Association of Individual and Contextual Factors with Chronic Spine Problems: An Analysis from the National Health Survey

The spine is the most affected region, which compromises functionality and generates absenteeism, increased health care costs, and disability retirement rates. Based on the biopsychosocial model, it is believed that chronic back problems are the result of a complex network of factors, both individual and contextual. A cross-sectional study was developed with data from the 2013 National Health Survey, the United Nations Development Programme, and the National Register of Health Establishments (state level) for the second and third levels of aggregation, respectively. Multilevel Poisson regression was performed at three levels. The prevalence of chronic back problems was 18.5% (95% CI 17.8; 19.1), with a higher prevalence in females (RP = 1.23; 95% CI 1.15; 1.30), those aged above 49 years (RP = 1.75; 95% CI 1.61; 1.90), those performing heavy activities at work (RP = 1.37; 95% CI 1.28; 1.46), those with depressive days (RP = 1.70; 95% CI 1.50; 1.94), those who were smokers (RP = 1.37; 95% CI 1.27; 1.48), and those in states with a higher coefficient of Family Health Support Team per 100,000 inhabitants (PR = 1.28; 95% CI 1.07; 1.54). Chronic spine problems were associated with biological and behavioral factors and were more strongly associated with the coefficient of Family Health Support Team in Brazilian municipalities.