Article Text

Original research
Do the associations of body mass index and waist circumference with back pain change as people age? 32 years of follow-up in a British birth cohort
  1. Stella Muthuri1,
  2. Rachel Cooper2,
  3. Diana Kuh1,
  4. Rebecca Hardy3
  1. 1MRC Unit for Lifelong Health and Ageing, UCL, London, UK
  2. 2Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
  3. 3CLOSER, Social Research Institute, UCL, London, UK
  1. Correspondence to Rebecca Hardy; rebecca.hardy{at}


Objectives To investigate whether cross-sectional and longitudinal associations of body mass index (BMI) and waist circumference (WC) with back pain change with age and extend into later life.

Design British birth cohort study.

Setting England, Scotland and Wales.

Participants Up to 3426 men and women from the MRC National Survey of Health and Development.

Primary outcome measures Back pain (sciatica, lumbago or recurring/severe backache all or most of the time) was self-reported during nurse interviews at ages 36, 43, 53 and 60–64 years and in a postal questionnaire using a body manikin at age 68.

Results Findings from mixed-effects logistic regression models indicated that higher BMI was consistently associated with increased odds of back pain across adulthood. Sex-adjusted ORs of back pain per 1 SD increase in BMI were: 1.13 (95% CI: 1.01 to 1.26), 1.11 (95% CI: 1.00 to 1.23), 1.17 (95% CI: 1.05 to 1.30), 1.31 (95% CI: 1.15 to 1.48) and 1.08 (95% CI: 0.95 to 1.24) at ages 36, 43, 53, 60–64 and 68–69, respectively. Similar patterns of associations were observed for WC. These associations were maintained when potential confounders, including education, occupational class, height, cigarette smoking status, physical activity and symptoms of anxiety and depression were accounted for. BMI showed stronger associations than WC in models including both measures.

Conclusions These findings demonstrate that higher BMI is a persistent risk factor for back pain across adulthood. This highlights the potential lifelong consequences on back pain of the rising prevalence of obesity within the population.

  • back pain
  • epidemiology
  • public health

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  • Contributors SM and RH had full access to all the data in the study and take full responsibility for the integrity and the accuracy of data analysis. SM, DK and RC conceived the idea for this study; SM, DK, RH and RC contributed to the development of the study objectives; DK, RH and RC acquired the data; SGM and RH analysed the data; SM and RH drafted the manuscript; all authors contributed to the manuscript’s critical revision and provided final approval of the version to be published.

  • Funding This work was supported by the UK Medical Research Council (Programme codes: MC_UU_12019/4 and MC_UU_12019/2). RH is Director of the CLOSER consortium which is supported by funding from the Economic and Social Research Council (ESRC) (award reference: ES/K000357/1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All waves of data collection have complied with ethical standards. Ethical approval for the most recent data collection at age 68–69 was obtained from the Queen Square Research Ethics Committee (14/LO/1073) and the Scotland A Research Ethics Committee (14/SS/1009). All methods were carried out in accordance with the relevant guidelines and regulations and written informed consent was obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data used in this publication are available to bona fide researchers upon request to the NSHD Data Sharing Committee via a standard application procedure. Further details can be found at doi: 10.5522/NSHD/Q101; doi: 10.5522/NSHD/Q102; 10.5522/NSHD/Q103.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.