Global, Regional, and National Burden of Low Back Pain, 1990–2020, Its Attributable Risk Factors, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

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SOURCE:   Lancet Rheumatology 2023 (May 23); 5 (6): E316-E329
Manuela L Ferreira, Katie de Luca, Lydia M Haile, Jaimie D Steinmetz, Garland T Culbreth, et al.

Faculty of Medicine and Health,
Institute of Bone and Joint Research,
The Kolling Institute, Northern Clinical School,
University of Sydney,
Sydney, NSW 2064, Australia.

Background   Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021.

Methods   Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates.

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Findings   In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people globally, with a projection of 843 million (759–933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100,000 (578–1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10·4% (10·9–10·0) and 10·5% (11·1–10·0), respectively. A total of 38·8% (28·7–47·0) of YLDs were attributed to occupational factors, smoking, and high BMI.

Interpretation   Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both

Funding   Bill and Melinda Gates Foundation.

From the FULL TEXT Article:


The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) systematically quantifies health loss due to diseases and injuries by age, sex, year, and geographical location, and allows for the comparison of burden across disparate diseases. [1] Previous GBD low back pain estimates [2–4] confirmed that low back pain is the leading cause of disability in most countries. It is expected that both the total disability burden and disease-related costs will further increase in the coming decades. [5]

In response, global efforts have been made to provide clearer directions for change in policy and practice and to support the use of evidence-based management and prevention. [5–8] In 2018, The Lancet published a three-part Series on the definition, best-evidence-based treatment, and future research directions for low back pain. The Series highlighted the roles of advice and education that support self-management, physical, and psychological interventions, especially as first-line treatments for low back pain. [5, 7, 8] However, there is still inappropriately high usage of imaging, prescribed bed rest, opioids, spinal injections, and other invasive procedures of questionable efficacy worldwide. [8] Paradoxically, the use of treatments of no or little efficacy can delay recovery and potentially increase the risk of long-term back-related disability, and consequently increase the burden of this condition globally.

In the current report we present global, regional, and national-level estimates of prevalence and years lived with disability (YLDs) of low back pain in the general population. Estimates are reported in terms of numbers (count) and age-standardised rates, by age and sex, for 204 countries and territories, from 1990 to 2020. We also highlight the relative contribution of occupational factors, smoking, and high BMI to the prevalence and burden of low back pain and present projections of cases for 2030–50.

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