Neighborhood walkability related to knee and low back pain for older people: A multilevel analysis

Abstract

Abstract Background Previous research has linked built environments to physical activity. However, the association between built environments and musculoskeletal pain is unknown. This study aimed to investigate the effects of neighborhood walkability as a built environment on the knee and low back pain for older people. Methods Data were from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independent people from aged 65 and older. A cross-sectional multilevel analysis was performed on 22,892 subjects in 792 neighborhoods. We used neighborhood walkability as regional level residents’ perception of access to parks and sidewalks and fresh food stores and difficulty in walking due to slopes and stairs and population density. Knee and low back pain which restrict daily life within the past year were our objective variables. Results The prevalence of knee pain was 26.2 %, and that of low back pain was 29.3 %. Neighborhood walkability was positively associated with knee and low back pain after adjusting for individual confounders and mediators such as physical activity, a quarter increased perception of access to parks and sidewalks decreased the prevalence of knee pain (PR: 0.85, 95% CI: 0.77-0.94), a quarter increased perception of access to fresh food store decreased the prevalence of knee and low back pain (PR: 0.90, 95% CI: 0.84-0.96, PR: 0.92, 95% CI: 0.86-0.98), a quarter increased population density decreased the prevalence of knee and low back pain (PR: 0.95; 95% CI: 0.93-0.98, PR: 0.96; 95% CI: 0.94-0.98). This trend remains after adjusting the population density, and higher difficulty in walking due to slopes and stairs is newly significant to knee pain (PR: 1.09; 95% CI: 1.01-1.18). Conclusions Some of the neighborhood walkability has a protective relation to the knee and low back pain for older people. Longitudinal and intervention studies of the built environment for musculoskeletal pain are required. Key messages To our knowledge, this is the first study to discover that neighborhood walkability has a protective relation to knee and low back pain considering various adjustments in a large-scale survey. Improvement of built environments could potentially reduce musculoskeletal pain. In the future, not only individual factors but also environmental determinants of pain should be studied.