Low back pain: epidemiology of consultations

Low back pain (LBP) affects most people at some stage in life. However, the burden on the health care system is unclear. We studied: 1) the 1-year consultation prevalence, 2) the rate of first-time consultation for LBP and the relationship of the frequency to other musculoskeletal conditions, and 3) the health care utilization of patients with LBP compared to the general population.

Using the health care register in Southern Sweden (population 1.2 million), including diagnoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) by physicians, we identified all patients who in 2009 were diagnosed with LBP, defined as lumbago with sciatica, low back pain, or other/unspecified dorsalgia. We defined first-time consultation as a consultation in 2009 without a record of an LBP diagnosis in 2004-2008. Standardized health care utilization ratios were calculated for LBP patients compared to the general population seeking care.

The 1-year consultation prevalence of LBP in the population was 3.8% (4.3% for women, 3.3% for men) and increased with age. LBP had been recorded in 17.1% of all patients (16.5% for women, 18.0% for men) who had been diagnosed with any musculoskeletal condition. The rate of first-time consultation was 238 per 10,000 adults (265 for women, 209 for men). The health care utilization ratios in female and male patients with LBP were 1.74 (95% confidence interval [95% CI] 1.73-1.75) and 1.81 (95% CI 1.80-1.82), respectively.

LBP, diagnosed in every sixth patient who consulted due to a musculoskeletal problem, is a public health concern that needs structured management. Patients with LBP consume close to twice as much health care as the general population and this warrants more awareness.