• Eric J Roseen, Michael P LaValley, Shanshan Li, Robert B Saper, David T Felson, Lisa Fredman, and Study of Osteoporotic Fractures.
• Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA, USA. Eric.Roseen@bmc.org.
• J Gen Intern Med. 2019 Jan 1; 34 (1): 909790-97.

BackgroundThe impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear.ObjectiveTo examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability.DesignProspective cohort study.SettingThe Study of Osteoporotic Fractures.ParticipantsWomen aged 65 or older.MeasurementOur primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators.ResultsOf 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively.LimitationsOnly white women were included.ConclusionFrequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.

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