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Comparison of the Prevalence of Low Back Pain and Related Spinal Diseases among Smokers and Nonsmokers: Using Korean National Health Insurance Database

 Ji-Won Kwon  ;  Joong-Won Ha  ;  Tae-Sung Lee  ;  Seong-Hwan Moon  ;  Hwan-Mo Lee  ;  Yung Park 
 CLINICS IN ORTHOPEDIC SURGERY, Vol.12(2) : 200-208, 2020-06 
Journal Title
Issue Date
Aged ; Female ; Humans ; Low Back Pain / epidemiology* ; Male ; Middle Aged ; National Health Programs / statistics & numerical data* ; Prevalence ; Republic of Korea / epidemiology ; Smoking / adverse effects* ; Spinal Diseases / epidemiology*
Big data ; Low back pain ; Prevalence ; Smoker ; Spinal disease
Backgroud: To compare the risk of low back pain (LBP) and related spinal diseases between smokers (exposure group) and nonsmokers (non-exposure group). No large registry study has so far investigated the association between smoking and LBP-related spinal diseases such as intervertebral disc disease, spinal stenosis, spinal instability, and spondylolisthesis.

Methods: A random sample was taken from the Korean National Health Insurance Research Database. In total, 204,066 men (160,105 smokers, 43,961 nonsmokers) who were followed up between 2002 and 2013 were included in the analysis. Patients with previous back pain or spinal disease in 2003 and 2004, patients with inappropriate data, and women (due to the lower percentage of smokers) were excluded. The Cox proportional hazard model was used to investigate the risk of LBP and related spinal diseases associated with smoking, while adjusting for demographic, clinical, and socioeconomic factors.

Results: The overall median follow-up period was 5.6 years (interquartile range, 3.48-8.43 years). Compared to the nonsmoker group, the smoker group had a higher incidence of LBP (p = 0.01), intervertebral disc disease (p < 0.001), spinal stenosis (p = 0.004), spinal instability (p < 0.001), and spondylolisthesis (p = 0.023). Compared to the nonsmoker group, the smoker group had a higher adjusted hazard ratio (HR) per year of LBP (HR, 1.18; 95% confidence interval [CI], 1.15 to 1.21), intervertebral disc disease (HR, 1.25; 95% CI, 1.21 to 1.30), spinal stenosis (HR, 1.52; 95% CI, 1.41 to 1.64), spinal instability (HR, 1.33; 95% CI, 1.24 to 1.44), and spondylolisthesis (HR, 1.49; 95% CI, 1.23 to 1.80).

Conclusions: Smokers in male samples were at higher risk for LBP and related spinal diseases than nonsmokers.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Ji-Won(권지원) ORCID logo https://orcid.org/0000-0003-4880-5310
Moon, Seong Hwan(문성환)
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
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