Prevalence of Chronic Back Pain and Associated Factors in Children and Adolescents: Secondary Analysis of the 2001-2019 Health Behavior in School-Aged Children Study

Background: Backache, which is considered a leading cause of adult disability worldwide, is seldom studied in children and adolescents despite it being associated with multiple detrimental health outcomes in this age group. Objective: The aim of this study is to explore the prevalence, time trends, and correlates of chronic backache among children and adolescents. Methods: Data were extracted from the cross-sectional Health Behavior in School-Aged Children (HBSC) study, which collected data from 2001 to 2019. The final sample size for this study consisted of 1,011,368 children and adolescents (515,899/1,011,368 or 51.01% were girls). Prevalence estimates and time trends were calculated using weighted proportions. Generalized linear mixed models were conducted to determine whether certain correlates (ie, age group, sex, socioeconomic status, excess weight status, or year of data collection) were associated with higher odds of reporting chronic backache in the population of the HBSC. Additionally, we analyzed country-level changes in chronic backache trends over time. Results: The weighted global prevalence of chronic backache among children and adolescents was 6.6% (n=12,641; wave 2017-2019). The time trend indicated a general increase in the prevalence of chronic backache in children and adolescents over time (from 2001 to 2019). Indeed, Northern and Eastern Europe, as well as parts of North America, presented relatively higher weighted prevalence rates of chronic backache, ranging from 7% to 9%. This corresponded to approximately 70,796 to 91,023 cases of 1,011,368 participants. Regarding correlates, older age (aged 12.5-14.5 y: odds ratio [OR] 1.10, 95% confidence interval [CI] 1.05-1.15; P<.001; aged 14.5-17 y: OR 1.27, 95% CI 1.22-1.32; P<.001), female sex (OR 1.22, 95% CI 1.17-1.28; P<.001), excess weight (OR 1.14, 95% CI 1.11-1.17; P<.001), and later years of data collection (OR 1.04, 95% CI 1.04-1.05; P<.001) were associated with higher odds of reporting chronic backache. In contrast, medium (OR 0.83, 95% CI 0.81-0.85; P<.001) and high (OR 0.90, 95% CI 0.86-0.93; P<.001) socioeconomic status showed lower odds of experiencing chronic backache than low socioeconomic status. Conclusions: This study revealed a sustained upward trend in the prevalence of backache in children and adolescents over the years (2001-2019), especially in North America and Northern and Eastern Europe. In addition, older age, female sex, excess weight, and later years of data collection were identified as correlates of experiencing chronic backache. Moreover, middle and high socioeconomic status were associated with lower odds of reporting chronic backache, potentially indicating differences in lifestyle, access to health care, or other protective factors.