Prevalence of low back pain in three occupational groups in Shanghai, People's Republic of China

https://doi.org/10.1016/j.jsr.2003.11.002Get rights and content

Abstract

Problem: Low back pain (LBP) is one of the most prevalent work-related conditions affecting employed populations in developed countries, yet little is known about this condition among the world's largest, single-nation labor force: The People's Republic of China. Method: This is a cross-sectional study of the prevalence of low back pain (LBP) among garment workers, battery/kiln workers, and teachers in Shanghai, People's Republic of China. Data were collected by personal interview and physical examination at six work sites. The overall response rate was 78%. Results: The overall (N=383) self-reported annual prevalence of LBP symptoms lasting 24 hours or more was 50%. Garment workers had a higher annual prevalence of LBP (74%) than teachers (40%), prevalence ratio (PR=1.9, 95% CI=1.4–2.4). Discussion: The overall annual prevalence of self-reported LBP (50%) was higher than that reported among 50 other Chinese employed study populations (30%). Healthy worker effects may have limited the conclusions from this cross-sectional study. Summary: These results suggest that LBP is a prevalent condition in Chinese workers and that more work should be done to estimate its impact on the Chinese workforce. The findings for garment workers were consistent with increased risk of LBP among persons doing work in fixed, sedentary postures.

Introduction

Low back pain (LBP) is among the most common work-related health problems in economically developed countries (Waddell, 1994). The lifetime incidence of LBP has been estimated to be as high as 85% of the adult population (Von Korff, Dworkin, LeResche, & Kruger, 1988) with an estimated 18% annual prevalence of back pain lasting at least one week in American adults (Guo et al., 1995). There is considerably less information about the magnitude and impact of LBP among adult, employed populations in developing nations. This situation has been argued to be the result of an overbalance of research on populations in the most economically developed (or highest income) countries. This lack of research leaves a profound gap in the knowledge of “LBP in the rest of the world,” where the bulk of the world's working population resides (Volinn, 1997).

The People's Republic of China (PRC) is the world's largest economically developing country. Its estimated 600 million workers compose the largest, single-nation labor force Leigh et al., 1999, Takala, 1999. Despite this economic and labor pre-eminence among developing countries, there have been relatively few studies of occupational LBP in the PRC. A recent review of existing literature on LBP in PRC workers, published in both English and Chinese, concluded that many studies were substantially limited by methodological or reporting flaws (Jin et al., 2000). Specific limitations included the lack of a clear and potentially generalizable definition of LBP, the absence of a systematic approach to documenting manual materials handling, and the often incomplete reporting of study methods including population characteristics, inclusion/exclusion criteria, participation rates, and other design details that would permit replication of the investigation.

To begin to address these limitations, a cross-sectional study of LBP prevalence was conducted in three Chinese occupational groups representing a diversity of workplace exposures: garment workers, battery and kiln factory workers, and teachers. The objectives of the study were to describe the prevalence of low back pain among employees in a variety of Chinese work environments and to identify work-related and personal factors potentially associated with LBP.

Section snippets

Participants

Six work environments in the Shanghai municipality were recruited for the study: an apparel manufacturer; the mold department of a battery factory; the brick kiln department of a fire retardant materials factory; and three primary schools. To be eligible for the study, subjects had to meet the following criteria: (a) at least 12 months employment at the work site; and (b) absence of a physician's current diagnosis of cancer, infection, neurological diseases, or traumatic injury (Bigos et al.,

Results

The demographic characteristics of the garment factory workers, battery and kiln product workers, and primary school teachers are summarized in Table 1. A total of 383 of 492 subjects (78%) agreed to be examined and interviewed. Three subjects from the group of garment workers were excluded because of pelvic inflammatory diseases; no other subjects were excluded because of diseases or injury. Study participation was 62% for teachers, 79% for garment workers, and 93% for battery and kiln product

Discussion

The results indicate that the overall annual prevalence of LBP lasting more than one day among all three work groups is considerable: 50%. This prevalence figure (50%) is higher than the median prevalence (30%) reported among 50 other Chinese employed populations (Jin et al., 2000). Caution is urged however when comparing these studies due to the differences in LBP definitions and study methods.

The LBP prevalence for garment workers in the past seven days (45%) and past year (74%) was higher

Acknowledgements

We are indebted to Drs. Yao Zhenjun and Lu Yaogang who performed the physical examinations for this study and to the following study interviewers: Jia Xiaodong, Gao Fei, Yan Xiaorong, Zhao Xinping, Zheng Ling, and Shen Xuan. Drs. David Lombardi, Glenn Pransky, Gordon Smith, Jeffrey Katz, and Ms. Helen Wellman provided helpful comments on earlier drafts of the manuscript. Ms. Patti Boelsen prepared the manuscript for submission. This research was completed while Dr. Sorock was a research

Kezhi Jin Ph.D. is Lecturer in the Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China. He is currently a post-doctoral fellow at the Harvard School of Public Health in Boston and the Liberty Mutual Research Institute for Safety in Hopkinton, MA. He has published work on occupational disease and injury including low back pain.

References (22)

  • I. Kuorinka et al.

    Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms

    Applied Ergonomics

    (1987)
  • M. Von Korff et al.

    An epidemiological comparison of pain complaints

    Pain

    (1988)
  • Bigos, S., Bowyer, O., Braen, G., et al., 1994. Acute Low Back Problems in Adults. Clinical Practice Guideline No....
  • C. Bombardier et al.

    A guide to interpreting epidemiologic studies on the etiology of back pain

    Spine

    (1994)
  • A. Burdorf et al.

    Comparison of methods for the assessment of postural load on the back

    Scand J Work Environ Health

    (1991)
  • A. Burdorf et al.

    Positive and negative evidence of risk factors for back disorders

    Scand J Work Environ Health

    (1997)
  • M.J. Gardner et al.
  • H.-R. Guo et al.

    Back pain among workers in the United States: national estimates and workers at high risk

    Am J Ind Med

    (1995)
  • K. Jin et al.

    Risk factors for work-related low back pain in the People's Republic of China

    Int J Occup Environ Health

    (2000)
  • D.G. Kleinbaum et al.
  • C. Leboeuf-Yde et al.

    The prevalence of low back pain in the literature. A structured review of 26 Nordic studies from 1954 to 1993

    Spine

    (1995)
  • Cited by (104)

    • Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study

      2019, Journal of Bodywork and Movement Therapies
      Citation Excerpt :

      It is the third most common cause of surgical intervention, the fifth most common reason to visit hospital emergency departments, and the second most frequent reason for physician visits (Chaiamnuay et al., 1998; Hart et al., 1995; Taylor et al., 1994). However, low back pain (LBP) is not simply a Western-culture phenomenon; it is a global issue with a similar prevalence in other less developed countries (Hoy et al., 2010; Jin and SorockTheodore, 2004; Luo et al., 2004; Ory et al., 1997). Approximately 24–80% of those who experience LBP will have another episode of back pain within one year (Luo et al., 2004).

    • EFFECTS OF CUPPING THERAPY IN PATIENTS WITH OLOW BACK PAIN

      2023, Revista de la Asociacion Espanola de Especialistas en Medicina del Trabajo
    View all citing articles on Scopus

    Kezhi Jin Ph.D. is Lecturer in the Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China. He is currently a post-doctoral fellow at the Harvard School of Public Health in Boston and the Liberty Mutual Research Institute for Safety in Hopkinton, MA. He has published work on occupational disease and injury including low back pain.

    Gary S. Sorock Ph.D. is Associate Professor of Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts. He specializes in the epidemiology of occupational injuries.

    Theodore K. Courtney M.S., CSP is Director of the Quantitative Analysis Unit at the Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts and Instructor on Injury, Safety and Ergonomics at the Harvard University School of Public Health, Boston, Massachusetts. He received the 2003 William Floyd Medal from the Ergonomics Society for significant contributions to ergonomics research. His recently published work includes: examining US occupational morbidity in large surveillance data systems; comparative studies on fall-related injuries in the US, UK, and Sweden; research on disabling injuries in construction workers; and studies of occupational fatalities in the People's Republic of China.

    View full text