title: Educational inequality as a predictor of rising back pain prevalence in Austria-sex differences.
abstract: BACKGROUND
  Back pain (BP) represents a widespread public health problem in Europe. The morbidity depends on several indicators, which must be investigated to discover risk groups. The examination of trends in socioeconomic developments should ensure a better understanding of the complex link between socioeconomic-status and BP. Therefore, the role of social inequalities for BP has been investigated among Austrian subpopulations over a 24-year period.
  
  
  METHODS
  Self-reported data from nationally representative health surveys (1983-2007) were analyzed and adjusted for self-report bias (N=121 486). Absolute changes (ACs) and aetiologic fractions (AF) were calculated to measure trends. To quantify the extent of social inequality, the relative index of inequality was computed based on educational levels.
  
  
  RESULTS
  The prevalence of BP nearly doubled between 1983 and 2007. When investigating educational groups, subjects with low educational level were most prevalent. Obese persons generally showed higher rates of BP than non-obese subjects. Continuously rising trends across the different educational groups were more evident in men. The AC was highest in obese men with high education (+32.9%). Education-related inequalities for BP were more evident in men than women.
  
  
  CONCLUSIONS
  Educational level is an important social indicator for BP. A gradient for low to high educational level in the trends of BP prevalence was clearly identified and stable only among men. We presume that the association 'education' and 'physical workload leading to BP' is more relevant for men than for women. The implementation of effective approaches to BP, in combination with target group-specific interventions focusing on educational status, is recommended.
authors.affiliation: 1 Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, A-8010 Graz, Austria franziska.grossschaedl@medunigraz.at.
authors.forename: Franziska
authors.initials: F
authors.lastname: Großschädl
authors.affiliation: 2 Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, A-8010 Graz, Austria.
authors.forename: Erwin
authors.initials: E
authors.lastname: Stolz
authors.affiliation: 2 Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, A-8010 Graz, Austria.
authors.forename: Hannes
authors.initials: H
authors.lastname: Mayerl
authors.affiliation: 2 Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, A-8010 Graz, Austria.
authors.forename: Éva
authors.initials: É
authors.lastname: Rásky
authors.affiliation: 2 Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, A-8010 Graz, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Freidl
authors.affiliation: 2 Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitätsstraße 6/I, A-8010 Graz, Austria.
authors.forename: Willibald
authors.initials: W
authors.lastname: Stronegger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D001416:Back Pain / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class