The course and contributors to back pain in middle-aged women over nine years: Data from the Australian Longitudinal Study on Women's Health

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Study Design.

Community-based, cohort study.


Our aim was to determine the course of back pain in middle-aged women over a nine-year period, and assess whether obesity and physical inactivity are associated with more frequent back pain.

Summary of Background Data.

Back pain is the leading cause of disability worldwide. With minimal effective therapies and rising financial burden, identifying modifiable risk factors remains a key priority.


The Australian Longitudinal Study on Women's Health is a cohort study of community-based, middle-aged women who completed questionnaires every three years between 2004 and 2013. 10,530 completed the survey in 2004 (mean age 55.5 years), 9,020 completed follow-up nine years later. Self-reported data on back pain in the last 12 months and other socio-demographic factors were collected at all four surveys. ‘Frequent back pain’ was defined as back pain reported at ≥ 3 surveys.


Back pain was common and persistent, with 48% having back pain in ≥ 3 out of four surveys. Baseline obesity (RR 1.18, 95% CI 1.12 - 1.25), lack of vigorous physical activity (RR 1.17, 95% CI 1.10 - 1.25), depressive symptoms (RR 1.40, 95% CI 1.33 - 1.47) and low education status (RR 1.17, 95% CI 1.12 – 1.24), were independently associated with an increased risk of frequent back pain (all p < 0.001). Overall, 28% of the risk of frequent back pain could be attributed to these factors, equating to one extra case of frequent back pain for every five women with depressive symptoms, for every 11 obese women, for every 12 women with low education status and for every 13 women who do not do vigorous physical activity, at baseline.


Obesity, depressive symptoms, low education status and lack of vigorous physical activity are associated with higher risk of frequent back pain over the following nine years among women in their mid-50 s. Targeting these risk factors may lessen the burden of back pain.


Level of Evidence: 2

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