Background/Purpose: The goal of this study was to determine a) if the age-trajectory (life course) of back pain differs by birth cohort and b) whether any cohort differences are explained by changes in socio-economic status (SES), lifestyle factors, and the presence of chronic conditions.

Methods: We used biannually collected data from the 1994-2010 Canadian Longitudinal National Population Health Survey: 10,330 participants born from 1925 to 1974 grouped in five 10-year birth cohorts: Pre-World War II, born 1925-1934; World War II generation, born 1935-1944; older baby boomers, born 1945-1954; younger baby boomers, born 1955-64; and generation X, born 1965-74. The outcome was reported back pain as a long term health conditions diagnosed by a health professional. We used multilevel logistic growth models to examine cohort effects in the age-trajectory of back pain adjusting for sex, SES (education, income), lifestyle factors (BMI, physical activity, sedentary behavior, smoking status) and multimorbidity (2+ conditions up to 17).

Results: There was a trajectory of increasing back pain with age up to middle age (50-55 years) and plateauing afterwards. In addition, there were also significant cohort differences (p<0.0001): when compared at the same age, each succeeding recent cohort had higher odds of reporting back pain than those in the earlier cohort. Low education, being a smoker, obesity, and sedentary behavior were associated with increased odds of reporting back pain, but did not substantially affect cohort differences. Addition of multimorbidity to the model significantly and substantially attenuated the cohort differences.

Conclusion: The results suggest that more recent cohorts of Canadian adults are more likely to have back pain and that they report back pain earlier than previous generations. These cohort differences were explained by cohort effects of increasing multimorbidity in more recent generations.¹ These findings are supported by descriptive studies showing high level of multimorbidity in people with back pain,² with important implications for our understanding of back pain and the delivery of healthcare and services.

1. Canizares M, Hogg-Johnson S, Gignac MAM, Glazier RH, Badley EM. Increasing Trajectories of Multimorbidity Over Time: Birth Cohort Differences and the Role of Changes in Obesity and Income. The journals of gerontology Series B, Psychological sciences and social sciences. 2017.

2. Badley EM, Millstone DB, Perruccio AV. Back Pain and Co-occurring Conditions: Findings from a Nationally Representative Sample. Spine (Phila Pa 1976). 2018.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cohort-effects-in-back-pain-the-effect-of-changes-in-life-style-and-co-occurring-conditions/