Suri Pradeep, Boyko Edward J, Rundell Sean D, Smith Nicholas L, Goldberg Jack
Seattle Epidemiologic Research and Information Center (ERIC), Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
Division of Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
BMC Musculoskelet Disord. 2018 Oct 10;19(1):362. doi: 10.1186/s12891-018-2282-5.
Poor general health predicts the transition to chronic back pain (CBP), but the role of specific medical conditions in the development of CBP is unclear. The study aim was to examine the association of medical conditions with the development of CBP ("incident CBP"), while controlling for familial factors, including genetics.
This was a longitudinal co-twin control study conducted in a nationwide United States sample from the Vietnam Era Twin Registry. The study sample included 3045 males without back problems at baseline, including 662 complete twin pairs, who were followed for 11 years. Baseline surveys inquired about self-reported medical conditions (arthritis, diabetes, hypertension, and coronary artery disease [CAD]). A medical comorbidity score was calculated based on the presence and/or treatment of 8 medical conditions. Covariates included age, race, and education. At 11-year follow-up, participants reported ever having had CBP. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated when considering twins as individuals, and in matched-pair co-twin control analyses adjusting for familial/genetic factors.
Mean age at baseline was 51 years and 17% of participants developed CBP over the 11-year follow-up. Arthritis was significantly associated with incident CBP in individual-level analysis (OR 1.8 [95% CI 1.4-2.2]), but not within-pair analysis (OR 0.9 [95% CI 0.4-1.9]. CAD (OR 1.6 [95% CI 1.0-2.3]), hypertension (OR 1.3 [95% CI 1.0-1.5]), and the medical comorbidity score (OR 1.2 [95%CI 1.1-2.2]) were significantly associated with incident CBP in individual-level analyses; associations in within-pair analyses were of comparable magnitude, but not statistically significant. Diabetes was not associated with incident CBP.
Arthritis, hypertension, CAD, and medical comorbidity score were associated with incident CBP in the current study. However, the association between arthritis and incident CBP was confounded by familial factors. This suggests that prevention or treatment of arthritis is unlikely to be useful for CBP prevention. Our findings cannot exclude the possibility of causal associations between CAD, hypertension, and medical comorbidities and incident CBP.
总体健康状况不佳预示着会转变为慢性背痛（CBP），但特定疾病在CBP发生过程中的作用尚不清楚。本研究的目的是在控制包括遗传学在内的家族因素的同时，研究疾病与CBP发生（“新发CBP”）之间的关联。
这是一项在美国全国范围内对越南战争时期双胞胎登记处样本进行的纵向双生子对照研究。研究样本包括3045名基线时无背部问题的男性，其中有662对完整的双胞胎，随访11年。基线调查询问了自我报告的疾病（关节炎、糖尿病、高血压和冠状动脉疾病[CAD]）。根据8种疾病的存在和/或治疗情况计算了一个疾病合并症评分。协变量包括年龄、种族和教育程度。在11年随访时，参与者报告曾患有CBP。在将双胞胎视为个体进行分析时，以及在调整家族/遗传因素的配对双生子对照分析中，估计了优势比（OR）和95%置信区间（CI）。
基线时的平均年龄为51岁，17%的参与者在11年随访期间发生了CBP。在个体水平分析中，关节炎与新发CBP显著相关（OR 1.8[95%CI 1.4 - 2.2]），但在配对分析中不相关（OR 0.9[95%CI 0.4 - 1.9]）。CAD（OR 1.6[95%CI 1.0 - 2.3]）、高血压（OR 1.3[95%CI 1.0 - 1.5]）和疾病合并症评分（OR 1.2[95%CI 1.1 - 2.2]）在个体水平分析中与新发CBP显著相关；配对分析中的关联程度相当，但无统计学意义。糖尿病与新发CBP无关。
在本研究中，关节炎、高血压、CAD和疾病合并症评分与新发CBP相关。然而，关节炎与新发CBP之间的关联受到家族因素的混杂影响。这表明预防或治疗关节炎对预防CBP可能没有用处。我们的研究结果不能排除CAD、高血压和疾病合并症与新发CBP之间存在因果关联的可能性。
