Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009–2010 National Health and Nutrition Examination Survey

Objective: To describe the epidemiologic characteristics and associations with increased health care utilization in US adults with chronic low back pain (LBP). Methods: The National Health and Nutrition Examination Survey 2009–2010 was administered to adults ages 20–69 years (n = 5,103). Chronic LBP was defined as pain in the area between the lower posterior margin of the rib cage and the horizontal gluteal fold, with a history of pain lasting almost every day for at least 3 months. Demographic and behavioral characteristics were compared between those with chronic LBP and those without. Factors associated with ≥10 health care visits per year were evaluated in the chronic LBP subgroup (n = 700). Results: Chronic LBP associations with adjusted odds ratios (OR_adj) ≥2 included age 50–69 years, less than high school education, annual household income <$20,000, income from disability, depression, sleep disturbances, and medical comorbidities. Subjects with chronic LBP were more likely to be covered by government-sponsored insurance plans (OR_adj 3.23 [95% confidence interval (95% CI) 2.19–4.75] for Medicaid and OR_adj 2.25 [95% CI 1.57–3.22] for Medicare; P < 0.0001), and visited health care providers more frequently (OR_adj 3.35 [95% CI 2.40–4.67] for ≥10 health care visits in the past year; P < 0.0001). In the chronic LBP subgroup, adjusted ORs ≥2 were found for associations between ≥10 visits per year and unemployment, income from disability, depression, and sleep disturbances. Conclusion: US adults with chronic LBP are socioeconomically disadvantaged, make frequent health care visits, and are often covered by government-sponsored health insurance. The clustering of behavioral, psychosocial, and medical issues should be considered in the care of Americans with chronic LBP.