Educational inequality as a predictor of rising back pain prevalence in Austria--sex differences

Background: Back pain (BP) represents a widespread public health problem in Europe. The morbidity depends on several indicators, which must be investigated to discover risk groups. The examination of trends in socioeconomic developments should ensure a better understanding of the complex link between socioeconomic-status and BP. Therefore, the role of social inequalities for BP has been investigated among Austrian subpopulations over a 24-year period. Methods: Self-reported data from nationally representative health surveys (1983–2007) were analyzed and adjusted for self-report bias (N=121 486). Absolute changes (ACs) and aetiologic fractions (AF) were calculated to measure trends. To quantify the extent of social inequality, the relative index of inequality was computed based on educational levels. Results: The prevalence of BP nearly doubled between 1983 and 2007. When investigating educational groups, subjects with low educational level were most prevalent. Obese persons generally showed higher rates of BP than non-obese subjects. Continuously rising trends across the different educational groups were more evident in men. The AC was highest in obese men with high education (+32.9%). Education-related inequalities for BP were more evident in men than women. Conclusion: Educational level is an important social indicator for BP. A gradient for low to high educational level in the trends of BP prevalence was clearly identified and stable only among men. We presume that the association 'education' and 'physical workload leading to BP' is more relevant for men than for women. The implementation of effective approaches to BP, in combination with target group-specific interventions focusing on educational status, is recommended.

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