The incidence and worsening of newly diagnosed low back pain in a population of young male military recruits

Abstract

BackgroundLow back pain (LBP) is a leading cause of referral to occupational health clinics and of consequent work absenteeism. There is lack of data concerning ages 18–21. The objective of our study was to evaluate the occurrence of newly diagnosed LBP and the recurrence and worsening of preexisting LBP in young male military recruits.MethodsIn this retrospective cohort study, we examined the medical history of army recruits during the 30-month period after their induction into the Israel Defense Forces (IDF). The duty status of soldiers in combat units (CU), maintenance units (MU) and administrative units (AU) was evaluated according to their morbidity. The study’s end point was defined as significant findings on clinical examination with presence of neurological deficits which correlate to radiological findings on CT or MRI showing herniated disks, spinal stenosis or pressure on neurological roots.ResultsThe annual incidence rate of LBP in a total of 159,295 recruits was 0.05 %. The relative risk (RR) for developing LBP was significantly higher among subjects who were assigned to AU as compared to CU and MU in all LBP categories. The RR for LBP recurrence in soldiers with a positive history of LBP (categories 3 and 4) was 4.1 and 10.7 compare to category 1 respectively.ConclusionsThe lower than expected overall incidence rate of 0.05 % reflects the fact that severe LBP occurrences are not common at this age group. This finding is a more truthful reflection of LBP occurrence rates relative to other studies since the end point is based on precise clinical definitions in medical records and not on questionnaires, as in most studies. The RR for developing LBP was significantly higher among subjects who were assigned to AU as compared to CU and MU in all LBP categories. Childhood history of LBP was found as a significant risk factor for LBP exacerbations at adulthood. Positive history of LBP was found as a risk factor for the recurrence of LBP in all occupation types and particularly in sedentary ones.

Real-world incidence and prevalence of low back pain using routinely collected data

“…The aim of this systematic literature review was to report LBP prevalence and incidence estimate from studies using patient electronic medical records. The included studies 2.0% M = 1.3%, F = 0.7% Spijker-Huiges et al [23] 1.0% Ernat et al [28] 3.0% Knox et al [24] 4.0% Bartholomeeusen et al [25] 5.1% (95% CI 4.9%, 5.3%), F = 5.3% (95% CI 5.1%, 5.5%), M = 4.9% (95% CI 4.7%, 5.2%) Kuijer et al [18] 5.4%; M = 5.0%, F = 4.0% Miedema et al [27] 0.024% (95% CI 0.022-0.027%), M = 0.031% (95% CI 0.028%, 0.035%), F = 0.003 (95% CI 0.002%, 0.005%) Waterman et al [29] 0.14% Moshe et al 2016 [30] 0.05% Table 4 LBP definition of the studies ICD international classification of disease, ICPC international classification of primary care…”

“…Various sources of data were reported in the included studies including the National Dutch Register [18]; Regie de'l Assurance Maladie du Quebec [19]; Skane Health Care Register [20]; Truven Health Market Scan Commercial Claims and Encounters [21]; National Hospital Discharge Register of Finland [22]; registration Network Groningen [23], US Defence Medical Epidemiology Database [24], the Intego Database [25], and the Emergency Department Information System [26] ( Table 1). The included studies were conducted in Belgium [25], Canada [19,26], Finland [22], the Netherlands [18,22,27], Sweden [20], USA [21,24,28,29], and Israel [30]. The sample size used to estimate the prevalence and incidence of LBP in the included studies ranged from 3900 to 7.5 million.…”

“…The incidence rate of LBP was reported in ten studies [18,[21][22][23][24][25][27][28][29][30]. The overall mean incidence of LBP reported from the nine studies ranged between 0.024 and 7.0%.…”

“…Beaudet et al [19] 3-digits ICD-9 codes 721, 722, 724 or 739 Joud et al [20] ICD-10: Lumbago with sciatica (M54.4), LBP (M54.5), other dorsaliga unspecified (M54.9) Mattila et al [22] ICD-10 (M51.1-lumbar and other intervertebral disc disorder with radiculopathy), M54.5-LBP and M54.9-dorsalgia. ICD-9 by codes 7227C, 3539X, 7242A, 7245A, and 7249X Spijker-Huiges et al [23] L02 and L03 for having pre-history and post-history of LBP in the DUTCH version of the ICPC-1 Ernat et al [28] ICD-9CM code 724.20 Knox et al [24] ICD-9CM code 724.20 Bartholomeeusenetal [25] LO3 (Low back symptom), L84 (back syndrome without radiating pain) or L86 (Back syndrome with radiating pain) Kuijer et al [18] Acute (L101, M545), subacute (L102, M545) and chronic (L103, M545) Moshe et al 2016 [30] Criteria based on the Israeli Defence Force book of medical records Edwards et al 2018 [26] ICD codes: LBP with no potential nerve root involvement; LBP with potential nerve root involvement; and LBP with attributed to trauma or other secondary factors reported incidence or prevalence data from North America and Europe including USA, the Netherlands, Canada, Sweden, Finland, Belgium and Israel. The methodological approach used as a search strategy identified no studies from developing countries.…”

“…Odds ratio Beaudet et al [19] 1.11 Goetzel et al [21] 0.34 Joud et al [20] 1.00 Spijker-Huiges et al [23] 1.32 Bartholomeeusen et al [25] 0.05 Moshe et al 2016 [30] 1.47 Kuijer et al [18] 17.29 Edwards et al 2018 [26] 0.89 and healthcare policy makers to evaluate alternative treatment options to prevent the incidence and reduce the prevalence of LBP. Further research studies are required to estimate the prevalence and incidence and identify the risk factors for LBP, particularly in developing countries using patients of electronic medical records.…”