Calais-Ferreira Lucas, Pozzobon Daniel, Pinheiro Marina B, Blyth Fiona M, Ordoñana Juan R, Duncan Glen E, Hopper John L, Ferreira Paulo H, Ferreira Manuela L
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Eur J Pain. 2023 Nov;27(10):1150-1160. doi: 10.1002/ejp.2146. Epub 2023 Jun 25.
Low back pain (LBP) is more likely to occur in people with a family history of this condition, highlighting the importance of accounting for familial factors when studying the individual risk of LBP. We conducted a study of opposite-sex twin pairs investigating sex differences in LBP while accounting for (genetic and shared environmental) familial factors.
We applied a matched co-twin control design to study 795 adult opposite-sex pairs from Australia, Spain, and the United States (US). We used mixed-effects logistic regression to assess the within-pair association between female sex and lifetime prevalence of LBP in unadjusted and adjusted models for body-mass-index, and depression, as well as interactions between female sex and age (<median age vs. ≥median age) in this association.
The mean age of the sample was 47.4 years (Standard Deviation = 16.5). The adjusted odds ratio (aOR) of the association between sex and LBP in the merged sample was 1.11 (95% Confidence Interval = 0.88-1.40), with 87.4% of the variance in the studied association explained by between-site heterogeneity (Q test; p = 0.001). Females had 2.37 (95% CI: 1.48-3.78) higher odds of LBP compared to their male co-twins in the Spanish sample (adjusted), but a sex association was not found in the Australian nor US samples.
We found no evidence of the association between sex and LBP in our merged sample. Between-population differences (i.e. cultural background or health system characteristics) are likely to be major factors leading to variation in the sex association with LBP when familial factors are accounted for.
Our study of adult opposite-sex twin pairs found no evidence of an association between female sex and lifetime prevalence of low back pain after controlling for familial factors in the merged sample from Australia, Spain and USA, contrary to findings from previous studies of unrelated individuals. Our findings indicate potentially relevant between-country genetic, cultural and environmental differences which may need to be considered for optimal and individualized strategies for the prevention and management of low back pain across the lifespan.
下背痛（LBP）在有该疾病家族史的人群中更易发生，这凸显了在研究LBP个体风险时考虑家族因素的重要性。我们对异性双胞胎进行了一项研究，在考虑（遗传和共同环境）家族因素的同时，调查LBP中的性别差异。
我们采用匹配的同卵双胞胎对照设计，对来自澳大利亚、西班牙和美国的795对成年异性双胞胎进行研究。我们使用混合效应逻辑回归，在未调整和调整了体重指数、抑郁的模型中，评估女性性别与LBP终生患病率之间的配对内关联，以及该关联中女性性别与年龄（<中位年龄与≥中位年龄）之间的相互作用。
样本的平均年龄为47.4岁（标准差=16.5）。合并样本中性别与LBP关联的调整后优势比（aOR）为1.11（95%置信区间=0.88-1.40），研究关联中87.4%的方差由地点间异质性解释（Q检验；p=0.001）。在西班牙样本中（调整后），女性患LBP的几率比其男性双胞胎高2.37（95%CI：1.48-3.78），但在澳大利亚和美国样本中未发现性别关联。
在我们的合并样本中，未发现性别与LBP之间存在关联的证据。当考虑家族因素时，人群间差异（即文化背景或卫生系统特征）可能是导致LBP性别关联存在差异的主要因素。
我们对成年异性双胞胎的研究发现，在控制了来自澳大利亚、西班牙和美国的合并样本中的家族因素后，没有证据表明女性性别与下背痛终生患病率之间存在关联，这与之前对非亲属个体的研究结果相反。我们的研究结果表明，国家间潜在的相关遗传、文化和环境差异可能需要在整个生命周期中预防和管理下背痛的最佳和个性化策略中加以考虑。
