Low Back Pain in Korea: Survey Weighted Analysis with Age Sex and Lumbar Radiographic Grade Matching

TL;DR

This study finds that low back pain in older Koreans is linked to mental health, income, and lifestyle factors, not just spinal issues.

Contribution

The study uniquely matches individuals by age, sex, and spinal imaging to isolate non-radiographic factors influencing low back pain.

Findings

25.1% of older Koreans reported low back pain, and 28.3% had radiographic lumbar spondylosis.

Low back pain was associated with depression, osteoporosis, lower income, alcohol intake, and physical activity.

Associations persisted even after matching for age, sex, and spinal imaging severity.

Abstract

What are the main findings?
In a nationally representative sample of Korean adults aged 50–79 years (KNHANES 2010–2011; weighted estimate 8,464,167), 25.1% reported low back pain (LBP) and 28.3% had radiographic lumbar spondylosis (Kellgren–Lawrence grade ≥ 2).Even under comparable objective conditions (matched by age, sex, and lumbar X-ray grade), LBP showed consistent associations with depressive mood (≥2 weeks), osteoporosis, lower household income, higher alcohol intake and physical activity, with additional sex-specific patterns in metabolic and behavioral factors.

In a nationally representative sample of Korean adults aged 50–79 years (KNHANES 2010–2011; weighted estimate 8,464,167), 25.1% reported low back pain (LBP) and 28.3% had radiographic lumbar spondylosis (Kellgren–Lawrence grade ≥ 2).

Even under comparable objective conditions (matched by age, sex, and lumbar X-ray grade), LBP showed consistent associations with depressive mood (≥2 weeks), osteoporosis, lower household income, higher alcohol intake and physical activity, with additional sex-specific patterns in metabolic and behavioral factors.

What are the implications of the main findings?
LBP in Korea appears to be influenced by psychosocial, socioeconomic, and systemic health factors beyond lumbar radiographic severity, supporting a more holistic risk assessment rather than reliance on imaging alone.Several psychosocial, socioeconomic, and systemic health factors were observed to co-occur with LBP beyond lumbar radiographic severity, highlighting the multidimensional nature of LBP in older adults.

LBP in Korea appears to be influenced by psychosocial, socioeconomic, and systemic health factors beyond lumbar radiographic severity, supporting a more holistic risk assessment rather than reliance on imaging alone.

Several psychosocial, socioeconomic, and systemic health factors were observed to co-occur with LBP beyond lumbar radiographic severity, highlighting the multidimensional nature of LBP in older adults.

Background/Objectives: Low back pain (LBP) is a major public health problem that contributes substantially to disability and impaired quality of life. Methods: Using nationally representative data from the fifth Korea National Health and Nutrition Examination Survey (KNHANES V), this study evaluated the epidemiology of LBP among Korean adults aged 50–79 years and explored factors associated with LBP in relation to lumbar radiographic findings. Weighted analyses corresponding to an estimated 8,464,167 individuals were performed. Multivariable logistic regression was used to explore factors associated with LBP. In addition, to explore patterns of association under comparable demographic and radiographic conditions, we conducted analyses stratified by age, sex, and lumbar radiographic grade as a descriptive, exploratory approach. Results: In weighted estimates, 25.1% of participants reported LBP and 28.3% demonstrated radiographic lumbar spondylosis (Kellgren–Lawrence grade ≥ 2). LBP was consistently associated with depressive mood, osteoporosis, lower household income, and lifestyle-related factors, even under similar age and radiographic conditions. Conclusions: These findings suggest that LBP in Korea may reflect multidimensional health factors beyond lumbar radiographic severity alone.

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