The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan

• Main Authors: Takaaki Ikeda, Kemmyo Sugiyama, Jun Aida, Toru Tsuboya, Ken Osaka
• Format: Article
• Language: English
• Published: MDPI AG 2019-10-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: unemployment rate; socioeconomic status; education; occupation; bayesian approach; e-value; spillover effect
• Online Access: https://www.mdpi.com/1660-4601/16/20/4016

This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese subnational level areas. Workers aged 18&#8722;64 years (<i>n</i> = 962,586) were eligible to participate in the study. A multilevel logistic model was used to examine the association between the unemployment rate and lower back pain. The self-report of lower back pain was a dependent variable. The prefecture-level unemployment rate was analyzed as an independent variable, adjusted for individual-level covariates (e.g., gender, age, socioeconomic status). After adjusting for all covariates, the main effect of the prefecture-level unemployment rate was statistically significant: the odds ratio (OR) (95% credible interval (CrI)) was 1.01 (1.002, 1.03). Additionally, the OR (95% CrI) for the interaction between gender and the prefecture-level unemployment rate was 1.02 (1.01, 1.03) indicating that women were more affected by area-level employment status than men. In conclusion, a significant association between the unemployment rate and lower back pain was observed in the Japanese working population. Women were more sensitive to the unemployment rate.