Association of Individual and Contextual Factors with Chronic Spine Problems: An Analysis from the National Health Survey
Abstract
1. Background
2. Materials and Methods
2.1. Study Design
2.2. Context and Research Participants
2.3. Variables and Data Sources
- 1.
- Individual demographics
- a.
- Sex (male and female)
- b.
- Age (up to 33 years, 34 to 48 years, and 49 years or older)
- 2.
- Individuals—Lifestyle
- a.
- Heavy activity at work (yes or no)
- b.
- Health status evaluation (very good, good, fair, bad, or very bad)
- c.
- Depressive days (none of the days, fewer than half of the days, more than half of the days, and almost every day)
- d.
- Smoking (never smoked, less than daily, and daily)
- 3.
- Contextual—Socioeconomic
- a.
- Gini coefficient (above 0.735, from 0.675 to 0.734, and up to 0.674)
- b.
- Human Development Index (HDI) (above 0.735, from 0.675 to 0.734, and up to 0.674)
- c.
- Sociodemographic conditions (low, intermediate, and high)
- 4.
- Contextual—Health Services
- a.
- Coefficient of Family Health Support Team per 100 thousand inhabitants (≤0.946; 0.947 to 1.876; ≥1.876)
2.4. Quantitative Variables
2.5. Statistical Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
Disability-adjusted life years | (DALYs) |
National Health Survey | (NHS) |
Brazilian Institute of Geography and Statistics | (IBGE) |
United Nations Development Programme | (UNDP) |
Human Development Index | (HDI) |
National Register of Health Establishments | (CNES) |
Prevalence ratios | (PRs) |
Family Health Support Team | (NASF) |
References
- Qing, L.; Zhu, Y.; Feng, L.; Wang, X.; Sun, Y.N.; Yu, C.; Ni, J. Exploring the association between Frailty Index and low back pain in middle-aged and older Chinese adults: A cross-sectional analysis of data from the China Health and Retirement Longitudinal Study (CHARLS). BMJ Open 2024, 14, e085645. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024, 403, 2133–2161. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Malta, D.C.; de Oliveira, M.M.; de Araújo Andrade, S.S.C.; Caiaffa, W.T.; de Souza, M.d.F.M.; Bernal, R.T.I. Factors associated with chronic back pain in adults in Brazil. Rev. Saúde Pública 2017, 51 (Suppl. 1), 9s. Available online: https://www.scielo.br/j/rsp/a/gNfbhmrcXzpY3Ghyvf3bGxm/?lang=pt&format=pdf (accessed on 20 February 2020). [CrossRef]
- Dzakpasu, F.Q.S.; Carver, A.; Brakenridge, C.J.; Cicuttini, F.; Urquhart, D.M.; Owen, N.; Dunstan, D.W. Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: A systematic review with meta-analysis. Int. J. Behav. Nutr. Phys. Act. 2021, 18, 159. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- de Oliveira, M.M.; de Araújo Andrade, S.S.C.; de Souza, C.A.V.; Ponte, J.N.; Szwarcwald, C.L.; Malta, D.C. Problema crônico de coluna e diagnóstico de distúrbios osteomusculares relacionados ao trabalho (DORT) autorreferidos no Brasil: Pesquisa Nacional de Saúde, 2013. Epidemiol. Serviços Saúde 2015, 24, 287–296. [Google Scholar] [CrossRef]
- Wirth, B.; Schweinhardt, P. Personalized assessment and management of non-specific low back pain. Eur. J. Pain 2024, 28, 181–198. [Google Scholar] [CrossRef] [PubMed]
- Knezevic, N.N.; Candido, K.D.; Vlaeyen, J.W.S.; Van Zundert, J.; Cohen, S.P. Low back pain. Lancet 2021, 398, 78–92. [Google Scholar] [CrossRef] [PubMed]
- Nogueira, R.P. Determinação Social da Saúde e Reforma Sanitária; Cebes: Rio de Janeiro, Brazil, 2010. [Google Scholar]
- Barros, M.B.A.; Cesar, C.L.G.; Carandina, L.; Torre, G.D. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciên Saude Colet 2006, 11, 911–926. [Google Scholar] [CrossRef]
- Damacena, G.N.; Szwarcwald, C.L.; Malta, D.C.; Souza Júnior, P.R.B.D.; Vieira, M.L.F.P.; Pereira, C.A.; Morais Neto, O.L.D.; Silva Júnior, J.B.D. The Development of the National Health Survey in Brazil, 2013. Epidemiol. Serviços Saúde 2015, 24, 197–206. Available online: https://www.scielo.br/scielo.php?pid=S2237-96222015000200197&script=sci_arttext&tlng=en (accessed on 20 February 2020). [CrossRef]
- Dahlgren, G.; Whitehead, M. Policies and Strategies to Promote Social Equity in Health; Institute for Futures Studies: Stockholm, Sweden, 1991; Available online: https://core.ac.uk/download/pdf/6472456.pdf (accessed on 20 February 2020).
- Buss, P.M.; Pellegrini Filho, A. A saúde e seus determinantes sociais. Physis Rev. Saúde Coletiva 2007, 17, 77–93. [Google Scholar] [CrossRef]
- Damásio, B.F. Uso da Análise Fatorial Exploratória em Psicologia. Avaliação Psicológica 2012, 11, 213–228. Available online: http://pepsic.bvsalud.org/pdf/avp/v11n2/v11n2a07.pdf (accessed on 29 October 2020).
- Hair Júnior, J.F.; Black, W.C.; Babin, B.J.; Anderson, R.E.; Tatham, R.L. Análise Multivariada De Dados, 6th ed.; Bookman: Stockholm, Sweden, 2009. [Google Scholar]
- Szwarcwald, C.L.; Malta, D.C.; Pereira, C.A.; Vieira, M.L.F.P.; Conde, W.L.; Souza Júnior, P.R.B.D.; Damacena, G.N.; Azevedo, L.O.; Azevedo e Silva, G.; Theme Filha, M.M.; et al. Pesquisa Nacional de Saúde no Brasil: Concepção e metodologia de aplicação. Ciência Saúde Coletiva 2014, 19, 333–342. Available online: https://www.scielo.br/j/csc/a/rysffTqrwZPZnghSq5CJHsG/?lang=pt (accessed on 29 October 2020). [CrossRef]
- Ferreira, G.D.; Silva, M.C.; Rombaldi, A.J.; Wrege, E.D.; Siqueira, F.V.; Hallal, P.C. Prevalência de dor nas costas e fatores associados em adultos do sul do Brasil: Estudo de base populacional. Braz. J. Phys. Ther. 2011, 15, 31–36. Available online: https://www.scielo.br/j/rbfis/a/RR8Ljwp75n3hNvdgjPY5Xfw/abstract/?format=html&lang=pt (accessed on 29 October 2020). [CrossRef]
- Madeira, H.G.R.; Garcia, J.B.S.; Lima, M.V.V.; Serra, H.O. Incapacidade e fatores associados à lombalgia durante a gravidez. Rev. Bras. Ginecol. Obs. 2013, 35, 541–548. [Google Scholar] [CrossRef] [PubMed]
- Dianat, I.; Alipour, A.; Asghari Jafarabadi, M. Prevalence and risk factors of low back pain among school age children in Iran. Health Promot. Perspect. 2017, 7, 223–229. [Google Scholar] [CrossRef] [PubMed]
- Sá, K.; Baptista, A.F.; Matos, M.A.; Lessa, I. Prevalência de dor crônica e fatores associados na população de Salvador, Bahia. Rev. Saúde Pública 2009, 43, 622–630. Available online: https://www.scielo.br/j/rsp/a/Xwyh3HtbdZFsNRNM9YV4LyD/?lang=en (accessed on 28 May 2025). [CrossRef]
- Wong, A.Y.L.; Karppinen, J.; Samartzis, D. Low back pain in older adults: Risk factors, management options and future directions. Scoliosis Spinal Disord. 2017, 12, 14. [Google Scholar] [CrossRef]
- Mikkonen, P.; Leino-Arjas, P.; Remes, J.; Zitting, P.; Taimela, S.; Karppinen, J. Is Smoking a Risk Factor for Low Back Pain in Adolescents?: A Prospective Cohort Study. Spine 2008, 33, 527–532. [Google Scholar] [CrossRef]
- Rivinoja, A.E.; Paananen, M.V.; Taimela, S.P.; Solovieva, S.; Okuloff, A.; Zitting, P.; Järvelin, M.R.; Leino-Arjas, P.; Karppinen, J.I. Sports, Smoking, and Overweight During Adolescence as Predictors of Sciatica in Adulthood: A 28-Year Follow-up Study of a Birth Cohort. Am. J. Epidemiol. 2011, 173, 890–897. [Google Scholar] [CrossRef]
- Cardoso Vde, F.; Pizzol, R.J.; Takamoto, P.M.; Gobbo, L.A.; Almeida ALde, J. Associação do diagnóstico clínico com a situação ocupacional de usuários de um serviço de fisioterapia. Fisioter. Pesquisa 2017, 24, 169–175. [Google Scholar] [CrossRef]
- Brasil Ministério da Saúde Gabinete do Ministro. Cria os Núcleos de Apoio à Saúde da Família–NASF. In PORTARIA N° 154 DE 24 DE JANEIRO DE 2008; Diário Oficial [da] União; Brasil Ministério da Saúde Gabinete do Ministro: Brasília, Brazil, 2008. Available online: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2008/prt0154_24_01_2008.html (accessed on 5 January 2018).
- Carvalho MNde Gil, C.R.R.; Costa, E.M.O.D.; Sakai, M.H.; Leite, S.N. Necessidade e dinâmica da força de trabalho na Atenção Básica de Saúde no Brasil. Ciência Saúde Coletiva 2018, 23, 295–302. [Google Scholar] [CrossRef] [PubMed]
- Brasil Ministério da Saúde. Gabinete do Ministro. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes e normas para a organização da Atenção Básica, para a Estratégia Saúde da Família (ESF) e o Programa de Agentes Comunitários de Saúde (PACS). In PORTARIA N° 2488, DE 21 DE OUTUBRO DE 2011; Diário Oficial [da] União; Brasil Ministério da Saúde: Brasília, Brazil, 2011. Available online: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2488_21_10_2011.html (accessed on 28 May 2025).
- Barros, R.P.O.; Foguel, M.N.O.; Ulyssea, G.O. Desigualdade De Renda no Brasil: Uma Análise Da Queda Recente; Ipea: Brasília, Brazil, 2007; Volume 2. [Google Scholar]
- Wilkinson, R.G.; Pickett, K.E. Income inequality and population health: A review and explanation of the evidence. Soc. Sci. Med. 2006, 62, 1768–1784. Available online: https://www.sciencedirect.com/science/article/pii/S0277953605004375 (accessed on 29 October 2020). [CrossRef] [PubMed]
Total (%) | Chronic Spine Disease | |
---|---|---|
n (%) | ||
Sex | ||
Male | 25.920 (43.1) | 3.957 (15.3) |
Female | 34.282 (56.9) | 6.621 (19.3) |
Age (years) | ||
≤33 | 20.263 (33.7) | 1.992 (9.8) |
34 to 48 | 19.732 (32.8) | 3.428 (17.4) |
≥49 | 20.207 (33.5) | 5.158 (25.5) |
Heavy work activity | ||
No | 27.182 (75.5) | 3.739 (13.8) |
Yes | 9.260 (25.5) | 1.959 (21.2) |
Health state self perception | ||
Very good | 7.433 (12.3) | 596 (8.0) |
Good | 31.708 (52.7) | 3.877 (12.2) |
Regular | 17.197 (28.6) | 4.530 (26.3) |
Bad | 3.099 (5.1) | 1.236 (39.9) |
Very bad | 765 (1.3) | 339 (44.3) |
Days with depression | ||
None | 46.712 (77.6) | 6.567 (14.1) |
Less than half days | 8.564 (14.2) | 2.321 (27.1) |
More than half days | 2.472 (4.1) | 805 (32.6) |
Almost everyday | 2.454 (4.1) | 885 (36.1) |
Smoking | ||
Never smoke | 41.215 (80.0) | 6.073 (14.7) |
Less then daily | 2.454 (4.8) | 547 (22.3) |
Daily basis | 7.804 (15.2) | 2.105 (26.0) |
Sociodemographic conditions | ||
Low | 18.864 (31.2) | 3.419 (18.1) |
Intermediate | 22.297 (36.9) | 4.009 (17.0) |
High | 19.300 (31.9) | 3.419 (18.6) |
Gini’s coefficient | ||
≤0.56 | 25.758 (42.8) | 4.580 (17.3) |
0.57 to 0.61 | 24.894 (41.3) | 4.385 (17.6) |
≥0.62 | 9.550 15.9) | 1.613 (16.9) |
Human Development Index (HDI) | ||
≥0.735 | 19.874 (44.0) | 3.539 (82.9) |
0.675 to 0.734 | 4.870 (10.8) | 3.492 (17.6) |
≤0.674 | 20.458 (45.3) | 3.547 (17.3) |
Family Health Support Team (NASF) | ||
≤0.946 | 21.966 (36.5) | 3.566 (16.2) |
0.947 to 1.876 | 18.974 (31.5) | 3.414 (17.0) |
≥1.876 | 19.262 (32.0) | 3.598 (18.7) |
Model Null | Model 1 1 (n = 60,202) | Model 2 2 (n = 60,202) | Final Model (n = 60,202) 3 | ||||
---|---|---|---|---|---|---|---|
Variables | (n = 60,202) | RP (95%IC) | p Value | RP (95%IC) | p Value | RP (95%IC) | p Value |
1° Level (individual) | |||||||
Sex | |||||||
Male | 1 | 1 | 1 | ||||
Female | 1.23 (1.15; 1.30) | <0.001 | 1.23 (1.15; 1.30) | <0.001 | 1.23 (1.15; 1.30) | <0.001 | |
Age (years) | |||||||
≤33 | 1 | 1 | 1 | ||||
34 to 48 | 1.45 (1.35; 1.56) | <0.001 | 1.45 (1.35; 1.56) | <0.001 | 1.45 (1.35; 1.46) | <0.001 | |
≥49 | 1.75 (1.61; 1.90) | <0.001 | 1.75 (1.61; 1.90) | <0.001 | 1.75 (1.61; 1.90) | <0.001 | |
Heavy work activity | |||||||
Não | 1 | 1 | 1 | ||||
Sim | 1.37 (1.28; 1.46) | <0.001 | 1.37 (1.28; 1.46) | <0.001 | 1.37 (1.28; 1.46) | <0.001 | |
Health state self perception | |||||||
Very good | 1 | 1 | 1 | ||||
Good | 1.51 (1.34; 1.69) | <0.001 | 1.51 (1.35; 1.70) | <0.001 | 1.51 (1.35; 1.70) | <0.001 | |
Regular | 2.54 (2.25; 2.87) | <0.001 | 2.55 (2.26; 2.88) | <0.001 | 2.55 (2.26; 2.88) | <0.001 | |
Bad | 3.45 (2.94; 4.04) | <0.001 | 3.46 (2.95; 4.05) | <0.001 | 3.46 (2.96; 4.05) | <0.001 | |
Very bad | 3.92 (3.03; 5.06) | <0.001 | 3.92 (3.03; 5.07) | <0.001 | 3.92 (3.03; 5.07) | <0.001 | |
Days with depression | |||||||
None | 1 | 1 | 1 | ||||
Less than half days | 1.52 (1.41; 1.63) | <0.001 | 1.52 (1.41; 1.63) | <0.001 | 1.51 (1.41; 1.63) | <0.001 | |
More than half days | 1.70 (1.51; 1.92) | <0.001 | 1.70 (1.51; 1.92) | <0.001 | 1.70 (1.51; 1.92) | <0.001 | |
Almost everyday | 1.71 (1.50; 1.94) | <0.001 | 1.70 (1.50; 1.94) | <0.001 | 1.70 (1.50; 1.94) | <0.001 | |
Smoking | |||||||
Never smoke | 1 | 1 | 1 | ||||
Less than daily | 1.24 (1.10; 1.40) | <0.001 | 1.24 (1.10; 1.40) | <0.001 | 1.24 (1.10; 1.40) | <0.001 | |
Daily basis | 1.37 (1.28; 1.48) | <0.001 | 1.37 (1.27; 1.48) | <0.001 | 1.37 (1.27; 1.48) | <0.001 | |
2° Level | |||||||
Sociodemografic conditions | |||||||
Low | 1 | 1 | |||||
Intermediate | 0.98 (0.69; 1.40) | 0.916 | 1.00 (0.78; 1.30) | 0.980 | |||
High | 1.09 (0.73; 1.63) | 0.672 | 1.10 (0.77; 1.59) | 0.577 | |||
Gini’s coefficient | |||||||
≥0.56 | 1 | 1 | |||||
0.57 to 0.61 | 1.00 (0.84; 1.21) | 0.929 | 1.00 (0.84; 1.20) | 0.959 | |||
≥0.62 | 0.96 (0.77; 1.19) | 0.701 | 0.95 (0.77; 1.18) | 0.664 | |||
Human Development Index (HDI) | |||||||
≥0.735 | 1 | - | - | ||||
0.675 to 0.734 | 0.91 (0.63; 1.30) | 0.588 | - | - | |||
≤0.674 | 0.79 (0.53; 1.18) | 0.249 | - | - | |||
Family Health Support Team | |||||||
≤0.946 | 1 | 1 | |||||
0.947 to 1.876 | 1.16 (0.99; 1.38) | 0.072 | 1.17 (1.00; 1.38) | 0.048 | |||
≥ 1.876 | 1.28 (1.06; 1.54) | 0.011 | 1.28 (1.07; 1.54) | 0.007 | |||
Aleatory Effects | |||||||
Variance (95 %CI) | 0.029 (0.016; 0.052) | 0.030 (0.016; 0.058) | 0.020 (0.010; 0.041) | 0.020 (0.010; 0.041) | |||
Change in Variation (%) | 59.8 | 37.4 | 0.0 | ||||
LR test (x2, p value) | 218.42 (<0.001) | 87.85 (<0.001) | 54.98 (<0.001) | 55.09 (<0.001) |
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Ferreira, A.M.d.S.; Assis, S.J.C.d.; Souza, C.G.d.; Sanchis, G.J.B.; Nunes, R.F.d.O.; Guedes, M.B.O.G.; Lopes, J.M.; Roncalli, A.G. Association of Individual and Contextual Factors with Chronic Spine Problems: An Analysis from the National Health Survey. Int. J. Environ. Res. Public Health 2025, 22, 879. https://doi.org/10.3390/ijerph22060879
Ferreira AMdS, Assis SJCd, Souza CGd, Sanchis GJB, Nunes RFdO, Guedes MBOG, Lopes JM, Roncalli AG. Association of Individual and Contextual Factors with Chronic Spine Problems: An Analysis from the National Health Survey. International Journal of Environmental Research and Public Health. 2025; 22(6):879. https://doi.org/10.3390/ijerph22060879
Chicago/Turabian StyleFerreira, Aryostennes Miquéias da Silva, Sanderson José Costa de Assis, Clécio Gabriel de Souza, Geronimo José Bouzas Sanchis, Rebeca Freitas de Oliveira Nunes, Marcello Barbosa Otoni Gonçalves Guedes, Johnnatas Mikael Lopes, and Angelo Giuseppe Roncalli. 2025. "Association of Individual and Contextual Factors with Chronic Spine Problems: An Analysis from the National Health Survey" International Journal of Environmental Research and Public Health 22, no. 6: 879. https://doi.org/10.3390/ijerph22060879
APA StyleFerreira, A. M. d. S., Assis, S. J. C. d., Souza, C. G. d., Sanchis, G. J. B., Nunes, R. F. d. O., Guedes, M. B. O. G., Lopes, J. M., & Roncalli, A. G. (2025). Association of Individual and Contextual Factors with Chronic Spine Problems: An Analysis from the National Health Survey. International Journal of Environmental Research and Public Health, 22(6), 879. https://doi.org/10.3390/ijerph22060879