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It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Baseline information about musculoskeletal pain and risk factors was elicited from 11\u00a0710 participants aged 20\u201359\u00a0years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12\u00a0months before baseline (\u2018pain propensity index\u2019). After a mean interval of 14\u00a0months, 9055 participants (77.3%) provided follow\u2010up data on disabling <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> in the past month. Baseline risk factors for disabling <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> at follow\u2010up were assessed by random intercept Poisson regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> (prevalence rate ratios up to 2.6, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 2.2\u20133.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> varied sevenfold (much more than within\u2010country differences between nurses and office workers), and correlated with mean pain propensity index (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.58).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Within our study, major international variation in the prevalence of disabling <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working 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