Original Article
Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007

https://doi.org/10.1016/j.jmpt.2012.12.001Get rights and content

Abstract

Objectives

The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services.

Methods

Using the MEPS 2-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71 838), we identified 12 104 respondents with back pain and further categorized 3842 as chronic cases and 8262 as nonchronic cases.

Results

Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007.

Conclusion

The prevalence of back pain, especially chronic back pain, is increasing. To the extent that the growth in chronic back pain is caused, in part, by an aging population, the growth will likely continue or accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for prioritizing health policy, clinical practice, and research efforts to improve care outcomes, costs, and cost-effectiveness and for health workforce planning.

Section snippets

Data Source and Sampling

The Palmer College institutional review board authorized an exemption from review for this study because it used publicly available and de-identified data from the MEPS. The MEPS is a nationally representative survey of the noninstitutionalized US population, conducted annually by the Agency for Healthcare Research and Quality. Information is gathered on health care use, expenditures, and health behaviors. The MEPS 2-year longitudinal study design resurveys respondents during each of 5 separate

Analysis

We used SPSS version 19.0 (SPSS, Chicago, IL) to apply complex survey design methods to generate national estimates. Complex survey design methods account for the respondent's probability of selection and sampling design methodology.

In addition to estimating back pain prevalence and chronicity among the entire adult US population, we wanted to visualize the prevalence of chronic back pain and related use of various cohorts of interest as they aged their way through the health care system.

Results

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) (Table 1 and Fig 2). Over the entire 7-year period, chronic back pain accounted for more than half of the overall increase in back pain prevalence.

The mean (SD) age among all adults with

Discussion

Our study found that overall, the prevalence of back pain has increased by nearly 30% in recent years, of which the proportion of adults with chronic back pain has increased significantly. Our results corroborate previous reports that demonstrated the increasing prevalence of back pain4, 8 and increasing chronicity of back pain.11 We estimate that the total number of adults in the United States with chronic back pain increased by 64%, with a mean rate of increase of 8.3% per year. If the

Implications

Although this study shows that the prevalence of back pain is increasing, the rapid increase in the prevalence of chronic back pain is of the greatest concern. To the extent that this growth in chronic back pain is due partly to an aging population, the growth will likely continue to accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for

Limitations

Our study only investigated back pain trends among noninstitutionalized US adults 18 years or older. Trends may differ among children or among those in the military, and although we found a high rate of chronic back pain among the noninstitutionalized elderly population, we do not know how this compares with elderly residents of nursing homes. Also, because MEPS data on health care use and expenditures are derived from interviews, self-reporting errors may occur. However, MEPS attempts to

Conclusion

The prevalence of back pain is increasing, with chronic back pain showing the most rapid increase. An aging population likely contributes to the growing prevalence of chronic back pain, and increasing demand for back pain services will necessitate appropriate health workforce planning. Given that existing treatment patterns also contribute to driving concomitant growth in expenditures associated with back pain, priority should be given efforts to improve outcomes and the cost-effectiveness of

Funding Sources and Potential Conflicts of Interest

Monica Smith was supported in this work by National Institutes of Health (NIH) grant number 5K01AT002391. Matthew Davis was supported by NIH grant number 5K01AT006162. James Whedon was supported by NIH grant number 5K01AT005092. The contents of this manuscript are solely the responsibility of the author(s) and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the NIH.

Miron Stano contributed expertise in health economics and

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