468Google Scholar
  10. 10.
    Fuentes M, Hart-Johnson T, Green CR (2007) The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults. J Natl Med Assoc 99:1160–1169PubMedGoogle Scholar
  11. 11.
    Geyer S (2008) Single indicator or index? Comparison of measures of social differentiation. Gesundheitswesen 70:281–288PubMedCrossRefGoogle Scholar
  12. 12.
    Geyer S, Hemstrom O, Peter R et al (2006) Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health 60:804–810PubMedCrossRefGoogle Scholar
  13. 13.
    Geyer S, Schneller T, Micheelis W (2010) Social gradients and cumulative effects of income and education on dental health in the Fourth German Oral Health Study. Community Dent Oral Epidemiol 38:120–128PubMedCrossRefGoogle Scholar
  14. 14.
    Heistaro S, Vartiainen E, Heliovaara M et al (1998) Trends of back pain in eastern Finland, 1972–1992, in relation to socioeconomic status and behavioral risk factors. Am J Epidemiol 148:671–682PubMedCrossRefGoogle Scholar
  15. 15.
    Hestbaek L, Korsholm L, Leboeuf-Yde C et al (2008) Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional study of 4,771 Danish adolescents. Eur Spine J 17:1727–1734PubMedCrossRefGoogle Scholar
  16. 16.
    Hofreuter K, Koch U, Morfeld M (2008) Social inequality as a predictor of occupational reintegration of chronic back pain patients following medical rehabilitation. Gesundheitswesen 70:145–153PubMedCrossRefGoogle Scholar
  17. 17.
    Ichida Y, Kondo K, Hirai H et al (2009) Social capital, income inequality and self-rated health in Chita peninsula, Japan: a multilevel analysis of older people in 25 communities. Soc Sci Med 69:489–499PubMedCrossRefGoogle Scholar
  18. 18.
    Jacobsson L, Lindgarde F, Manthorpe R et al (1992) Effect of education, occupation and some lifestyle factors on common rheumatic complaints in a Swedish group aged 50–70 years. Ann Rheum Dis 51:835–843PubMedCrossRefGoogle Scholar
  19. 19.
    Kaila-Kangas L, Keskimaki I, Notkola V et al (2006) How consistently distributed are the socioeconomic differences in severe back morbidity by age and gender? A population based study of hospitalisation among Finnish employees. Occup Environ Med 63:278–282PubMedCrossRefGoogle Scholar
  20. 20.
    Kaluza G, Hanke C, Keller S et al (2002) Salutogenctic factors in chronic back pain – Do job satisfaction, social support, and physical activity moderate the relationship between job stress and back pain activity? Z Klin Psychol Psychother 31:159–168CrossRefGoogle Scholar
  21. 21.
    Kohlmann T, Schmidt CO (2005) Rückenschmerzen in Deutschland – eine epidemiologische Bestandsaufnahme. Orthopädie & Rheuma: 40–43Google Scholar
  22. 22.
    Kopec JA, Sayre EC, Esdaile JM (2004) Predictors of back pain in a general population cohort. Spine 29:70–77PubMedCrossRefGoogle Scholar
  23. 23.
    Korn EL, Graubard BI (1999) Analysis of health surveys. John Wiley, New YorkGoogle Scholar
  24. 24.
    Latza U, Kohlmann T, Deck R et al (2004) Can health care utilization explain the association between socioeconomic status and back pain? Spine 29:1561–1566PubMedCrossRefGoogle Scholar
  25. 25.
    Latza U, Kohlmann T, Deck R et al (2000) Influence of occupational factors on the relation between socioeconomic status and self-reported back pain in a population-based sample of German adults with back pain. Spine 25:1390–1397PubMedCrossRefGoogle Scholar
  26. 26.
    Leclerc A, Chastang JF, Ozguler A et al (2006) Chronic back problems among persons 30 to 64 years old in France. Spine 31:479–484PubMedCrossRefGoogle Scholar
  27. 27.
    Leino-Arjas P, Hanninen K, Puska P (1998) Socioeconomic variation in back and joint pain in Finland. Eur J Epidemiol 14:79–87PubMedCrossRefGoogle Scholar
  28. 28.
    Macfarlane GJ, Norrie G, Atherton K et al (2009) The influence of socioeconomic status on the reporting of regional and widespread musculoskeletal pain: results from the 1958 British Birth Cohort Study. Ann Rheum Dis 68:1591–1595PubMedCrossRefGoogle Scholar
  29. 29.
    Mackenbach JP, Kunst AE, Cavelaars AE et al (1997) Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet 349:1655–1659PubMedCrossRefGoogle Scholar
  30. 30.
    Mackenbach JP, Stirbu I, Roskam AJ et al (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481PubMedCrossRefGoogle Scholar
  31. 31.
    Mielck A (2005) Soziale Ungleichheit und Gesundheit. Einführung in die aktuelle Diskussion. Huber, BernGoogle Scholar
  32. 32.
    Neuhauser H, Ellert U, Ziese T (2005) Chronic back pain in the general population in Germany 2002/2003: prevalence and highly affected population groups. Gesundheitswesen 67:685–693PubMedCrossRefGoogle Scholar
  33. 33.
    Pincus T, Burton AK, Vogel S et al (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27:109–120CrossRefGoogle Scholar
  34. 34.
    Pincus T, Callahan LF, Burkhauser RV (1987) Most chronic diseases are reported more frequently by individuals with fewer than 12 years of formal education in the age 18–64 United States population. J Chronic Dis 40:865–874PubMedCrossRefGoogle Scholar
  35. 35.
    Punnett L, Pruss-Utun A, Nelson DI et al (2005) Estimating the global burden of low back pain attributable to combined occupational exposures. Am J Ind Med 48:459–469PubMedCrossRefGoogle Scholar
  36. 36.
    Reisbord LS, Greenland S (1985) Factors associated with self-reported back-pain prevalence: a population-based study. J Chronic Dis 38:691–702PubMedCrossRefGoogle Scholar
  37. 37.
    Ross CE, Wu CL (1996) Education, age, and the cumulative advantage in health. J Health Soc Behav 37:104–120PubMedCrossRefGoogle Scholar
  38. 38.
    Rothman KJ, Greenland S, Lash T (2008) Modern Epidemiology. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  39. 39.
    Sarfati H (2009) Growing unequal? Income distribution and poverty in OECD countries. Int Labour Rev 148:199–204CrossRefGoogle Scholar
  40. 40.
    Schmidt CO, Kohlmann T (2008) Risk quantification in epidemiologic studies. Int J Public Health 53:118–119PubMedCrossRefGoogle Scholar
  41. 41.
    Schmidt CO, Kohlmann T (2008) When to use the odds ratio or the relative risk? Int J Public Health 53:165–167PubMedCrossRefGoogle Scholar
  42. 42.
    Schmidt CO, Raspe H, Kohlmann T (2010) Graded back pain revisited – do latent variable models change our understanding of severe back pain in the general population? Pain 149:50–56PubMedCrossRefGoogle Scholar
  43. 43.
    Schmidt CO, Raspe H, Pfingsten M et al (2007) Back pain in the German adult population. Prevalence, severity, and sociodemographic correlates in a multi-regional survey. Spine 32:2005–2011PubMedCrossRefGoogle Scholar
  44. 44.
    Schneider S, Schmitt H, Zoller S et al (2005) Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population. Int Arch Occup Environ Health 78:253–269PubMedCrossRefGoogle Scholar
  45. 45.
    Sogaard AJ, Selmer R, Bjertness E et al (2004) The Oslo Health Study: The impact of self-selection in a large, population-based survey. Int J Equity Health 3:3PubMedCrossRefGoogle Scholar
  46. 46.
    Stranjalis G, Tsamandouraki K, Sakas DE et al (2004) Low back pain in a representative sample of Greek population: analysis according to personal and socioeconomic characteristics. Spine 29:1355–1360PubMedCrossRefGoogle Scholar
  47. 47.
    Vind AB, Andersen HE, Pedersen KD et al (2009) Baseline and follow-up characteristics of participants and nonparticipants in a randomized clinical trial of multifactorial fall prevention in Denmark. J Am Geriatr Soc 57:1844–1849PubMedCrossRefGoogle Scholar
  48. 48.
    Von Korff M, Ormel J, Keefe F et al (1992) Grading the severity of chronic pain. Pain 50:133–149CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • C.O. Schmidt
    • 1
  • J. Moock
    • 1
  • R.A. Fahland
    • 1
  • Y.Y.-S. Feng
    • 1
  • T. Kohlmann
    • 1
  1. 1.Institut für Community MedicineUniversität GreifswaldGreifswaldDeutschland

Personalised recommendations