The Influence of Adolescent Health-related Behaviors on Degenerative Low Back Pain Hospitalizations and Surgeries in Adulthood: A Longitudinal Study

Overview

Journal Spine (Phila Pa 1976)

Specialty Orthopedics

Date 2024 Aug 6

PMID 39104046

Authors

Matias Vaajala

Alisa Teuho

Rasmus Liukkonen

Ville Ponkilainen

Arja Rimpela

Leena K Koivusilta

Ville M Mattila

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective longitudinal study.

Objective: This study aims to investigate the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on the development of low back pain requiring hospitalization or surgery.

Summary Of Background Data: The baseline data were surveys gathered biennially in 1981-1997 (the Adolescent Health and Lifestyle Survey) and individually linked with outcome data, degenerative low back pain hospitalizations, and spine surgeries retrieved from the Care Register for Health Care. A total of 47 724 participants were included. Explanatory variables included physical activity, high BMI, smoking, monthly drunkenness, chronic diseases, and family SES.

Methods: A logistic regression model was used to analyze the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on degenerative low back pain hospitalization, lumbar disc herniation (LDH) hospitalization and/or spine surgery. Covariates were selected using directed acyclic graphs (DAGs).

Results: A total of 5538 participants had degenerative low back pain hospitalizations, 2104 had LDH hospitalizations, and 913 had spinal surgery over an average of 27-years follow-up. High BMI (aOR 1.25, CI 1.12-1.38), smoking (aOR 1.53, CI 1.43-1.62), monthly drunkenness (aOR 1.17, CI 1.10-1.26), and chronic diseases (aOR 1.47, CI 1.35-1.61) in adolescence increased the odds of hospitalizations during follow-up. In addition, high BMI (aOR 1.37, CI 1.09-1.72), smoking (aOR 1.40, CI 1.21-1.61), and monthly drunkenness (aOR 1.19, CI 1.01-1.39) increased the odds of spine surgeries.

Conclusions: We found that smoking, high BMI, monthly drunkenness, chronic diseases, and low family SES in adolescence increased the likelihood of degenerative low back pain hospitalizations in adulthood. In addition, high BMI, smoking, and monthly drunkenness in adolescence increased the odds of spinal surgeries.

References

Lucas R, Fraga S, Ramos E, Barros H . Early initiation of smoking and alcohol drinking as a predictor of lower forearm bone mineral density in late adolescence: a cohort study in girls. PLoS One. 2012; 7(10):e46940. PMC: 3475705. DOI: 10.1371/journal.pone.0046940. View

Gautam N, Dessie G, Rahman M, Khanam R . Socioeconomic status and health behavior in children and adolescents: a systematic literature review. Front Public Health. 2023; 11:1228632. PMC: 10616829. DOI: 10.3389/fpubh.2023.1228632. View

Jantti S, Ponkilainen V, Mantymaki H, Uimonen M, Kuitunen I, Mattila V . Trends in emergency department visits due to back pain and spine surgeries during the COVID-19 pandemic in Finland. Medicine (Baltimore). 2022; 101(23):e29496. PMC: 9276135. DOI: 10.1097/MD.0000000000029496. View

Trompeter K, Fett D, Platen P . Prevalence of Back Pain in Sports: A Systematic Review of the Literature. Sports Med. 2016; 47(6):1183-1207. PMC: 5432558. DOI: 10.1007/s40279-016-0645-3. View

Joensuu L, Kujala U, Kankaanpaa A, Syvaoja H, Kulmala J, Hakonen H . Physical fitness development in relation to changes in body composition and physical activity in adolescence. Scand J Med Sci Sports. 2020; 31(2):456-464. DOI: 10.1111/sms.13847. View

Al-Bashaireh A, Haddad L, Weaver M, Chengguo X, Kelly D, Yoon S . The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms. J Osteoporos. 2019; 2018:1206235. PMC: 6304634. DOI: 10.1155/2018/1206235. View

Buchbinder R, van Tulder M, Oberg B, Costa L, Woolf A, Schoene M . Low back pain: a call for action. Lancet. 2018; 391(10137):2384-2388. DOI: 10.1016/S0140-6736(18)30488-4. View

Hallal P, Victora C, Azevedo M, Wells J . Adolescent physical activity and health: a systematic review. Sports Med. 2006; 36(12):1019-30. DOI: 10.2165/00007256-200636120-00003. View

Picado C, Luengo M . Corticosteroid-induced bone loss. Prevention and management. Drug Saf. 1996; 15(5):347-59. DOI: 10.2165/00002018-199615050-00005. View

10.

Krall E, Dawson-Hughes B . Smoking increases bone loss and decreases intestinal calcium absorption. J Bone Miner Res. 1999; 14(2):215-20. DOI: 10.1359/jbmr.1999.14.2.215. View

11.

Parreira P, Maher C, Steffens D, Hancock M, Ferreira M . Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018; 18(9):1715-1721. DOI: 10.1016/j.spinee.2018.05.018. View

12.

Deyo R, Cherkin D, Conrad D, Volinn E . Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health. 1991; 12:141-56. DOI: 10.1146/annurev.pu.12.050191.001041. View

13.

Vaajala M, Kuitunen I, Nyrhi L, Ponkilainen V, Kekki M, Huttunen T . Pregnancy and delivery after spine fracture or surgery: A nationwide population-based register study in Finland. PLoS One. 2022; 17(8):e0272579. PMC: 9355215. DOI: 10.1371/journal.pone.0272579. View

14.

Sampson H . Alcohol's harmful effects on bone. Alcohol Health Res World. 2005; 22(3):190-4. PMC: 6761900. View

15.

Paavola M, Vartiainen E, Haukkala A . Smoking, alcohol use, and physical activity: a 13-year longitudinal study ranging from adolescence into adulthood. J Adolesc Health. 2004; 35(3):238-44. DOI: 10.1016/j.jadohealth.2003.12.004. View

16.

OKeeffe M, George S, OSullivan P, OSullivan K . Psychosocial factors in low back pain: letting go of our misconceptions can help management. Br J Sports Med. 2018; 53(13):793-794. DOI: 10.1136/bjsports-2018-099816. View

17.

Moeller J, Rifat S . Spondylolysis in active adolescents: expediting return to play. Phys Sportsmed. 2010; 29(12):27-32. DOI: 10.3810/psm.2001.12.1074. View

18.

Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C . The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6):968-74. DOI: 10.1136/annrheumdis-2013-204428. View

19.

Oiestad B, Hilde G, Tveter A, Peat G, Thomas M, Dunn K . Risk factors for episodes of back pain in emerging adults. A systematic review. Eur J Pain. 2019; 24(1):19-38. DOI: 10.1002/ejp.1474. View

20.

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J . Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020; 8(6):299. PMC: 7186678. DOI: 10.21037/atm.2020.02.175. View