Inverse Association Between Neck Pain and All-Cause Mortality in Community-Dwelling Older Adults

Objective - In a previous study, we found an apparent protective effect of neck pain on all-cause mortality in subjects over 85 years of age. The present longitudinal investigation was performed to verify this unexpected finding in a larger sample, and to establish its significance. Design – Population follow-up study. Setting – Three towns of Northern Italy. Subjects – We examined 5253 community dwelling residents aged 65-102 years, 55% female. Methods - Through postal questionnaire baseline information was obtained concerning cardiovascular risk factors, self-rated health, physical activity, cardiovascular events, medical therapy and presence of pain in the main joints. The 7-year all-cause mortality was the end-point. Results - During follow-up 1250 people died. After adjustment for age, sex, anti-inflammatory drugs, physical activity and main risk factors, neck pain was inversely associated with mortality (hazard ratio 0.74; 95% confidence interval 0.64-0.86; P<0.001). This association was present, with high significance, in each of the following subgroups: men, women, age 65-74, age 75-84, age ≥85, residents of each of the 3 towns. The subjects without neck pain (N=3158) were older, more often men, less often hypercholesterolemic, less physically active and more frequently with previous stroke than the subjects with neck pain (N=2095). There were no differences in the causes of death between subjects with or without neck pain. Conclusions - This study has confirmed the existence of an independent inverse association between neck pain and mortality in the elderly, suggesting that reduced sensitivity to neck pain may be a new marker of frailty.