Smoking, Alcohol Use, and Low Back Pain: A Large-Scale Study Identifying a Synergistic Lifestyle Risk

Study DesignAnalytical Cross-sectional Study.ObjectiveTo investigate the association between smoking exposure and the prevalence of low back pain, and to evaluate whether this association varies by alcohol consumption in a large Taiwanese population.MethodsThis cross-sectional study analyzed 22,471 adults aged 30-70 years from the Taiwan Biobank. Smoking exposure, alcohol consumption, and low back pain were ascertained using standardized questionnaires. Multivariable binary logistic regression models were employed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for low back pain, controlling for demographic and comorbidities. Interaction between smoking and alcohol consumption was assessed through stratified analyses.ResultsAfter multivariable adjustment, smoking exposure was independently associated with a higher prevalence of low back pain (OR 1.15; 95% CI 1.06 to1.24). Alcohol consumption alone was not significantly associated with low back pain. A significant interaction between smoking and alcohol use was observed. Smoking was associated with low back pain among participants without alcohol exposure (OR 1.12; 95% CI 1.03 to 1.22), whereas an association was noted among those with alcohol exposure (OR 1.40; 95% CI 1.08 to 1.83).ConclusionsSmoking was associated with low back pain, with a potential interaction with alcohol use. However, the effect size was modest, and the findings should be interpreted with caution.