Socio-demographic determinants of musculoskeletal pain incidence among slum and rural dwellers living in and around Dhaka, Bangladesh: A survival analysis

Background: Musculoskeletal pain is a significant public health problem, however, due to definitional and diagnostical difficulties there are very few estimates of its incidence, especially in developing countries. Available studies indicate inconsistencies in study design (cross-sectional) and in measurement and imprecise pain definition, making it difficult to obtain interpretable and comparable results. Materials and Methods: To identify influencing factors of musculoskeletal pain among residents of urban slums and rural areas, 9-month cohort data from Dhaka, Bangladesh, was analysed using survival analysis. The occurrence of six kinds of pain (body, joint, hip, back, breast and head), were visualized with Kaplan-Meier graphs, distinguished by sociodemographic factors and stratified by residential area. The Log-Rank test identified binary associations. Significant results as well as the factor sex were included into Cox-Regression model. Hazard ratios expressed the cumulative risk of pain event within nine month. Results: Out of 810 pain-free men (n=464) and women (n=346) at baseline study, 566 pain-free respondents were registered after 9 month of observation. Overall, 133 pain cases were identified and 111 people got lost-to-follow-up. Binary analysis showed significant associations between pain event and residential area, education, income, age, mental health and job dissatisfaction. After stratification by area, only age was significantly associated with pain. Multivariable analysis showed an increased pain risk for women, residents with low income, job dissatisfaction, age over 39 years and living in urban area (e.g. hazard ratio urban vs. rural area: 1.853, 95% CI: 1.09–3.13, p<0.022). Discussion: Musculoskeletal pain is identified as an important health problem among urban slum dwellers in Dhaka, Bangladesh. Therefore group-specific intervention strategies are necessary to enable a better life with less pain under disadvantaged conditions. Further comparable research is needed.