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Open Access Highly Accessed Research article

Over-indebtedness and its association with the prevalence of back pain

Elke B Ochsmann12*, Heiko Rueger3, Stephan Letzel3, Hans Drexler2 and Eva Muenster3

Author Affiliations

1 Institute of Occupational and Social Medicine, Medical Faculty, RWTH Aachen University Pauwelsstrasse 30, D-52074 Aachen, Germany

2 Institute of Occupational, Social, and Environmental Medicine, University of Erlangen-Nuremberg, Schillerstrasse 25, D-91054 Erlangen, Germany

3 Institute of Occupational, Social, and Environmental Medicine, University of Mainz, Obere Zahlbacher Strasse 67, D-55131 Mainz, Germany

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BMC Public Health 2009, 9:451  doi:10.1186/1471-2458-9-451

Published: 6 December 2009



Over-indebtedness is an increasing phenomenon worldwide. Massive financial strain, as found in over-indebted persons, might influence the occurrence of back pain. In this explorative study we examined the prevalence of back pain in over-indebted persons in Germany for the first time ever and compared it to the prevalence of back pain in the German general population.


A cross sectional study comprising 949 participants (52.6% women) was conducted to collect data on the point prevalence of back pain in an over-indebted collective. A representative sample of the German general population (N = 8318, 53.4% women) was used as non-indebted reference group.


The point prevalence of back pain was 80% in the over-indebted collective, compared to 20% in the general population. The influence of socioeconomic factors on the prevalence of back pain differed partially between the general population and the over-indebted collective. Being over-indebted was identified as an independent effect modifier and was associated with an eleven times increased probability to suffer from back pain (aOR: 10.92, 95%CI: 8.96 - 13.46).


Until now, only little is known about the effects of intense financial strain like over-indebtedness on health. Our study suggests that over-indebted persons represent a risk group for back pain and that it might be sensible to take financial strain into account when taking a medical history on back pain. Over-indebtedness and private bankruptcy is of increasing importance in industrialized countries, therefore more research on the subject seems to be necessary.