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      Quantifying the association between psychological distress and low back pain in urban Europe: a secondary analysis of a large cross-sectional study

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      1 , , 2
      BMJ Open
      BMJ Publishing Group
      EPIDEMIOLOGY, PUBLIC HEALTH, MENTAL HEALTH

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          Abstract

          Objectives

          This study aims to estimate the prevalence of low back pain (LBP) in Europe and to quantify its associated mental and physical health burdens among adults in European urban areas.

          Design

          This research is a secondary analysis of data from a large multicountry population survey.

          Setting

          The population survey on which this analysis is based was conducted in 32 European urban areas across 11 countries.

          Participants

          The dataset for this study was collected during the European Urban Health Indicators System 2 survey. There were a total of 19 441 adult respondents but data from 18 028, 50.2% female (9 050) and 49.8% male (8 978), were included in these analyses.

          Primary and secondary outcome measures

          Being a survey, data on the exposure (LBP) and outcomes were collected simultaneously. The primary outcomes for this study are psychological distress and poor physical health.

          Results

          The overall European prevalence of LBP was 44.6% (43.9–45.3) widely ranging from 33.4% in Norway to 67.7% in Lithuania. After accounting for sex, age, socioeconomic status and formal education, adults in urban Europe suffering LBP had higher odds of psychological distress aOR 1.44 (1.32–1.58) and poor self-rated health aOR 3.54 (3.31–3.80). These associations varied widely between participating countries and cities.

          Conclusion

          Prevalence of LBP, and its associations with poor physical and mental health, varies across European urban areas.

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          Most cited references36

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          Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.

          Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies

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              A systematic review of the global prevalence of low back pain.

              To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence. We conducted a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review. Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40-80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%. As the population ages, the global number of individuals with low back pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies. Copyright © 2012 by the American College of Rheumatology.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                16 February 2023
                : 13
                : 2
                : e047103
                Affiliations
                [1 ]departmentDepartment of Public Health and Policy, Institute of Population Health Sciences , University of Liverpool , Liverpool, UK
                [2 ]departmentDepartment of Public Health, Institute of Population Health , University of Liverpool , Liverpool, Merseyside, UK
                Author notes
                [Correspondence to ] Dr Chukwuebuka Immanuel Ugwu; mazibukaz@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-9171-4516
                Article
                bmjopen-2020-047103
                10.1136/bmjopen-2020-047103
                9936285
                36797024
                49cedf90-3aee-4c69-b52d-5c47d2227c88
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 23 November 2020
                : 24 September 2021
                Funding
                Funded by: The Commonwealth Scholarship Commission;
                Award ID: NGSS-184-2015
                Funded by: FundRef http://dx.doi.org/10.13039/501100000836, University of Liverpool;
                Award ID: N/A
                Categories
                Epidemiology
                1506
                1692
                Original research
                Custom metadata
                unlocked

                Medicine
                epidemiology,public health,mental health
                Medicine
                epidemiology, public health, mental health

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