Influence of occupational factors on the relation between socioeconomic status and self-reported back pain in a population-based sample of German adults with back pain

Study Design, Population-based cross-sectional postal survey and interview substudy. Objectives. To examine the association between socioeconomic status and sev ere back pain and to determine whether this association can be explained by occupational factors, Summary of Background Data. Like other disorders, back pain and its consequ ences are inversely related to indicators of high socioeconomic status. Methods. The associations between indicators of socioeconomic status and pr esence or severity of current back pain (no back pain or back pain of low i ntensity and low disability versus back pain with high intensity and/or hig h disability) were investigated in a survey among German adults 25 to 74 ye ars of age (n = 2731) and an interview substudy of 770 participants with a recent history of back pain. Results. In the survey, educational level was inversely associated with bac k pain and severe current back pain. Similarly, in the interview substudy, educational level, vocational training, occupational class, household incom e, and health insurance status were inversely related to severe current bac k pain. Age-adjusted and gender adjusted odds ratios were 0.36 (95% confide nce interval [CI] 0.25-0.52) for immediate educational level and 0.37 (95% CI 0.18-0.73) for high educational level. Recalled work tasks at the onset of back pain were significant risk factors of severe current back pain (hea vy physical work: odds ratio [OR] 1.77, 95% CI 1.06-2.93; work in bent posi tion among males: OR 1.89, 95% CI 1.03-3.46). After adjusting for occupatio nal class or work tasks, the association between educational level and seve re current back pain remained unchanged. Conclusions. The findings support the hypothesis that severe back pain is l ess prevalent among adults of higher socioeconomic status. The underlying m echanism could not be explained by differences in self-reported occupationa l factors.