title: Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population.
abstract: BACKGROUND
  Neck and low back pain are common musculoskeletal complaints generating large societal costs in Western populations. In this study we evaluate the magnitude of long-term health outcomes for neck and low back pain, taking possible confounders into account.
  
  
  METHODS
  A cohort of 2,351 Swedish male farmers and rural non-farmers (40-60 years old) was established in 1989. In the first survey, conducted in 1990-91, 1,782 men participated. A 12-year follow-up survey was made in 2002-03 and 1,405 men participated at both times. After exclusion of 58 individuals reporting a specific back diagnosis in 1990-91, the study cohort encompassed 1,347 men. The health outcomes primary care consultation, hospital admission, sick leave and disability pension were assessed in structured interviews in 2002-03 (survey 2). Symptoms and potential confounders were assessed at survey 1, with the exception of rating of depression and anxiety, which was assessed at survey 2. Multiple logistic regression generating odds ratios (OR) with 95% confidence intervals (95% CI) was performed to adjust the associations between reported symptoms and health outcomes for potential confounders (age, farming, workload, education, demand and control at work, body mass index, smoking, snuff use, alcohol consumption, psychiatric symptoms and specific back diagnoses during follow up).
  
  
  RESULTS
  Of the 836 men reporting current neck and/or low back pain at survey 1, 21% had had at least one primary care consultation for neck or low back problems, 7% had been on sick leave and 4% had disability pension owing to the condition during the 12 year follow up. Current neck and/or low back pain at survey 1 predicted primary care consultations (OR = 4.10, 95% CI 2.24-7.49) and sick leave (OR = 3.22, 95% CI 1.13-9.22) after potential confounders were considered. Lower education and more psychiatric symptoms were independently related to sick leave. Lower education and snuff use independently predicted disability pension.
  
  
  CONCLUSIONS
  Few individuals with neck or low back pain were on sick leave or were granted a disability pension owing to neck or low back problems during 12 years of follow up. Symptoms at baseline independently predicted health outcomes. Educational level and symptoms of depression/anxiety were important modifiers.
authors.affiliation: Research and Development Centre, Kronoberg County Council, Box 1223, SE-351 12 Växjö, Sweden. sara.holmberg@ltkronoberg.se
authors.forename: Sara A C
authors.initials: SA
authors.lastname: Holmberg
authors.forename: Anders G
authors.initials: AG
authors.lastname: Thelin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data / Q000639:trends*; D017116:Low Back Pain / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology / Q000503:physiopathology*; D016017:Odds Ratio; D011320:Primary Health Care / Q000706:statistics & numerical data / Q000639:trends*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D012423:Rural Health / Q000706:statistics & numerical data / Q000639:trends; D018582:Sick Leave / Q000706:statistics & numerical data / Q000639:trends*; D013548:Sweden / Q000453:epidemiology