{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:17:58Z","timestamp":1773379078589,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Care"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite growing research, the relationship between social determinants of health (SDoH) and low back pain (LBP) remains inconsistent. This study aimed to investigate the associations between SDoH and self\u2010reported LBP in the Portuguese population in 2019 and explore potential differences between rural and urban areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a cross\u2010sectional study that includes 13,230 participants from the 2019 Portuguese National Health Interview Survey. Multivariable logistic regression models were used to assess the associations between SDoH and LBP. Interaction effects were examined to determine whether these relationships are modified by the degree of urbanisation\/rurality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The regression model for demographic and economic determinants showed associations between LBP and sex, age, marital status, education and financial capacity, with older rural residents having a higher likelihood of reporting LBP. The psychosocial model revealed that poor health status, sleep disturbances, fatigue, and dissatisfaction with life course were positively associated with LBP. In the behavioural model, obesity and history of smoking increased the probability of reporting LBP, whereas exercise behaviours reduced it and significantly varied across urban and rural regions. Health\u2010system factors, including hospital visits, medication use, consultations with rehabilitation professionals, delayed healthcare access, and unmet health needs due to financial constraints, were associated with LBP. Rural residents were more likely to seek outpatient care at hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>These findings emphasise the importance of integrating the evaluation of SDoH into healthcare settings to develop tailored interventions for LBP management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LBP was influenced by several SDoH, but differences between rural and urban areas were limited.<\/jats:p><\/jats:sec>","DOI":"10.1002\/msc.70025","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T04:44:41Z","timestamp":1735015481000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Low Back Pain Disparities in Portugal: A Population\u2010Based Study Analysing the Role of Social Determinants of Health"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2542-1456","authenticated-orcid":false,"given":"Susana Tinoco","family":"Duarte","sequence":"first","affiliation":[{"name":"Comprehensive Health Research Center National School of Public Health NOVA University Lisbon  Lisbon Portugal"},{"name":"Physical Therapy Department Polytechnic Institute of Set\u00fabal Campus do Instituto Polit\u00e9cnico de Set\u00fabal  Set\u00fabal Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joana","family":"Alves","sequence":"additional","affiliation":[{"name":"Comprehensive Health Research Center National School of Public Health NOVA University Lisbon  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo Brazete","family":"Cruz","sequence":"additional","affiliation":[{"name":"Physical Therapy Department Polytechnic Institute of Set\u00fabal Campus do Instituto Polit\u00e9cnico de Set\u00fabal  Set\u00fabal Portugal"},{"name":"Comprehensive Health Research Center NOVA University Lisbon  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Heleno","sequence":"additional","affiliation":[{"name":"Comprehensive Health Research Center NOVA Medical School NOVA University Lisbon Rua do Instituto Bacteriol\u00f3gico n\u00ba5  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Comprehensive Health Research Center National School of Public Health NOVA University Lisbon  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen\u20102015\u2010000166"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106963\u201012\u2010357"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)30488\u20104"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2021.07.005"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31815e7f94"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102018\u2010100087"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2017.09.004"},{"key":"e_1_2_10_9_1","unstructured":"European Union.2024. \u201cEurostat: Degree of Urbanisation.\u201dhttps:\/\/ec.europa.eu\/eurostat\/web\/gisco\/geodata\/population\u2010distribution\/degree\u2010urbanisation. July 23 2024."},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665\u20109913(23)00098\u2010X"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665\u20109913(23)00098\u2010X"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000809"},{"key":"e_1_2_10_13_1","article-title":"The Burden of Chronic Low Back Pain in the Adult Portuguese Population: An Epidemiological Population\u2010Based Study Under the Scope of Epireumapt","author":"Gouveia N.","year":"2015","journal-title":"Faculdade de Ci\u00eancias M\u00e9dicas da Universidade Nova de Lisboa"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296\u2010015\u20103398\u20107"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)30480\u2010X"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34347"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001933"},{"key":"e_1_2_10_18_1","volume-title":"Inqu\u00e9rito Nacional de Sa\u00fade 2014: Edi\u00e7\u00e3o 2016","author":"Instituto Nacional de Estat\u00edstica (INE)","year":"2016"},{"key":"e_1_2_10_19_1","volume-title":"Documento Metodol\u00f3gico. Inqu\u00e9rito Nacional de Sa\u00fade 2019","author":"Instituto Nacional de Estat\u00edstica (INE)","year":"2019"},{"key":"e_1_2_10_20_1","unstructured":"Instituto Nacional de Estat\u00edstica (INE).2023.Instituto Nacional de Estat\u00edstica.https:\/\/www.ine.pt\/xportal\/xmain?xpid=INE&xpgid=ine_indicadores&indOcorrCod=0008800&contexto=bd&selTab=tab2&xlang=pt."},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1532\u20102149.2012.00170.x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.15263"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2022.04.001"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001944"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.3676"},{"key":"e_1_2_10_26_1","first-page":"39","article-title":"Sociodemographic Characterization of Self\u2010Reported Chronic Low Back Pain Prevalence in Portugal: Results From the National Health Survey 2014","volume":"9","author":"Kislaya I.","year":"2017","journal-title":"Boletim Epidemiol\u00f3gico Observa\u00e7\u00f5es"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)00733\u20109"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00103\u2010017\u20102568\u2010z"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.09.1585"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586\u2010019\u201005918\u20101"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/23337214231190244"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l251"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.120627"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.578"},{"issue":"11","key":"e_1_2_10_35_1","first-page":"e476","article-title":"Framework for Building Primary Care Capacity to Address the Social Determinants of Health","volume":"63","author":"Pinto A. D.","year":"2017","journal-title":"Canadian Family Physician"},{"issue":"4","key":"e_1_2_10_36_1","first-page":"589","article-title":"Socio\u2010economic Inequalities in Occurrence and Health Care Costs in Rheumatic and Musculoskeletal Diseases: Results From a Spanish Population\u2010Based Study Including 1.9 Million Persons","volume":"36","author":"Putrik P.","year":"2018","journal-title":"Clinical and Experimental Rheumatology"},{"key":"e_1_2_10_37_1","volume-title":"Debates, Policy & Practice, Case Studies","author":"Solar O.","year":"2010"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.226050"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.2471\/blt.07.045120"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)32154\u20102"},{"key":"e_1_2_10_41_1","unstructured":"World Health Organization (WHO).2016. \u201cSocial Determinants of Health.\u201dhttp:\/\/www.who.int\/social_determinants\/en\/."}],"container-title":["Musculoskeletal Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/msc.70025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T02:24:51Z","timestamp":1735266291000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/msc.70025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/msc.70025"],"URL":"https:\/\/doi.org\/10.1002\/msc.70025","archive":["Portico"],"relation":{},"ISSN":["1478-2189","1557-0681"],"issn-type":[{"value":"1478-2189","type":"print"},{"value":"1557-0681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"2024-11-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70025"}}