摘要：Objectives . This study examined predictors of low back pain onset in a British birth cohort. Methods . Univariate and multivariate analyses focused on individuals who experienced onset of low back pain at 32 to 33 years of age (n= 571) and individuals who were pain free (n = 5210). Participants were members of the 1958 British birth cohort. Results . Incident pain was elevated among those with psychological distress at 23 years of age (adjusted odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.65, 3.86) and among persistent moderate or heavy smokers (adjusted OR = 1.63, 95% CI = 1.23, 2.17). Significant univariate associations involving other factors (e.g., social class, childhood emotional status, body mass index, job satisfaction) did not persist in multivariate analyses. Conclusions . This prospectively studied cohort provides evidence that psychological distress more than doubles later risk of low back pain, with smoking having a modest independent effect. Other prospective studies are needed to confirm these findings before implications for low back pain prevention can be assessed. Low back pain, a leading cause of disability in the industrialized world, is well recognized as having a multifactorial etiology. The main predictors of back pain include physical stress (e.g., prolonged lifting, driving, forceful or repetitive movements involving the back), 1– 7 psychosocial stress (e.g., high perceived workload and time pressure, low control and lack of social support at work), 8, 9 personal characteristics (e.g., psychological status 10, 11 and tobacco use 12– 14 ), and physical characteristics (e.g., obesity and height). 15, 16 Although these factors represent conditions existing during working life as well as conditions accumulated during the prework period, most studies focus exclusively on ergonomic and psychosocial working conditions. With a few exceptions, 15, 17 there exists, to our knowledge, almost no research on the contribution to low back pain of prework experiences in combination with working life factors. Relevant longitudinal data on early life risk factors and adult low back pain are available from the 1958 British birth cohort study. First, with regard to back pain, data obtained in the 23- and 33-year follow-ups allow differentiation of incident and chronic pain. The aim of this article is to identify independent risk factors for incident pain in the year before the 33-year follow-up. Second, with regard to risk factors, the 1958 study contains extensive information on prework experiences as well as working life factors. Prework experiences include early life factors (e.g., social class at birth, growth patterns, and socioemotional status), physical characteristics (e.g., obesity and height), and early adult factors (e.g., educational attainment, psychological status, and smoking behavior). Information relevant to working life includes job title (from which ergonomic exposure can be inferred), psychosocial work characteristics, family circumstances, and adult emotional and practical support. The study therefore provides an opportunity for simultaneous investigation of both earlier and working life risks from birth to 33 years of age.
