Association of individual and contextual factors to chronic spine problems: analysis from the PNS 2013

Abstract

Abstract Background: Chronic pain is a frequent health problem, causing 6.8% of the Disability-Adjusted Life Years lost. Spine is the most affected region, which compromises functionality and generates absenteeism, increased health care costs, and disability retirement rates. Based on the biopsychosocial model, it is believed that chronic spinal problems are the result of a complex network of factors, both individual and contextual. Method: This is a cross-sectional study, with data from the 2013 National Health Survey, the United Nations Development Programme, and the National Register of Health Establishments - state level - for the second and third level of aggregation, respectively. Multilevel Poisson regression was performed at 3 levels, with the first level being individual variables, the second added context variables, and the third added health program variables. Results: The prevalence of chronic back problems was 18.5% (95%CI 17.8;19.1), with higher prevalence in female gender (RP = 1.23; 95%CI1.15;1.30), aged above 49 years (RP = 1.75; 95%CI 1.61;1.90), performing heavy activities at work (RP = 1.37; 95%CI 1.28;1.46), depressive days (RP = 1.70; 95%CI 1.50;1.94), smokers (RP = 1.37; 95%CI 1.27;1.48) and in states with higher coefficient of Multiprofessional Teams in Primary Care per 100. 000 habitants (PR = 1.28; 95%CI 1.07; 1.54). Conclusion: Spine chronic problems were associated with biological and behavioral factors, besides the association with higher coefficient of Multiprofessional Teams in Primary Care in Brazilian municipalities.