Study Design. A 5-year observational cohort design using data from a randomized controlled trial of calcium intervention. Objective. To describe the epidemiology of back pain and determine the association of back pain frequency to mortality, coronary heart events, mobility, and quality of life in elderly women. Summary of Background Data. Although back pain is a common physical symptom in the elderly, little is known of its effects and long-term outcomes. Methods. The study subjects were 1484 community dwelling Australian women 70 to 85 years of age. At baseline and 5 years, back pain frequency was assessed by self-report, mobility by the Timed Up and Go Test (TUAG) and Quality of Life by the SF-36 questionnaire. The all cause of death data were ascertained from death certificates available for all deaths over 5 years, and incident clinical coronary heart disease (CHD) data were adjudicated from patient diaries verified by primary care physician and medication records. Results. At baseline and 5 years, 21.7% and 26.9% subjects experienced daily back pain ( >= 1/day) and 27.6% and 24.4% subjects experienced frequent back pain (1/mo to 1/day), respectively. Compared with those with infrequent ( < 1/mo) back pain, subjects with daily back pain had significantly lower quality of life physical component score and mobility as assessed by TUAG at both baseline and 5 years. Daily back was associated with greater overall mortality risk ( hazards ratio = 2.03; 95% confidence interval, 1.14-3.60) and greater risk of CHD mortality and new CHD diagnosis ( hazards ratio = 2.13; 95% CI, 1.35 3.34) after adjusted for baseline age. The effects remained significant after further adjustment for cardiovascular risk factors and physical activity level. Conclusion. Daily back pain is associated with reduced quality of life, mobility and longevity and increased risk of coronary heart events. The adverse health effects of chronic back pain deserve greater recognition.