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Chronic backpain among adolescents in Denmark: trends 1991–2018 and association with socioeconomic status


Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991–2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11–15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10–1.31) in middle, and 1.56 (95% CI: 1.41–1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations.

Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain.

What is Known:
• Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood.
What is New:
• The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018.
• The prevalence was highest among adolescents from lower SES families.

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Fig. 1

Availability of data and material

The data underlying this article will be shared on reasonable request to the Principal Investigator, Dr. Katrine Rich Madsen (

Code availability

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Socioeconomic status


Health Behaviour in School-aged Children


HBSC Symptom Check List


Occupational social class


Confidence interval


Odds ratio


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The Nordea Foundation (grant number 02–2011-0122) provided economic support for the 2010 study and The Danish Health Authority (grant number 1–1010-274/13) for the 2018 survey. The funding agencies had no role in the study design, data collection, analysis, interpretation, or writing of this article.

Author information




All authors have contributed substantially to the conception and design of the paper, to the interpretation of data, and to the data collection. BEH and MTD performed the analyses. BEH wrote the first draft of the manuscript. All authors contributed to the writing of the manuscript and a critical revision of the intellectual content. All authors have approved the final version of the manuscript and are accountable for all aspects of the work.

Corresponding author

Correspondence to Bjørn E. Holstein.

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Ethics approval

There is no formal agency for approval of questionnaire-based surveys in Denmark. Therefore, we asked the school board as the parents’ representative, the headmaster, and the students’ council in each of the participating schools to approve the study. The Danish Data Protection Authority has granted acceptance for the 2014 survey (Case No. 2013–54-0576) and the 2018 survey (Case 10 622, University of Southern Denmark).

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The participants received oral and written information that participation was voluntary, and that data were treated confidentially. The study complies with national standards for data protection.

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Not applicable.

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The authors declare no competing interests.

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Holstein, B.E., Damsgaard, M.T., Madsen, K.R. et al. Chronic backpain among adolescents in Denmark: trends 1991–2018 and association with socioeconomic status. Eur J Pediatr (2021).

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  • Adolescents
  • Backpain
  • Health Behaviour in School-aged Children (HBSC) study
  • Social inequality
  • Socioeconomic status
  • Trend study