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Investigating the determinants of international differences in the prevalence of chronic widespread pain: evidence from the European Male Ageing Study
  1. G J Macfarlane1,
  2. S R Pye2,
  3. J D Finn3,
  4. F C W Wu3,
  5. A J Silman2,
  6. G Bartfai4,
  7. S Boonen5,
  8. F Casanueva6,
  9. G Forti7,
  10. A Giwercman8,
  11. T S Han9,
  12. I T Huhtaniemi10,
  13. K Kula11,
  14. M E J Lean9,
  15. T W O’Neill2,
  16. N Pendleton12,
  17. M Punab13,
  18. D Vanderschueren14,
  19. and the EMAS Study Group
  1. 1
    Aberdeen Pain Research Collaboration (Epidemiology Group), University of Aberdeen, Scotland, UK
  2. 2
    Arthritis Research Campaign Epidemiology Unit, School of Translational Medicine, The University of Manchester, Manchester, UK
  3. 3
    The University of Manchester, Department of Endocrinology, Manchester Royal Infirmary, Manchester, UK
  4. 4
    Department of Obstetrics, Gynaecology and Andrology, Albert Svent-Gyorgy Medical University, Szeged, Hungary
  5. 5
    Leuven University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
  6. 6
    Division of Endocrinology, Department of Medicine, University of Santiago de Compostela, Santiago, Spain
  7. 7
    Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
  8. 8
    Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Lund, Sweden
  9. 9
    Department of Human Nutrition, University of Glasgow, Glasgow, Scotland, UK
  10. 10
    Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK
  11. 11
    Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland
  12. 12
    Clinical Gerontology, The University of Manchester, Manchester, UK
  13. 13
    Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
  14. 14
    Leuven University Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
  1. Professor G J Macfarlane, Epidemiology Group, Department of Public Health, University of Aberdeen, School of Medicine, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; g.j.macfarlane{at}


Objectives: To determine whether among middle-aged and elderly men there is evidence of international differences in the prevalence of chronic widespread pain (CWP) and whether any such differences could be explained by psychological, psychosocial factors or differences in physical health status.

Methods: The European Male Ageing Study (EMAS) sampled from population registers in cities (centres) of eight European countries. Each centre recruited an age-stratified sample of men aged 40–79 years. Information on pain was collected by questionnaire and subjects were classified according to whether they satisfied the American College of Rheumatology definition of CWP. Information was collected on social status, mental health, recent life events and co-morbidities.

Results: Across all centres 3963 subjects completed a study questionnaire, with participation rates ranging from 24% in Hungary to 72% in Estonia. There were significant differences in prevalence: between 5% and 7% in centres in Italy, England, Belgium and Sweden, 9–15% in centres in Spain, Poland and Hungary and 15% in Estonia. There were strong relationships between poor mental health, adverse recent life events, co-morbidities and CWP. Adjustment for these factors explained between half and all of the excess risk in the eastern European centres: the excess risk in Poland was explained (odds ratio (OR) 1.1, 95% CI 0.9 to 1.2) but there remained excess risk in Hungary (OR 1.6, 95% CI 1.4 to 1.8) and Estonia (OR 2.6, 95% CI 2.2 to 2.9).

Conclusions: This study is the first directly to compare the occurrence of CWP internationally. There is an excess prevalence in countries of eastern Europe and this excess is associated with adverse psychosocial factors as well as poorer psychological and physical health.

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  • Competing interests: None.

  • Funding: The European Male Ageing Study was funded by the European Commission Framework Programme 5 QoL-2001-6 The Aging Population and their Disabilities, grant QLRT-2001-00258.

  • Ethics approval: Ethics approval was obtained from local ethics committees of each of the participating centres.

  • i Defined as pain lasting more than 6 months, having pain during the past month, several times during the past week, and last experienced pain having an intensity of 5 or more on a numeric rating scale: 1 (no pain) to 10 (worst pain imaginable).

  • The EMAS Study Group: Florence (Gianni Forti, Luisa Petrone, Antonio Cilotti); Leuven (Dirk Vanderschueren, Steven Boonen, Herman Borghs); Lodz (Krzysztof Kula, Jolanta Slowikowska-Hilczer, Renata Walczak-Jedrzejowska); London (Ilpo Huhtaniemi); Malmö (Aleksander Giwercman); Manchester (Frederick Wu, Alan Silman, Terence O’Neill, Joseph Finn, Philip Steer, Abdelouahid Tajar, David Lee, Stephen Pye); Santiago (Felipe Casanueva, Marta Ocampo, Mary Lage); Szeged (George Bartfai, Imre Földesi, Imre Fejes); Tartu (Margus Punab, Paul Korrovitz); Turku (Min Jiang).