Sociodemographic disparities in primary care management of back pain in children and young people: a population-based cohort study

Background
Research on the primary care management of back pain in children and young people (CYP) is scarce. Sociodemographic factors may influence presentation and management, potentially contributing to disparities in care and outcomes. This study aimed to describe the management of back pain in CYP and examine associations with sociodemographic characteristics.

Methods
Data were extracted from the Clinical Practice Research Datalink (CPRD) Aurum for 425,000 randomly sampled CYP aged 8–18 years with a new musculoskeletal pain episode between 2005 and 2021. Analgesia prescriptions, referrals and imaging within 6 months of an index consultation for back pain were extracted. Adjusted risk ratios (aRR) were calculated for age, gender, deprivation, ethnicity, region and index year.

Results
Of 51,335 CYP presenting with back pain, 78% had symptom-based codes for back pain or low back pain, and 12% had more specific diagnostic codes such as spinal deformities. 19% patients reconsulted for back pain in the 6 months following the index date. Analgesia was prescribed to 36% with higher prescribing rates among older CYP and those from more deprived areas (aRR most vs. least deprived 1.64; 95% CI 1.56, 1.72). Referrals (28%) and imaging (13%) were more common in older adolescents but less frequent among more deprived and minority ethnic groups. Prescribing declined over time (46% in 2005–2009 to 16% in 2020–2021), whereas referrals increased (17% to 40%).

Conclusions
Back pain in CYP often recurs and is primarily managed with analgesia and referrals. Socioeconomic and ethnic disparities in management highlight the need for equitable access to specialist care and consistent, evidence-based approaches.