Abstract
Few studies have focused on a relationship between the built environment and musculoskeletal pain. This study aimed to investigate an association between neighborhood walkability and knee and low back pain in older people. Data were derived from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independently living people ≥65 years old. A cross-sectional multilevel analysis was performed, of 22,892 participants in 792 neighborhoods. Neighborhood walkability was assessed by residents’ perceptions and population density. Dependent variables were knee and low back pain restricting daily activities within the past year. The prevalence of knee pain was 26.2% and of low back pain 29.3%. After adjusting for sociodemographic covariates, the prevalence ratio (PR) of knee and low back pain was significantly lower in neighborhoods with better access to parks and sidewalks, good access to fresh food stores, and higher population densities. After additionally adjusting for population density, easier walking in neighborhoods without slopes or stairs was significantly inversely correlated with knee pain (PR 0.91, 95% confidence interval 0.85–0.99). Neighborhoods with walkability enhanced by good access to parks and sidewalks and fresh food stores, easy walking without slopes or stairs, and high population densities, had lower prevalences of knee and low back pain among older people. Further studies should examine environmental determinants of pain.
Highlights
Musculoskeletal diseases, including osteoarthritis (OA), are major public health problems
We evaluated neighborhood walkability by asking about access to parks and sidewalks, access to fresh food stores, and easy walking without slopes or stairs
PR = prevalence ratio; 95% confidence intervals (CI) = 95% confidence interval. a Model 1 was adjusted for sex, age, equivalent annual income, educational background, and past occupation. b Model 2 was adjusted for the covariates in Model 1 plus walking time, physical activity, driving status, body mass index (BMI), and depressive symptoms. c Model 3 was adjusted for the covariates in Model 2 plus population density. * p < 0.05
Summary
Musculoskeletal diseases, including osteoarthritis (OA), are major public health problems. Between one in three and one in five people live with painful musculoskeletal conditions, making these diseases the second highest contributor to global disability. Low back pain alone is the leading cause of disability worldwide [1]. A strong relationship exists between musculoskeletal pain and a reduced capacity to engage in physical activity. This often results in functional decline, frailty, reduced quality of life, and loss of independence [2]. The prevalence and impact of musculoskeletal diseases are high in older people. While OA may be treated surgically when severe, it is considered amenable
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