FORMAL EDUCATION AND BACK-RELATED DISABILITY - IN SEARCH OF AN EXPLANATION

Study Design. The present study is a 2-year prospective study with rep eated measurements. Objectives. To examine the association of educatio n with back-related disability along with four sets of variables that might explain this relationship: clinical, behavioral, and environment al factors; occupational variables; health care use; and interactions between stressful events and coping strategies. Summary of Background Data. Although education has been found to be associated with back-rel ated disability in previous reports, this relationship remains to be e xplained. Examination of this association may yield a better understan ding of the causes and natural history of disability resulting from ba ck pain. Methods. Subjects were 1213 enrollees of a Health Maintenance Organization (HMO) who consulted a primary care physician for back pa in in 1989-1990, completed a baseline telephone interview, and had a f ollow-up evaluation after 1 and 2 years; using a modified version of t he Roland-Morris Scale to measure disability. Results. Subjects who co mpleted 13 years or more of schooling had less disability and a greate r decline in their disability over time than those who completed less schooling, Occupational characteristics and somatization were among th e strongest explanatory factors, Cigarette smoking contributed to the explanation of the cross-sectional association. Conclusions. Education is associated cross-sectionally and longitudinally with disability re sulting from back pain. A wide range of variables may mediate the educ ation-back-related disability association, including a propensity to r eport diffuse physical symptoms (somatization), lifestyle (e.g., cigar ette smoking), and occupational factors.