The Prevalence and Factors Associated with Musculoskeletal Pain Among Pilgrims During the Hajj

Figures & data

Table 1 Characteristics of the Respondents

Variables		N (%)
		Male	Female	Total
Respondents Included for Falls Analysis
Sex		920 (53.64)	795 (46.36)	1715 (100)
Age (years)	18–29	307 (52.03)	283 (47.97)	590 (34.40)
	30–39	250 (58.00)	181 (42.00)	431 (25.13)
	40–49	142 (49.65)	144 (50.35)	286 (16.68)
	50–59	133 (53.20)	117 (46.80)	250 (14.58)
	≥60	88 (55.70)	70 (44.30)	158 (9.21)
BMI (kg/cm^2)	Underweight (<18.5)	45 (62.50)	27 (37.5‬0)	72 (4.20)
	Normal weight (18.5–24.9)	379 (50.60)	370 (49.40)	749 (43.67)
	Overweight (25–29.9)	210 (51.98)	194 (48.02)	404 (23.56)
	Obese (≥30)	286 (58.37)	204 (41.63)	490 (28.57)
Respondents Included for Musculoskeletal Pain Analysis^a
Sex		811 (54.83)	668 (45.17)	1479 (100)
Age (years)	18–29	283 (53.60)	245 (46.40)	528 (35.70)
	30–39	228 (59.22)	157 (40.78)	385 (26.03)
	40–49	123 (50.20)	122 (49.80)	245 (16.57)
	50–59	103 (53.37)	90 (46.63)	193 (13.05)
	≥60	74 (57.81)	54 (42.19)	128 (8.65)
BMI (kg/cm^2)	Underweight (<18.5)	39 (61.90)	24 (38.10)	63 (4.26)
	Normal weight (18.5–24.9)	329 (52.14)	302 (47.86)	631 (42.66)
	Overweight (25–29.9)	188 (53.11)	166 (46.89)	354 (23.94)
	Obese (≥30)	255 (59.16)	176 (40.84)	431 (29.14)

Note: ^aRespondents who experienced falls (n=263) during the Hajj were excluded from the musculoskeletal pain analysis.

Abbreviations: N, number; %, percentage; BMI, body mass index; kg, kilogram; cm, centimeter.

Table 2 Prevalence of Falls by Sex and Age

Variables		Male	Female	P-value	Male and Female
Sex		11.85 (9.92–14.10)	15.97 (13.59–18.68)	0.013	13.76 (12.21–15.47)
Age Group	18–29	7.82 (5.31–11.37)	13.43 (9.94–17.89)	0.026	10.51 (8.28–13.24)
	30–39	8.80 (5.88–12.96)	13.26 (9.07–18.97)	0.139	10.67 (8.10–13.94)
	40–49	13.38 (8.74–19.95)	15.28 (10.31–22.05)	0.647	14.34 (10.75–18.87)
	50–59	22.56 (16.28–30.37)	23.08 (16.37–31.49)	0.922	22.80 (18.03–28.39)
	≥60	15.91 (9.72–24.95)	22.86 (14.59–33.95)	0.269	18.99 (13.64–25.81)
	P-value	0.000	0.054		0.000

Notes: The results of prevalence of falls with 95% CIs are presented as percentages (%). Based on Pearson’s chi-squared tests, the P-values of statistically significant differences (P<0.05) between sex and age groups are shown in bold.

Table 3 Point Prevalence of Musculoskeletal Pain by Anatomical Site, Sex and Age

Pain Site	Sex	Age Group					P-value
		18–29	30–39	40–49	50–59	≥60
Shoulder	Male	12.37 (9.03–16.71)	13.16 (9.37–18.16)	7.32 (3.90–13.32)	16.50 (10.57–24.85)	14.86 (8.51–24.69)	0.290
	Female	17.14 (12.94–22.36)	17.83 (12.64–24.57)	20.49 (14.28–28.50)	16.67 (10.37–25.69)	11.11 (5.19–22.19)	0.669
Upper Arm	Male	1.41 (0.55–3.58)	3.95 (2.09–7.33)	4.88 (2.25–10.23)	1.94 (0.53–6.81)	2.70 (0.74–9.33)	0.261
	Female	3.27 (1.66–6.31)	3.18 (1.37–7.24)	0.00 (0.00–3.05)	0.00 (0.00–4.09)	1.85 (0.33–9.77)	0.131
Elbow	Male	1.41 (0.55–3.58)	2.19 (0.94–5.03)	1.63 (0.45–5.74)	0.97 (0.17–5.30)	4.05 (1.39–11.25)	0.575
	Female	0.41 (7e-04–2.28)	3.18 (1.37–7.24)	2.46 (0.84–6.98)	4.44 (1.74–10.88)	1.85 (0.33–9.77)	0.146
Forearm	Male	1.77 (0.76–4.07)	2.19 (0.94–5.03)	1.63 (0.45–5.74)	4.85 (2.09–10.86)	4.05 (1.39–11.25)	0.376
	Female	3.27 (1.66–6.31)	1.27 (0.35–4.53)	0.82 (0.14–4.50)	5.56 (2.40–12.35)	1.85 (0.33–9.77)	0.172
Wrist/Hand	Male	3.53 (1.93–6.38)	1.75 (0.68–4.42)	1.63 (0.45–5.74)	5.83 (2.70–12.13)	8.11 (3.77–16.58)	0.045
	Female	3.27 (1.66–6.31)	3.18 (1.37–7.24)	4.10 (1.76–9.24)	10.00 (5.35–17.92)	1.85 (0.33–9.77)	0.056
Head	Male	12.72 (9.33–17.11)	10.09 (6.82–14.68)	12.20 (7.53–19.15)	15.53 (9.79–23.75)	16.22 (9.53–26.24)	0.555
	Female	14.69 (10.81–19.67)	23.57 (17.61–30.79)	19.67 (13.59–27.60)	15.56 (9.50–24.43)	5.56 (1.91–15.11)	0.022
Neck	Male	6.36 (4.06–9.83)	12.28 (8.63–17.18)	11.38 (6.90–18.20)	17.48 (11.35–25.94)	17.57 (10.56–27.77)	0.007
	Female	17.14 (12.94–22.36)	13.38 (8.92–19.58)	13.11 (8.24–20.25)	10.00 (5.35–17.92)	5.56 (1.91–15.11)	0.158
Thoracic	Male	13.07 (9.64–17.50)	10.96 (7.54–15.69)	8.13 (4.48–14.32)	12.62 (7.53–20.40)	13.51 (7.51–23.12)	0.650
	Female	13.88 (10.10–18.77)	12.74 (8.40–18.86)	6.56 (3.36–12.41)	17.78 (11.25–26.94)	11.11 (5.19–22.19)	0.151
Lumbar	Male	19.43 (15.25–24.44)	28.07 (22.64–34.23)	28.46 (21.23–36.99)	32.04 (23.81–41.56)	36.49 (26.44–47.87)	0.010
	Female	31.43 (25.94–37.49)	32.48 (25.65–40.15)	32.79 (25.09–41.53)	21.11 (13.95–30.63)	37.04 (25.42–50.37)	0.249
Hip/Pelvis	Male	1.41 (0.55–3.58)	2.19 (0.94–5.03)	1.63 (0.45–5.74)	2.91 (1.00–8.22)	13.51 (7.51–23.12)	0.000
	Female	6.12 (3.75–9.85)	2.55 (1.00–6.37)	6.56 (3.36–12.41)	14.44 (8.64–23.16)	9.26 (4.02–19.91)	0.009
Thigh	Male	11.66 (8.42–15.92)	13.16 (9.37–18.16)	8.94 (5.07–15.31)	10.68 (6.07–18.12)	17.57 (10.56–27.77)	0.445
	Female	19.59 (15.11–25.01)	13.38 (8.92–19.58)	12.30 (7.59–19.30)	11.11 (6.15–19.26)	3.70 (1.02–12.54)	0.019
Knee	Male	12.37 (9.03–16.71)	17.98 (13.54–23.48)	19.51 (13.48–27.39)	30.10 (22.09–39.54)	39.19 (28.86–50.58)	0.000
	Female	17.96 (13.66–23.25)	14.01 (9.44–20.31)	28.69 (21.41–37.27)	46.67 (36.71–56.90)	37.04 (25.42–50.37)	0.000
Leg	Male	24.03 (19.42–29.33)	25.44 (20.22–31.47)	26.02 (19.07–34.41)	24.27 (17.02–33.38)	43.24 (32.57–54.59)	0.018
	Female	36.33 (30.56–42.52)	28.03 (21.59–35.51)	30.33 (22.87–38.98)	38.89 (29.47–49.22)	40.74 (28.68–54.03)	0.209
Ankle/Foot	Male	43.46 (37.81–49.29)	37.72 (31.68–44.17)	35.77 (27.85–44.56)	24.27 (17.02–33.38)	35.14 (25.24–46.50)	0.015
	Female	42.86 (36.82–49.12)	40.76 (33.39–48.58)	34.43 (26.59–43.22)	41.11 (31.51–51.44)	27.78 (17.62–40.89)	0.216
Lower Extremity^a	Male	57.60 (51.78–63.22)	60.09 (53.61–66.23)	60.98 (52.15–69.14)	59.22 (49.57–68.22)	77.03 (66.25–85.13)	0.049
	Female	71.84 (65.90–77.10)	66.24 (58.54–73.17)	68.85 (60.17–76.39)	78.89 (69.37–86.05)	72.22 (59.11–82.38)	0.304
All^b	Male	69.96 (64.39–75.01)	77.19 (71.32–82.16)	80.49 (72.61–86.52)	78.64 (69.77–85.45)	83.78 (73.76–90.47)	0.040
	Female	85.71 (80.78–89.55)	82.80 (76.13–87.90)	86.89 (79.75–91.76)	90.00 (82.08–94.65)	87.04 (75.58–93.58)	0.616

Notes: ^aMusculoskeletal pain at the hip/pelvis, thigh, knee, leg and ankle/foot sites. ^bMusculoskeletal pain at any site. The results of point prevalence of musculoskeletal pain with 95% CIs are presented as percentages (%). Based on Pearson’s chi-squared tests, the values of statistically significant differences (P<0.05) between sexes (prevalence values) and age groups (P-values) are shown in bold.

Figure 1 The prevalence of musculoskeletal pain by site. This figure shows the point prevalence of musculoskeletal pain among pilgrims. The results are presented as frequencies and percentages for each site.

Table 4 Risk Ratios for Overall (Pain at Any Site) and Total Lower Limb (Pain in the Hip/Pelvis, Thigh, Knee, Leg and Ankle/Foot) Musculoskeletal Pain in the Hajj Population by Sex, Age and BMI

Variables		Model 1 (CRR)^a	P-value	Model 2 (ARR)^b	P-value
Overall Musculoskeletal Pain
Sex	Male	1	-	1	-
	Female	1.13 (1.08–1.19)	0.000	1.13 (1.07–1.18)	0.000
Age (years)	18–29	1	-	1	-
	30–39	1.03 (0.96–1.10)	0.421	1.02 (0.95–1.09)	0.632
	40–49	1.08 (1.01–1.16)	0.031	1.06 (0.99–1.14)	0.121
	50–59	1.09 (1.01–1.17)	0.036	1.07 (0.99–1.15)	0.092
	≥60	1.10 (1.01–1.20)	0.027	1.07 (0.98–1.16)	0.140
BMI (kg/cm^2)	<18.5	1.00 (0.88–1.15)	0.958	1.03 (0.91–1.17)	0.652
	18.5–24.9	1	-	1	-
	25–29.9	1.03 (0.96–1.10)	0.358	1.02 (0.96–1.09)	0.469
	≥30	1.04 (0.98–1.10)	0.251	1.03 (0.97–1.09)	0.338
Total Lower Limb Musculoskeletal Pain
Sex^c	Male	1	-	1	-
	Female	1.17 (1.08–1.26)	0.000	1.16 (1.08–1.25)	0.000
Age (years)^c	18–29	1	-	1	-
	30–39	0.97 (0.88–1.08)	0.620	0.98 (0.88–1.08)	0.618
	40–49	1.01 (0.90–1.13)	0.851	0.99 (0.89–1.12)	0.983
	50–59	1.07 (0.95–1.20)	0.282	1.07 (0.96–1.20)	0.228
	≥60	1.17 (1.04–1.32)	0.010	1.14 (1.02–1.28)	0.024
BMI (kg/cm^2)^d	<18.5	0.99 (0.82–1.21)	0.933	1.03 (0.85–1.26)	0.731
	18.5–24.9	1	-	1	-
	25–29.9	1.01 (0.92–1.11)	0.834	1.03 (0.93–1.13)	0.610
	≥30	1.07 (0.98–1.16)	0.154	1.09 (1.01–1.19)	0.039

Notes: ^aUnadjusted risk ratio. ^bRisk ratio adjusted for sex, age and BMI. ^cRisk ratio adjusted for only sex and age as the convergence was not achieved when a third factor (BMI) was included in the model 2. ^dRisk ratio adjusted for only sex and BMI as the convergence was not achieved when a third factor (age) was included in the model 2. The results are presented as risk ratios with 95% CIs. Based on log-binomial models, the P-values of statistically significant associations (P<0.05) are shown in bold.

Abbreviations: CRR, crude risk ratio; ARR, adjusted risk ratio; CI, confidence interval; BMI, body mass index; kg, kilogram; cm, centimeter.

Table 5 Risk Ratios for the Most Common Sites of Musculoskeletal Pain in the Hajj Population by Sex, Age and BMI

Variables		Model 1 (CRR)^a	P-value	Model 2 (ARR)^b	P-value	Model 1 (CRR)^a	P-value	Model 2 (ARR)^b	P-value
		Ankle/Foot Pain				Leg Pain
Sex	Male	1	-	1	-	1	-	1	-
	Female	1.05 (0.92–1.20)	0.457	1.05 (0.92–1.20)	0.444	1.28 (1.10–1.50)	0.002	1.28 (1.09–1.49)	0.002
Age (years)	18–29	1	-	1	-	1	-	1	-
	30–39	0.90 (0.77–1.06)	0.204	0.90 (0.77–1.06)	0.202	0.89 (0.72–1.10)	0.286	0.88 (0.71–1.10)	0.260
	40–49	0.81 (0.67–0.99)	0.039	0.81 (0.66–0.99)	0.045	0.95 (0.75–1.20)	0.656	0.92 (0.72–1.17)	0.494
	50–59	0.74 (0.59–0.93)	0.011	0.74 (0.59–0.93)	0.011	1.05 (0.82–1.34)	0.725	1.03 (0.80–1.33)	0.821
	≥60	0.74 (0.57–0.97)	0.031	0.74 (0.56–0.97)	0.032	1.42 (1.11–1.81)	0.005	1.39 (1.08–1.78)	0.010
BMI (kg/cm^2)	<18.5	0.99 (0.72–1.37)	0.969	0.97 (0.70–1.33)	0.842	0.86 (0.55–1.33)	0.492	0.85 (0.55–1.32)	0.463
	18.5–24.9	1	-	1	-	1	-	1	-
	25–29.9	0.85 (0.71–1.01)	0.065	0.91 (0.76–1.08)	0.278	1.03 (0.84–1.25)	0.774	1.01 (0.83–1.24)	0.914
	≥30	0.99 (0.85–1.15)	0.872	1.07 (0.91–1.25)	0.408	1.03 (0.85–1.24)	0.791	1.01 (0.84–1.23)	0.889
		Low Back Pain				Knee Pain
Sex	Male	1	-	1	-	1	-	1	-
	Female	1.17 (0.99–1.38)	0.051	1.18 (1.01–1.39)	0.045	1.24 (1.02–1.50)	0.031	1.23 (1.02–1.48)	0.029
Age (years)	18–29	1	-	1	-	1	-	1	-
	30–39	1.19 (0.97–1.48)	0.101	1.13 (0.91–1.40)	0.257	1.09 (0.81–1.48)	0.564	1.06 (0.78–1.44)	0.724
	40–49	1.22 (0.96–1.56)	0.097	1.13 (0.89–1.45)	0.323	1.61 (1.19–2.18)	0.002	1.50 (1.10–2.05)	0.010
	50–59	1.07 (0.82–1.41)	0.594	0.98 (0.73–1.29)	0.863	2.53 (1.93–3.32)	0.000	2.33 (1.75–3.10)	0.000
	≥60	1.47 (1.12–1.93)	0.005	1.36 (1.03–1.80)	0.028	2.56 (1.90–3.45)	0.000	2.37 (1.74–3.22)	0.000
BMI (kg/cm^2)	<18.5	0.60 (0.33–1.07)	0.086	0.62 (0.35–1.12)	0.114	0.99 (0.57–1.74)	0.979	1.06 (0.61–1.84)	0.836
	18.5–24.9	1	-	1	-	1	-	1	-
	25–29.9	1.11 (0.90–1.37)	0.324	1.08 (0.87–1.33)	0.494	1.28 (0.99–1.66)	0.055	1.10 (0.85–1.42)	0.458
	≥30	1.23 (1.02–1.48)	0.033	1.20 (0.99–1.46)	0.062	1.60 (1.27–2.00)	0.000	1.30 (1.03–1.64)	0.025

Notes: ^aUnadjusted risk ratio. ^bRisk ratio adjusted for sex, age and BMI. The results are presented as risk ratios with 95% CIs. Based on log-binomial models, the P-values of statistically significant associations (P<0.05) are shown in bold.

Abbreviations: BMI, body mass index; CRR, crude risk ratio; ARR, adjusted risk ratio; CI, confidence interval; kg, kilogram; cm, centimeter.

Table 6 Association Between Ankle/Foot Pain and Pain in the Leg, Knee and Lower Back

Variables		Model 1 (CRR)^a	P-value	Model 2 (ARR)^b	P-value
Leg	No pain	1	-	1	-
	Pain	1.44 (1.27–1.64)	0.000	1.47 (1.29–1.67)	0.000
Knee	No pain	1	-	1	-
	Pain	1.35 (1.17–1.54)	0.000	1.43 (1.25–1.65)	0.000
Lower back	No pain	1	-	1	-
	Pain	1.21 (1.06–1.39)	0.004	1.24 (1.08–1.42)	0.002

Notes: ^aUnadjusted risk ratio. ^bRisk ratio adjusted for sex, age and BMI. Based on log-binomial models, the P-values of statistically significant associations (P<0.05) are shown in bold.

Abbreviations: CRR, crude risk ratio; ARR, adjusted risk ratio; CI, confidence interval; BMI, body mass index; kg, kilogram; cm, centimeter.