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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (02) : 70 -79. doi: 10.3877/cma.j.issn.2096-0263.2024.02.002

老年骨科流行病学

中国中老年人群腰背痛患病率及相关危险因素的队列研究
冯江涛1, 王奇1, 胡永成2, 张树泉1,†()   
  1. 1. 300100　天津市中西医结合医院（天津市南开医院）骨科
    2. 300211　天津市天津医院骨与软组织肿瘤科
  • 收稿日期:2023-10-05 出版日期:2024-04-05
  • 通信作者: 张树泉
  • 基金资助:
    天津市自然科学基金(多元投入青年项目：21JCQNJC01040)

Prevalence and risk factors of low back pain in China: The China Health and Retirement ongitudinal Study (CHARLS)

Jiangtao Feng1, Qi Wang1, Yongcheng Hu2, Shuquan Zhang1,†()   

  1. 1. Department of Orthopedics, Tianjin NanKai Hospital, Tianjin 300100, China
    2. Department of Bone and Soft tissue oncology, Tianjin Hospital, Tianjin300211, China
  • Received:2023-10-05 Published:2024-04-05
  • Corresponding author: Shuquan Zhang
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引用本文：

冯江涛, 王奇, 胡永成, 张树泉. 中国中老年人群腰背痛患病率及相关危险因素的队列研究[J]. 中华老年骨科与康复电子杂志, 2024, 10(02): 70-79.

Jiangtao Feng, Qi Wang, Yongcheng Hu, Shuquan Zhang. Prevalence and risk factors of low back pain in China: The China Health and Retirement ongitudinal Study (CHARLS)[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(02): 70-79.

目的

腰背痛（LBP）可导致活动功能障碍，是中老年人群活动能力丧失的主要原因。然而，关于腰背痛在中国的流行病学研究尚缺乏。本研究旨在调查中国中老年人腰背痛的流行病学特征。

方法

基于2011-2018年开展的全国性纵向队列研究，中国健康与退休纵向研究（CHARLS），其中2018年的横断面调查有19752名受访者，2011-2018年的队列研究有9708名参与者。我们根据社会人口学、生活方式、健康状况和地理因素估计了腰背痛的患病率，Cox比例风险回归模型用于探究腰背痛相关的危险因素。

结果

在CHARLS 2018年全国横断面调查中，腰背痛患病率为41.4%。腰背痛在女性中更为常见（48.58%）。另外，低教育水平、生活在农村地区、心脏病、关节炎、酗酒史和睡眠质量差与腰痛风险增加相关，HRs范围为1.16~1.51。东部地区腰背痛患病率最低（32.77%），西南部地区最高（48.54%）。地区差异中，与北方地区相比，东部、东北、中南部、西北和西南地区腰背痛的HRs（95% CI）分别为0.74（0.66，0.83）、1.16（0.99，1.35）、0.89（0.79，1.00）、1.14（0.98，1.32）和1.11（0.98，1.26）。

结论

腰背痛在中国发病率较高，且患病率因社会人口学、生活方式、健康状况和地理因素而异。女性、文化程度低、农村地区、心脏病、关节炎、饮酒史、睡眠质量差、西部地理位置是发生腰背痛的主要危险因素。

关键词: 腰背痛, 发生率, 危险因素, 纵向研究
Objective

Low back pain (LBP), the leading cause of disability, has been an emergent global health crisis. However, studies regarding the epidemiology and prevalence of LBP in China are lacking. Therefore, we aimed to investigate the prevalence and risk factors of LBP.

Methods

Data collected from the China Health and Retirement Longitudinal Study (CHARLS), a population-based longitudinal cohort study conducted between 2011 to 2018. There were 19752 participants involved in 2018 survey, and 9708 participants involved in 2011 to 2018 survey of CHARLS. We estimated the prevalence of LBP according to sociodemographic, lifestyle, health status, and geographic factors. Cox proportional hazards regression models were applied to estimate the hazard ratios (HRs) and 95% CIs of LBP in relation to baseline risk factors.

Results

The prevalence of LBP was 41.4% in the CHARLS 2018 national survey. LBP was more common in women (48.58%) than in men (HR, 1.45; 95% CI: 1.28, 1.64). Low education level, live in rural areas, heart disease, arthritis, former drinkers, and poor sleep quality were associated with increased risk of LBP, with HRs range from 1.16 to 1.51. The East regions had the lowest prevalence of LBP (32.77%), while the South-West had the highest prevalence (48.54%). Compared to the North region, the HRs (95% CI) of LBP for the East, North-East, South-Central, North-West, and South-West regions were 0.74 (0.66, 0.83), 1.16 (0.99, 1.35), 0.89 (0.79, 1.00), 1.14 (0.98, 1.32), and 1.11 (0.98, 1.26), respectively.

Conclusions

LBP in China was prevalent, and the prevalence varied according to sociodemographic, lifestyle, health status, and geographic factors. Women, low education level, rural areas, heart disease, arthritis, previous drinkers, poor sleep quality, and West region of geographic location were risk factors for LBP.

Key words: Low back pain, prevalence, risk factors, longitudinal Study
图1 本研究中研究样本选择的流程图
表1 CHARLS全国调查中受访者腰背痛状况的基线特征
一般特征 CHARLS 2018横断面研究 CHARLS 2011 - 2018队列研究
总体(n=16799) 腰背痛患病率 P值 总体(n=9708) 腰背痛发病率 P值
否(n=9847) 是(n=6952) 否(n=5524) 是(n=4184)
性别(男,%) 9028 (53.7) 4642 (47.1) 4386 (63.1) <0.001 4942 (50.9) 2433 (44.0) 2509 (60.0) <0.001
年龄（岁，±s） 62.03 (9.99) 62.01（10.01） 62.06 (9.95) 0.740 57.29 (9.18) 57.32 (9.24) 57.25 (9.10) 0.690
<50 1649 (9.8) 961 (9.8) 688 (9.9) 0.241 2395 (24.7) 1367 (24.7) 1028 (24.6) 0.465
50～59 5434 (32.3) 3246 (33.0) 2188 (31.5)   3682 (37.9) 2108 (38.2) 1574 (37.6)  
60～69 5899 (35.1) 3428 (34.8) 2471 (35.5)   2577 (26.5) 1435 (26.0) 1142 (27.3)  
≥70 3817 (22.7) 2212 (22.5) 1605 (23.1)   1054 (10.9) 614 (11.1) 440 (10.5)  
教育水平[例(%)]       <0.001       <0.001
文盲 6927 (41.2) 3685 (37.4) 3242 (46.6)   4044 (41.7) 2072 (37.5) 1972 (47.1)  
小学 4812 (28.6) 2875 (29.2) 1937 (27.9)   2215 (22.8) 1276 (23.1) 939 (22.4)  
初中/高中 4822 (28.7) 3111 (31.6) 1711 (24.6)   3287 (33.9) 2065 (37.4) 1222 (29.2)  
大学及以上 238 (1.4) 176 (1.8) 62 (0.9)   162 (1.7) 111 (2.0) 51 (1.2)  
户口[例(%)]       <0.001       <0.001
城市 6361 (37.9) 4016 (40.8) 2345 (33.7)   3724 (38.4) 2279 (41.3) 1445 (34.5)  
农村 10438 (62.1) 5831 (59.2) 4607 (66.3)   5984 (61.6) 3245 (58.7) 2739 (65.5)  
目前工作状态[例(%)] 10756 (64.0) 6321 (64.2) 4435 (63.8) 0.608 6634 (68.3) 3831 (69.4) 2803 (67.0) 0.014
慢性疾病史[例(%)]                
高血压 6615 (39.4) 3663 (37.2) 2952 (42.5) <0.001 2281 (23.5) 1229 (22.2) 1052 (25.1) 0.001
糖尿病 2217 (13.2) 1172 (11.9) 1045 (15.0) <0.001 500 (5.2) 283 (5.1) 217 (5.2) 0.926
心脏病 3488 (20.8) 1535 (15.6) 1953 (28.1) <0.001 931 (9.6) 413 (7.5) 518 (12.4) <0.001
关节炎 6894 (41.0) 2950 (30.0) 3944 (56.7) <0.001 2640 (27.2) 1014 (18.4) 1626 (38.9) <0.001
血脂紊乱 3792 (22.6) 1911 (19.4) 1881 (27.1) <0.001 858 (8.8) 449 (8.1) 409 (9.8) 0.005
吸烟史[例(%)]       <0.001       <0.001
从不吸烟 9751 (58.0) 5362 (54.5) 4389 (63.1)   5517 (56.8) 2914 (52.8) 2603 (62.2)  
以前吸烟 2604 (15.5) 1685 (17.1) 919 (13.2)   1077 (11.1) 672 (12.2) 405 (9.7)  
目前吸烟 4444 (26.5) 2800 (28.4) 1644 (23.6)   3114 (32.1) 1938 (35.1) 1176 (28.1)  
饮酒史[例(%)]       <0.001       <0.001
从不饮酒 8902 (53.0) 4956 (50.3) 3946 (56.8)   5858 (60.3) 3184 (57.6) 2674 (63.9)  
以前饮酒 2340 (13.9) 1395 (14.2) 945 (13.6)   717 (7.4) 399 (7.2) 318 (7.6)  
目前饮酒 5557 (33.1) 3496 (35.5) 2061 (29.6)   3133 (32.3) 1941 (35.1) 1192 (28.5)  
体质指数[例(%)]       0.023       0.008
低体重 6247 (37.2) 3679 (37.4) 2568 (36.9)   508 (5.2) 269 (4.9) 239 (5.7)  
正常体重 866 (5.2) 467 (4.7) 399 (5.7)   3973 (40.9) 2253 (40.8) 1720 (41.1)  
超重 3588 (21.4) 2138 (21.7) 1450 (20.9)   2049 (21.1) 1226 (22.2) 823 (19.7)  
肥胖 6098 (36.3) 3563 (36.2) 2535 (36.5)   3178 (32.7) 1776 (32.2) 1402 (33.5)  
睡眠质量[例(%)]       <0.001       <0.001
理想 7735 (46.0) 5369 (54.5) 2366 (34.0)   5333 (54.9) 3356 (60.8) 1977 (47.3)  
一般 5258 (31.3) 2775 (28.2) 2483 (35.7)   2882 (29.7) 1465 (26.5) 1417 (33.9)  
不理想 3806 (22.7) 1703 (17.3) 2103 (30.3)   1493 (15.4) 703 (12.7) 790 (18.9)  
地区[例(%)]       <0.001       <0.001
北部 2190 (13.0) 1239 (12.6) 951 (13.7)   1353 (13.9) 745 (13.5) 608 (14.5)  
西部 5202 (31.0) 3428 (34.8) 1774 (25.5)   3111 (32.0) 1974 (35.7) 1137 (27.2)  
东北部 1173 (7.0) 625 (6.3) 548 (7.9)   668 (6.9) 365 (6.6) 303 (7.2)  
中南部 3970 (23.6) 2373 (24.1) 1597 (23.0)   2418 (24.9) 1403 (25.4) 1015 (24.3)  
西北部 1289 (7.7) 675 (6.9) 614 (8.8)   623 (6.4) 300 (5.4) 323 (7.7)  
西南部 2975 (17.7) 1507 (15.3) 1468 (21.1)   1535 (15.8) 737 (13.3) 798 (19.1)  
图2 在CHARLS 2018年全国调查中，中国不同地区腰痛的患病率
表2 在CHARLS 2018年全国调查中腰背痛患病率的亚组分析
一般特征 患病率（%） 总体 模型1 OR (95%CI) a P值 模型2 OR (95%CI) b P值
男 女
年龄,(岁)              
<50 29.78 42.02 37.26 1.00 (Ref.) - - -
50-59 31.48 45.35 38.72 1.01 (0.90-1.13) 0.886 - -
60-69 32.88 49.34 41.30 1.10 (0.98-1.23) 0.090 - -
70~ 32.68 50.07 41.60 1.11 (0.99-1.26) 0.073 - -
教育水平              
文盲 37.56 50.18 46.27 1.00 (Ref.) - 1.00 (Ref.) -
小学 32.08 45.53 38.15 0.77 (0.71-0.83) <0.001 0.99 (0.91-1.08) 0.671
初中/高中 28.98 42.50 34.29 0.63 (0.58-0.67) <0.001 0.84 (0.77-0.92) <0.001
大学及以上 20.08 33.59 24.67 0.40 (0.30-0.54) <0.001 0.67 (0.49-0.92) 0.015
居住地              
城镇 27.52 41.98 35.23 1.00 (Ref.) - 1.00 (Ref.) -
农村 35.04 50.70 43.26 1.35 (1.27-1.44) <0.001 1.30 (1.21-1.40) <0.001
高血压              
否 30.51 43.85 37.56 1.00 (Ref.) - 1.00 (Ref.) -
是 34.52 52.46 44.02 1.25 (1.17-1.33) <0.001 1.00 (0.93-1.08) 0.607
糖尿病              
否 31.75 45.94 39.18 1.00 (Ref.) - 1.00 (Ref.) -
是 34.23 54.83 45.82 1.31 (1.20-1.43) <0.001 1.08 (0.97-1.20) 0.108
心脏病              
否 29.59 42.83 36.32 1.00 (Ref.) - 1.00 (Ref.) -
是 44.69 61.79 55.14 2.12 (1.96-2.28) <0.001 1.64 (1.51-1.79) <0.001
关节炎              
否 23.69 35.39 29.37 1.00 (Ref.) - 1.00 (Ref.) -
是 48.70 62.24 56.76 3.07 (2.88-3.27) <0.001 2.46 (2.30-2.63) <0.001
血脂紊乱              
否 30.40 44.23 37.63 1.00 (Ref.) - 1.00 (Ref.) -
是 38.21 57.03 48.54 1.54 (1.43-1.66) <0.001 1.33 (1.22-1.45) <0.001
吸烟史              
从不吸烟 27.88 46.35 34.70 1.00 (Ref.) - 1.00 (Ref.) -
以前吸烟 31.54 60.42 35.78 1.27 (1.13-1.42) <0.001 1.09 (0.97-1.24) 0.100
目前吸烟 33.92 54.39 43.41 1.39 (1.25-1.54) <0.001 1.27 (1.13-1.43) <0.001
饮酒史              
从不饮酒 31.00 46.39 35.87 1.00 (Ref.) - 1.00 (Ref.) -
以前饮酒 34.11 49.20 39.33 1.14 (1.04-1.26) 0.008 1.02 (0.92-1.13) 0.554
目前饮酒 31.83 50.17 42.88 1.09 (1.00-1.18) 0.038 1.16 (1.07-1.27) 0.003
睡眠质量              
理想 23.87 36.89 29.68 1.00 (Ref.) - 1.00 (Ref.) -
一般 38.54 48.03 43.50 2.03 (1.89-2.18) <0.001 1.71 (1.59-1.85) <0.001
不理想 40.91 54.56 49.63 2.80 (2.59-3.04) <0.001 2.05 (1.88-2.24) <0.001
体质指数              
低体重 40.84 50.21 45.76 1.22 (1.06-1.41) 0.006 1.14 (0.98-1.33) 0.061
正常体重 35.07 47.46 40.97 1.00 (Ref.) - 1.00 (Ref.) -
超重 32.67 46.74 40.41 0.97 (0.89-1.06) 0.500 0.93 (0.85-1.02) 0.091
肥胖 29.17 49.57 41.36 1.02 (0.95-1.09)   0.91 (0.84-0.99) 0.017
工作状态              
否 30.92 46.61 40.69 1.00 (Ref.) - - -
是 32.54 47.65 39.71 0.98 (0.92-1.05)   - -
地区              
北部 32.46 50.77 41.96 1.00 (Ref.) - 1.00 (Ref.) -
西部 24.58 40.06 32.77 0.67 (0.61-0.75)   0.74 (0.66-0.83) <0.001
东北部 34.84 54.55 45.31 1.14 (0.99-1.32)   1.16 (0.99-1.35) 0.057
中南部 32.56 43.80 38.52 0.88 (0.79-0.97)   0.89 (0.79-1.00) 0.041
西北部 37.95 53.14 46.10 1.19 (1.03-1.36)   1.14 (0.98-1.32) 0.132
西南部 40.36 55.88 48.54 1.27 (1.14-1.42)   1.11 (0.98-1.26) 0.175
图3 2011年至2018年全国调查中腰背痛多因素Cox比例风险回归模型风险比(HRs)和95%置信区间(CI)注：对性别、年龄、教育程度、居住地、高血压、糖尿病、心脏病、关节炎、血脂异常、吸烟、饮酒、工作、体重指数、睡眠质量、地理位置等因素进行多元模型调整。
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