Fernandez M, Boyle E, Hartvigsen J, Ferreira M L, Refshauge K M, Maher C G, Christensen K, Hopper J L, Ferreira P H
Faculty of Health Sciences, The University of Sydney, NSW, Australia.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
Eur J Pain. 2017 May;21(5):938-948. doi: 10.1002/ejp.996. Epub 2017 Feb 17.
Few studies have examined the potentially reduced life expectancy associated with spinal pain (i.e. low back and neck pain) in an ageing population, particularly after controlling for familial factors, including genetics.
We investigated whether spinal pain increased the rate of all-cause and disease-specific cardiovascular mortality in older Danish twins aged ≥70 years. Data from 4391 participants collected at baseline were linked with the Danish Cause of Death Registry with the study ending on 31 December 2014. Two crude and adjusted Cox proportional hazards regression analyses determined the rate of all-cause and disease-specific cardiovascular mortality by baseline spinal pain exposure; unpaired (total sample analysis) and twin pair (intra-pair analysis). Analyses were also adjusted for confounders; baseline physical functional ability and depressive symptoms. Competing risk regression models determined the rate of cardiovascular mortality, adjusting for similar confounders and using the total sample only.
Spinal pain was associated with an increased rate of all-cause mortality, hazard ratio (HR): 1.13 [95% confidence interval (CI): 1.06-1.21]. There was no association between spinal pain and cardiovascular disease mortality, sub-distribution hazard ratio (SHR): 1.08 [95% CI 0.96-1.21]. After adjusting for confounders (physical functional ability and depressive symptoms), the association became non-significant. All intra-pair analyses were statistically non-significant, although greater in magnitude for monozygotic twins.
Older people reporting spinal pain have 13% increased risk of mortality per years lived but the connection is not causal. We found no association between spinal pain and cardiovascular-specific mortality. The influence of shared familial factors is unlikely.
Older people reporting spinal pain have 13% increased risk of mortality per year lived. However, this association is not likely to be causal, with the relevant confounders contributing to this relationship. Thus, pain in the spine may be part of a pattern of poor health, which increases mortality risk in the older population.
很少有研究探讨在老龄化人口中，脊柱疼痛（即腰背痛和颈痛）与预期寿命潜在缩短之间的关系，尤其是在控制包括遗传因素在内的家族因素之后。
我们调查了脊柱疼痛是否会增加年龄≥70岁的丹麦老年双胞胎的全因死亡率和特定疾病心血管死亡率。在基线时收集的4391名参与者的数据与丹麦死亡原因登记处相关联，研究于2014年12月31日结束。两次粗率和校正后的Cox比例风险回归分析确定了基线脊柱疼痛暴露情况下的全因死亡率和特定疾病心血管死亡率；未配对（总样本分析）和双胞胎对（配对内分析）。分析还对混杂因素进行了校正；基线身体功能能力和抑郁症状。竞争风险回归模型确定了心血管死亡率，对类似的混杂因素进行了校正，且仅使用总样本。
脊柱疼痛与全因死亡率增加相关，风险比（HR）：1.13[95%置信区间（CI）：1.06 - 1.21]。脊柱疼痛与心血管疾病死亡率之间无关联，亚分布风险比（SHR）：1.08[95%CI 0.96 - 1.21]。在对混杂因素（身体功能能力和抑郁症状）进行校正后，该关联变得不显著。所有配对内分析在统计学上均不显著，尽管同卵双胞胎的幅度更大。
报告有脊柱疼痛的老年人每年的死亡风险增加13%，但这种关联并非因果关系。我们未发现脊柱疼痛与心血管特异性死亡率之间存在关联。共享家族因素的影响不太可能。
报告有脊柱疼痛的老年人每年的死亡风险增加13%。然而，这种关联不太可能是因果关系，相关混杂因素导致了这种关系。因此，脊柱疼痛可能是健康状况不佳模式的一部分，这会增加老年人群的死亡风险。
