Over the period examined in this study, the total number of adults with any back pain increased by 29% (from 30.2 million in 2000–2001 to 38.9 million adults in 2006–2007), whereas the total number of adults with chronic back pain increased by 64% (from 7.8 million in 2000–2001 to 12.8 million in 2006–2007) ( and ). Over the entire 7-year period, chronic back pain accounted for more than half of the overall increase in back pain prevalence.
Estimated total US adults with back pain.a, Chronic back pain defined as back pain reported for 3 or more MEPS rounds during 2-year longitudinal panel survey.b, Nonchronic back pain defined as back pain reported for 1 or 2 MEPS rounds.
The mean (SD) age among all adults with back pain increased from 2000 to 2007, from 45.9 (0.6) years to 48.2 (0.5) years (). The mean (SD) age among adults with chronic back pain increased from 48.5 (1.0) years in 2000–2001 to 52.2 (0.7) years in 2006–2007.
A picture of “creeping chronicity” becomes readily apparent by mapping secular trends that demonstrate the progression of chronic back pain among aging adults with back pain (). Most noticeably, upward of 25% of older adults with back pain (elders, preboomers, and boomers age categories) already have chronic back pain as they enter retirement age. Noteworthy also, up to 40% of back pain may eventually become chronic among oldest elders. For the 2 younger cohorts born after 1964 (postboomers and younger adults), the prevalence of chronic back pain was lower overall.
Among US adults with back pain, percentage with chronic back pain according to birth year category. Chronic back pain defined as back pain reported for 3 or more MEPS rounds during 2-year longitudinal panel survey.
Use of health care services for back pain is significantly related to back pain chronicity. Overall, 94% of patients with chronic back pain use services, whereas 75% of those with nonchronic back pain use services (odds ratio, 4.7; 95% confidence interval, 4.0–5.6). This association was significant for each of our age groups, although use of services for both chronic and nonchronic back pain did increase with age. Among our youngest cohort of younger adults, 90% of patients with chronic back pain and 71% of those with nonchronic back pain used services; among our oldest group of elder adults, 97% of patients with chronic back pain and 81% of those with nonchronic back pain used services.
Biennial expenditures (2010 dollars) for ambulatory care of back pain for those who did not receive inpatient care (96%–97% across the panels) are shown in . The number of adults in this category increased from 23.5 million in 2000 to 2001 to 30.3 million in 2006 to 2007, as a result of a growing adult population and a growing share of the adult population. With rising mean cost per patient (from $1146 to $1742), estimated biennial national expenditures increased from $26.9 billion in 2000 to 2001 to $52.8 billion in 2006 to 2007 (2010 dollars).
Biennial national expenditures ($2010) on ambulatory services for back pain among US adults, 2000 to 2007
Separate analyses of the chronic and nonchronic categories reveal dramatic effects of the growing chronicity described earlier. Not only has the chronic population increased much more rapidly than the nonchronic population, but the mean biennial cost per patient with chronic back pain is substantially higher (eg, $3152 for chronic vs $903 for nonchronic in 2006–2007). Thus, the estimated national biennial costs for patients with chronic back pain are substantially higher than costs for patients with nonchronic back pain, despite the latter being the larger population. In 2006 to 2007, the national costs for patients with chronic back pain were $35.7 billion compared with $17.2 billion for patients with nonchronic back pain ().
Fig 4 Estimated total US inflation-adjusted expenditures ($2010) on back pain.a, Chronic back pain defined as back pain reported for 3 or more MEPS rounds during 2-year longitudinal panel survey.b, Nonchronic back pain defined as back pain reported for 1 or (more ...)
The distribution of expenditures on health care, in general, is highly skewed, and our estimates are consistent with this pattern. For both patients with chronic and patients with nonchronic back pain, mean costs (eg, $3152 and $903, respectively, for years 2006–2007) are substantially higher than median costs ($1149 and $273, respectively). contains additional information on the 2006 to 2007 expenditure distributions for both patients with chronic and patients with nonchronic back pain, as well as for several age groups among the former.
Biennial expenditures ($2010) on ambulatory services for back pain in 2006 to 2007 (MEPS panel 11), by birth category
The top decile among users with chronic back pain accounts for 57% of costs, and the top quintile accounts for 72%. The corresponding values for the nonchronic population are similar, 57% and 75%, respectively. also shows the corresponding values for the 3 dominant birth cohorts: boomers (who account for 51% of total chronic costs), preboomers (the second highest spending group with 16% of total chronic costs), and postboomers (who will begin entering retirement [age 65 years] in the year 2030 and who already account for 13% of the cost).