Institute of Social Medicine,Centre for Public Health,Medical University of Vienna,Vienna,Austria,Wien,Austria.
Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
Psychol Med. 2016 Jan;46(2):425-36. doi: 10.1017/S003329171500197X. Epub 2015 Oct 15.
The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).
All 4,823,069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].
HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70).
Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.
本研究旨在分析腰痛与常见精神障碍（CMD）之间可能存在协同作用，进而对未来残疾抚恤金（DP）的影响。
2004 年 12 月所有年龄在 16-64 岁之间、2005 年未领取养老金且 2004/2005 年转换时无病假的 4823069 名居住在瑞典的个体均为该基于登记的研究队列的一部分。估计了（2006-2010 年）残疾抚恤金（DP）的风险比（HR）和 95%置信区间（CI）。暴露变量为腰痛（M54）（2005 年病假、住院或专科门诊治疗）和 CMD（F40-F48）[2005 年病假、住院或专科门诊治疗或抗抑郁药（N06a）]。
女性和男性腰痛患者的 DP 风险比（HR）分别为 4.03（95%CI 3.87-4.21）和 3.86（95%CI 3.68-4.04）。女性和男性 CMD 患者的 DP HR 分别为 4.98（95%CI 4.88-5.08）和 6.05（95%CI 5.90-6.21）。患有两种疾病的女性和男性 DP 的 HR 分别为 15.62（95%CI 14.40-16.94）和 19.84（95%CI 17.94-21.94）。在女性中，协同指数、交互归因超额风险和归因比例分别为 1.24（95%CI 1.13-1.36）、0.18（95%CI 0.11-0.25）和 2.08（95%CI 1.09-3.06）。男性的相应数字为 1.45（95%CI 1.29-1.62）、0.29（95%CI 0.22-0.36）和 4.21（95%CI 2.71-5.70）。
腰痛和 CMD 的合并症与 DP 风险的相关性高于任何单一病症，这可能具有临床意义，可以预防进一步残疾和劳动力市场排斥。
