Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
Centre for Economic Demography, Lund University, Lund, Sweden.
Pain. 2021 Apr 1;162(4):1135-1143. doi: 10.1097/j.pain.0000000000002081.
Sociodemographic inequalities in the occurrence of low back pain (LBP) are well-studied. This study aimed to examine complex sociodemographic inequalities in the risk of LBP consultation in the population from a socioeconomical intersectional perspective. Using register data, we identified 458,852 individuals aged 35 to 75 years residing in Skåne in 2013, with no previous LBP consultation since 2006. We created 108 strata using categories of age, sex, education, income, and nativity. With individuals nested within strata, we modelled the absolute risk of LBP consultation during 2014 in a series of multilevel logistic regression models. We quantified discriminatory accuracy (DA) of these variables by computing the variance partition coefficient and area under the receiver operating characteristic curve (AUC). We identified 13,657 (3.0%) people with an LBP consultation. The absolute risk ranged from 2.1% (95% credible interval: 1.9%-2.3%) among young native men with high education and high income to 4.8% (4.3%-5.5%) among young foreign-born women with medium education and low income (2.3-fold relative difference). Discriminatory accuracy of intersectional strata was very low (variance partition coefficient 1.1% (0.7-1.6); and AUC 0.56 [0.55-0.56]). Sex (35.6%) and nativity (19.2%) had the largest contributions in explaining the initially small between-strata variation in risk of LBP. The low DA of the intersectional strata indicates the existence of limited intersectional inequalities in LBP consultation. Therefore, interventions to reduce LBP risk should be universal rather than targeted to specific socioeconomic groups with a higher average risk. Before planning targeted intervention, other risk factors with higher DA need to be identified.
社会人口因素与腰痛（LBP）的发生之间存在明显关联，这一现象已得到广泛研究。本研究旨在从社会经济交叉视角，检验人群中腰痛就诊风险的复杂社会人口因素不平等。我们使用登记数据，确定了 2013 年居住在斯科讷地区、年龄在 35-75 岁之间、2006 年以来无 LBP 就诊史的 458852 名个体。我们创建了 108 个类别，包括年龄、性别、教育程度、收入和出生国。通过个体嵌套在类别中，我们在一系列多水平逻辑回归模型中模拟了 2014 年 LBP 就诊的绝对风险。我们通过计算方差分解系数和接收者操作特征曲线下面积（AUC）来量化这些变量的判别准确性（DA）。我们发现 13657 人（3.0%）进行了 LBP 就诊。绝对风险从高收入和高教育的年轻本土男性（2.1%[95%置信区间：1.9%-2.3%]）到中收入和低收入的年轻外国出生女性（4.8%[4.3%-5.5%]）不等，相差 2.3 倍。交叉阶层的判别准确性非常低（方差分解系数 1.1%[0.7-1.6]；AUC 0.56[0.55-0.56]）。性别（35.6%）和出生地（19.2%）对解释最初风险分层之间较小差异的贡献最大。交叉阶层的低 DA 表明 LBP 就诊的交叉不平等现象有限。因此，减少 LBP 风险的干预措施应该是普遍的，而不是针对具有更高平均风险的特定社会经济群体。在规划有针对性的干预措施之前，需要确定具有更高 DA 的其他风险因素。
