title: Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis.
abstract: Background:The link between body weight status and spinal diseases has been suggested by a number of cross-sectional and cohort studies with a limited range of patient populations. No population-representative samples have been used to examine the link between obesity and spinal diseases. The present study is based on a nationally representative sample drawn from the Medical Expenditure Panel Survey.Methods:Using the cross-sectional sample of the 2014 Medical Expenditure Panel Study, we built four weighted logistic regression analyses of the associations between body weight status and the following four spinal diseases: low back pain, spondylosis, other cervical disorders and intervertebral disc disorder (IDD). Each respondent's body weight status was used as the key independent variable with three categories: normal/underweight, overweight, and obese. We controlled for marital status, gender, age, smoking status, household income, health insurance coverage, educational attainment and the use of health services for other major categories of diseases.Results:A total sample of 23,048 respondents was used in our analysis. Overweight and obese respondents, as compared to normal/underweight respondents, were more likely to develop lower back problems (Overweight: logged odds = 0.218,p< 0.01; Obese: logged odds = 0.395,p< 0.001) and IDD (Overweight: logged odds = 0.441,p< 0.05; Obese: logged odds = 0.528,p< 0.001). The associations between bodyweight status and spondylitis were statistically insignificant (Overweight: logged odds = 0.281,p= 0.442; Obese: logged odds = 0.680,p= 0.104). The associations between body weight status and other cervical disorders (Overweight: logged odds = -0.116,p= 0.304; Obese: logged odds = -0.160,p= 0.865) were statistically insignificant.Conclusions:As the first study using a national sample to study bodyweight and spinal diseases, our paper supports the hypothesis that obesity adds to the burden of low back pain and IDD. Longitudinal and interventional studies are needed to understand the specific mechanisms behind these positive associations.
authors.affiliation: First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China. bwsheng271@sina.com.cn.
authors.forename: Binwu
authors.initials: B
authors.lastname: Sheng
authors.affiliation: Samuel Curtis Johnson Graduate School of Management, Cornell University, Ithaca, NY 14853, USA. chaoling.feng@gmail.com.
authors.forename: Chaoling
authors.initials: C
authors.lastname: Feng
authors.affiliation: Department of Health Policy and Management, University of Georgia, Athens, GA 30609, USA. dzhang@uga.edu.
authors.forename: Donglan
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC 29631, USA. HSPITLE@clemson.edu.
authors.forename: Hugh
authors.initials: H
authors.lastname: Spitler
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC 29631, USA. lus@clemson.edu.
authors.forename: Lu
authors.initials: L
authors.lastname: Shi
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000209:etiology*; D007405:Intervertebral Disc Displacement / Q000209:etiology*; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D012044:Regression Analysis; D013851:Thinness / Q000150:complications*; D014481:United States / Q000453:epidemiology
keywords: cervical diseases; disc degeneration; low back pain; obesity; spinal disease; spondylosis