Background & Aims

Over several years, the Global Burden of Disease studies have identified low back pain (LBP) alone as the single leading global cause of disability; cervical spine pain (cervicalgia (CSP)) and thoracic spine pain (TSP) are also highly prevalent and associated with diminished quality of life and productivity [1, 2]. Clinically, the spine is divided into multiple regions, including the cervico-atlanto-axis complex immediately beneath the skull; the cervical region; the thoracic region; the lumbar region; the sacral region; and the coccygeal region; junctional regions of cervico-thoracic, thoraco-lumbar, and lumbo-sacral are also noted. The association of primary spine pain diagnoses, i.e., CSP, TSP, and LBP, with specific spine conditions is not firmly established and subject to debate. The purpose of this study is to appraise large data evidence for the association of spine pain diagnoses with a broad range of degenerative spine condition diagnoses in a large sample of older adults.

Methods

Data for this study were selected from the 2017 CMS Medicare Standard Analytical 5% sample Files (CMS-5), specifically the carrier claims, outpatient, Medicare beneficiary summary files. The beneficiaries included in this study were alive, enrolled in Part B, not enrolled in Part C (Medicare Advantage) for all 12 months of 2017; and were between 65 and 100 years of age as of January 1, 2017. The number of beneficiaries meeting these criteria was 1,239,007. Previously, we’ve found that both very low and very high claim numbers are associated with diagnostic rate estimates that are likely biased [3]. For this reason, we limited the study population to those with between 6 and 180 claims filed during the study year, representing, approximately, the median 90% of the total population by claims, resulting in a final study population of 1,124,114 individuals. Condition definition files were developed with reference to the literature adapted to the specific needs of this study.

Results

Low back pain was the most prevalent regional spine pain condition, being diagnosed in 20.0 (±0.2)% (average (±95% confidence interval)) of older adult females and 17.2 (±0.2)% of older adult males aged 65-100. Cervical spine (neck) pain as diagnosed in 10.1 (±0.2)% and 7.8 (±0.2)% of older females and males respectively; rates of thoracic spine pain diagnosis were 4.6 (±0.1)% and 3.3 (±0.1)% respectively. For analysis, degenerative spine conditions (M series codes) were sorted by region and secondarily by total prevalence. Cervical dorsopathies had elevated rates of neck pain (cervicalgia) with non-overlap of 95% confidence intervals vs. the baseline total population cervicalgia. Several thoracic dorsopathies had elevated thoracic pain rates, although modest. Virtually all common dorsopathies of the lumbar, lumbosacral, sacro-iliac, and sacral spine had elevated rates of low back pain (all data adjusted for multiple comparisons). Logistic regression confirmed the unadjusted findings.

Conclusions

This study demonstrates conclusively that spinal conditions are associated with increased rates of spine pain in older adults, with the major spine pain diagnoses correlating with spinal region affected by degenerative spine conditions. An extensive literature has debated whether specific spinal conditions are painful or not. This study demonstrates that for older adults, there is a strong association between dorsopathies and at-level pain. Across a very large population sample, rates of spine pain diagnoses are markedly increased in patients with spinal conditions associated with each major spinal level, e.g., cervical, thoracic, and lumbar. Even though studies of this magnitude may give rise to statistical differences when substantive pathophysiological differences are not meaningful– this is not the case here as the magnitude of change, observed across the range of common dorsopathies, and adjusted for potentially relevant comorbidities illustrates a robust major pattern.

References

1. Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299.

2. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968–74.

3. Hogans B, Siaton B, Sorkin J. Diagnostic rate estimation from Medicare records: Dependence on claim numbers and latent clinical features. J Biomed Inform. 2023 Sep;145:104463. doi: 10.1016/j.jbi.2023.104463. Epub 2023 Jul 28. PMID: 37517509; PMCID: PMC10576984.

Presenting Author

Beth Hogans

Poster Authors

Beth Hogans

M.S. (Biomath), M.D., Ph.D.

Johns Hopkins SOM/ VA Maryland

Lead Author

Bernadette Siaton

M.S.

University of Maryland School of Medicine/VA Maryland

Lead Author

Suraj Malhan

M.D.

University of Maryland School of Medicine

Lead Author

John Sorkin

M.D.

University of Maryland School of Medicine/VA Maryland

Lead Author

Topics

  • Epidemiology