Multimorbidity Patterns in Patients with Back Pain: A Study of Patient Records at a Primary Health Care Centre in Sweden

1.                   Abstract

In Primary Care, multimorbidity is the norm in most patients. A large part of these have pain disorders, very often related to the spine. Patients with back pain have a higher degree of multimorbidity than many other groups of patients. The aim of this epidemiological study was to elucidate various patterns of multimorbidity in terms of clusters of diseases among patients with low back pain (LBP).

1.1.              Methods: A retrospective cross-sectional study was performed containing all registered encounters with patients receiving a LBP related diagnosis at one Primary Health Care Centre (PHCC) in Stockholm area, Sweden. The period October 2011 to September 2014 was studied. The Johns Hopkins Case-mix System “Adjusted Clinical Groups” (ACG^©) was used for grouping and analysing data.

1.2.              Results: Out of 15,092 patients visiting the PHCC during the 3-year period exactly 10,000 got at least one diagnosis and 1,431 of those patients were diagnosed with LBP. Most common simultaneous groups of diagnoses were in order administrative concerns, hypertension, other musculoskeletal disorders and neurologic signs and symptoms. The proportion of patients with LBP disorders having five or more diagnoses was about 29%, and the equivalent proportion of patients without LBP was 9%. Different types of morbidity in terms of Aggregated Diagnosis Groups (ADGs) showed that about 55% of patients with LBP had three or more ADGs compared to 26% among patients who had no LBP. Patterns of multimorbidity in terms of the ACGs showed that patients with LBP were about twice as common in higher risk categories than patients without those diagnoses (52% vs 26%)

1.3.              Discussion: Our study showed that patients with LBP had a high degree of multimorbidity compared to those who did not have LBP and type of concurrent diseases differed between the two groups. The patterns of diagnosis clusters were analysed further and showed results that differed between various groups of patients with LBP, predominately depending on age. Further analysis is needed in order to understand what causes the various patterns of multimorbidity among patients with LBP.

2.                   Keywords: Low Back Pain; Multimorbidity; Adjusted Clinical Groups; Primary Care