Level of education and back pain in France: the role of demographic, lifestyle and physical work factors.

PURPOSE To investigate the pathways from level of education to low back pain (LBP) in the adult population, especially concerning the role of physical working constraints, and personal factors (overweight, tobacco consumption, and tallness). METHODS The study population consisted of 15,534 subjects from the National Health Survey, with data on LBP, level of education, personal factors, and physical working constraints. Logistic models for LBP (pain more than 30 days during the previous 12 months) were compared in order to check the consistency of the data with specific causal pathways. RESULTS Low back pain was strongly associated with level of education. This association was almost completely explained if present or past exposure to tiring work postures and handling of heavy loads were taken into account. For men, the OR for "no diploma", adjusted only for age, was 1.75; it was 1.02 after additional adjustment on physical work factors. Personal factors played also a role, especially overweight for women. Among them, the OR associated with a body mass index = 27 or more was 1.58 after adjustment on all the other factors. CONCLUSIONS In this national population the main pathways from education to LBP were through occupational exposure and lifestyle factors.