THE EPIDEMIOLOGY OF BACK PAIN IN CHILDREN AND ADOLESCENTS: A CROSS-SECTIONAL STUDY OF 2,001 AMERICAN YOUTH
Authors: Schachne Jonathan M. , Wixted Colleen , Green Daniel W. , Widmann Roger F. , Fabricant Peter D. 
Published: March 2019

Background: Back pain is a common condition that affects millions of Americans each year, including both adult and pediatric populations. To our knowledge, there has been no study that has epidemiologically studied back pain in a representative cohort of American children and adolescents. The purpose of this study was to establish the prevalence of back pain in American children and adolescents 10-18 years old and investigate for any demographic or physical activity predictors of increased risk. Methods: A cross-sectional survey-based investigation was performed in 2,001 children and adolescents, equally split by age and sex, and representing census-weighted distributions of state of residence, race/ethnicity, and health insurance status. Overall prevalence of back pain (at present and any time in past year) was calculated, and comparative analyses were performed to investigate any relationship between back pain and age, sex, backpack use, race/ethnicity, BMI, insurance status, and level of activity. Results: Two thousand and one subjects completed the survey of which 1,000 were male (50%) and 1,001 were female (50%). The mean age of the respondents was 14.0±2.6 years and the mean BMI was 22.4±8.1. A majority of subjects (1,633; 81.6%) stated that they participated in a sport or physical activity, with basketball being the most common sport followed by soccer, baseball, dance, and football. In total, 743 subjects (37.1%) stated that they had back pain within the last year, most commonly in the lumbar region (64.9%). The mean age of the subjects with back pain was significantly higher than those who did not experience back pain in the previous year (14.76±2.4 vs. 13.6±2.6 years old, P<0.001). Regression analysis demonstrated that the proportion of subjects who experienced back pain within the previous year increased linearly by age from 10 to 16 years old before plateauing just under 50% from age 16 to 18 (Figure 1). Age accounted for 94% of the variation of the response data for back pain in the past year, and 84% for those currently experiencing back pain (P<0.001 for both). Subjects with back pain had greater BMI than those without back pain (23.5±9.5 vs. 21.8±7.0, P<0.001). Subjects that used backpacks with two straps were least likely to have back pain (33.0%), while those who used rolling backpacks (57.1%), backpacks with two straps and the waistband fastened (55.9%), and backpacks with one strap (46.9%) were more likely to have back pain (P<0.05 for all). Females were more likely to have had back pain than males in the previous year (41.5% vs. 32.8%, P<0.001). Varsity and national/internationally competitive athletes demonstrated the highest rate of back pain in the previous year (51.0% and 49.2%, respectively). This was significantly higher than the prevalence of back pain in recreational, local/community, and junior varsity athletes (33.5%, 29.7%, 44.4%, respectively, P<0.05 for all pairwise comparisons). No associations were found between subjects’ health insurance status or race/ethnicity and occurrence of back pain. Conclusions/Significance: The current study quantifies the prevalence of back pain in an epidemiologic, census-derived sample of 2,001 American children and adolescents. There was a statistically significant linear increase by age from 10 to 16 years old before plateauing just under 50% from age 16 to 18. Additional statistically significant associations between presence of back pain in the previous year and BMI, backpack use, sex, and level of athletic participation were discovered. No association between insurance status or race and back pain was reported. These results will aid in future research and clinical care by demonstrating the epidemiology of back pain within the 10-18 year old American pediatric population. Figure Legend: [Figure: see text]