Is educational attainment associated with the onset and outcomes of low back pain? a systematic review and meta-analysis
Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (...
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| creator | Lawan, Aliyu Aubertin, Alex Mical, Jane Hum, Joanne Graf, Michelle L Marley, Peter Bolton, Zachary Walton, David M |
| description | Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (EA) being a key component of SES. The association between EA and LBP has yet to be the subject of a dedicated review and meta-analysis.
To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible.
An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE.
After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes.
We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects. |
| doi_str_mv | 10.1371/journal.pone.0308625 |
| format | Article |
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To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible.
An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE.
After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes.
We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0308625</identifier><identifier>PMID: 39137213</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Back pain ; Backache ; Bias ; Chronic illnesses ; Data analysis ; Database searching ; Disability ; Education ; Educational attainment ; Educational Status ; Estimates ; Heterogeneity ; Humans ; Internet/Web search services ; Low back pain ; Low Back Pain - epidemiology ; Medicine and Health Sciences ; Meta-analysis ; Online searching ; Pain ; Physical Sciences ; Prevention ; Prognosis ; Registration ; Research and Analysis Methods ; Reviews ; Social Sciences ; Socioeconomics ; Software ; Statistical methods ; Systematic review</subject><ispartof>PloS one, 2024-08, Vol.19 (8), p.e0308625</ispartof><rights>Copyright: © 2024 Lawan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Lawan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Lawan et al 2024 Lawan et al</rights><rights>2024 Lawan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c572t-97e61e862edebe1964385d53bb3ff10b3964a31b4e19dc9aff1ccdfdd2bbc3a63</cites><orcidid>0000-0001-9155-3337 ; 0000-0002-5942-7864 ; 0009-0002-3997-9458</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321572/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321572/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23871,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39137213$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Ali, Mohammad</contributor><creatorcontrib>Lawan, Aliyu</creatorcontrib><creatorcontrib>Aubertin, Alex</creatorcontrib><creatorcontrib>Mical, Jane</creatorcontrib><creatorcontrib>Hum, Joanne</creatorcontrib><creatorcontrib>Graf, Michelle L</creatorcontrib><creatorcontrib>Marley, Peter</creatorcontrib><creatorcontrib>Bolton, Zachary</creatorcontrib><creatorcontrib>Walton, David M</creatorcontrib><title>Is educational attainment associated with the onset and outcomes of low back pain? a systematic review and meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (EA) being a key component of SES. The association between EA and LBP has yet to be the subject of a dedicated review and meta-analysis.
To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible.
An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE.
After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes.
We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects.</description><subject>Analysis</subject><subject>Back pain</subject><subject>Backache</subject><subject>Bias</subject><subject>Chronic illnesses</subject><subject>Data analysis</subject><subject>Database searching</subject><subject>Disability</subject><subject>Education</subject><subject>Educational attainment</subject><subject>Educational Status</subject><subject>Estimates</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Internet/Web search services</subject><subject>Low back pain</subject><subject>Low Back Pain - epidemiology</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Online searching</subject><subject>Pain</subject><subject>Physical Sciences</subject><subject>Prevention</subject><subject>Prognosis</subject><subject>Registration</subject><subject>Research and Analysis 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review and meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2024-08-13</date><risdate>2024</risdate><volume>19</volume><issue>8</issue><spage>e0308625</spage><pages>e0308625-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (EA) being a key component of SES. The association between EA and LBP has yet to be the subject of a dedicated review and meta-analysis.
To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible.
An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE.
After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes.
We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39137213</pmid><doi>10.1371/journal.pone.0308625</doi><tpages>e0308625</tpages><orcidid>https://orcid.org/0000-0001-9155-3337</orcidid><orcidid>https://orcid.org/0000-0002-5942-7864</orcidid><orcidid>https://orcid.org/0009-0002-3997-9458</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_3092758843 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Analysis Back pain Backache Bias Chronic illnesses Data analysis Database searching Disability Education Educational attainment Educational Status Estimates Heterogeneity Humans Internet/Web search services Low back pain Low Back Pain - epidemiology Medicine and Health Sciences Meta-analysis Online searching Pain Physical Sciences Prevention Prognosis Registration Research and Analysis Methods Reviews Social Sciences Socioeconomics Software Statistical methods Systematic review |
| title | Is educational attainment associated with the onset and outcomes of low back pain? a systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-12T19%3A03%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Is%20educational%20attainment%20associated%20with%20the%20onset%20and%20outcomes%20of%20low%20back%20pain?%20a%20systematic%20review%20and%20meta-analysis&rft.jtitle=PloS%20one&rft.au=Lawan,%20Aliyu&rft.date=2024-08-13&rft.volume=19&rft.issue=8&rft.spage=e0308625&rft.pages=e0308625-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0308625&rft_dat=%3Cgale_plos_%3EA804681983%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3092758843&rft_id=info:pmid/39137213&rft_galeid=A804681983&rft_doaj_id=oai_doaj_org_article_78c2382fa3c9466cb00f455d375fc171&rfr_iscdi=true |