Summary
Background
Low back pain is highly prevalent and the leading cause of years lived with disability (YLD). We present the most up-to-date global, regional and national data on prevalence and YLDs for low back pain from the 2021 Global Burden of Diseases, Injuries and Risk Factors Study.
Methods
Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and contributor dataset contributions were used to estimate 1990 prevalence and YLDs for low back pain. by 2020, for 204 countries and territories.
Low back pain was defined as pain between the 12th ribs and the gluteal folds lasting one day or more; Input data using alternative definitions were fitted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and ADLs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using the sociodemographic index as a predictor and then multiplying by the projected population estimates.
Results
In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people worldwide, with a projected 843 million (759–933) prevalent cases by 2050.
In 2020, the overall age-standardized rate of YLD was 832 per 100,000 (578–1070). Between 1990 and 2020, age-standardized prevalence rates and ADLs 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 .
Figure : Global prevalence of low back pain by age and sex in 2020
Interpretation Low back pain remains the leading cause of YLD worldwide, and in 2020, there were more than 500 million prevalent cases of low back pain worldwide. While age-standardized rates have declined modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges remain in obtaining country-level primary data on low back pain, and there is an urgent need for more high-quality country-level primary data on prevalence and severity distributions to improve accuracy and monitor change. |
Discussion
This report presents estimates of the prevalence and burden of low back pain at the global, regional and national levels. In 2020, there were more than 500 million prevalent cases of low back pain worldwide, accounting for 7.7% of all YLDs and therefore the largest contribution to the global burden of disability. By 2050, a 36.4% increase in the total number of low back pain cases is expected globally, with the most substantial increases expected to be seen in Asia and Africa. Decomposition analyzes show that most of the increase in prevalence will be driven by population growth, except in some regions where population aging appears to be the main reason for the increase in the number of low back pain cases by 2050.
The high prevalence rate of low back pain observed in all regions of the world could have some important social and economic consequences, especially considering the substantial cost of care for this condition. For example, from 2012 to 2014, the direct aggregate costs for all people with a spinal condition in the US were $315 billion with a substantial proportion of the costs attributed to surgical procedures .
Additionally, medications prescribed for spinal conditions in Australia have shown a marked increase in recent years, with opioids becoming the most commonly prescribed class of medications for low back pain. It is now widely recognized that opioids are responsible for significant adverse health events, including high rates of addiction, accidental overdose, and death, resulting in additional costs to the individual and society due to medical care for opioid abuse and loss. of productivity. While speculative, it is possible that improving access to effective non-pharmacological care for low back pain could reduce some of the impact of the opioid epidemic.
Estimates show that among those available in the GBD study, three modifiable factors play an important role in the overall burden of low back pain. Nearly a quarter of YLDs due to low back pain were attributed to occupational ergonomic factors , which may include prolonged sitting or standing, bending, or lifting. As discussed above, low back pain forces more people out of the workplace than any other chronic health condition. Occupational exposures to lifting, bending, awkward postures, vibrations, and tasks considered physically demanding are associated with an increased risk of developing low back pain; however, no independent causal relationships have been demonstrated.
Globally, 12.5% and 11.5% of YLDs due to low back pain were attributed to lifestyle factors, smoking, and high BMI, respectively. Although both smoking and obesity have been shown to be associated with the occurrence of low back pain and the development of persistent low back pain, the specific causal mechanisms for these associations remain uncertain. Likewise, we lack evidence on the effectiveness of preventive strategies aimed at these two risk factors.
Comments
Analysis of more than 30 years of data has shown that the number of low back pain cases is increasing , and models suggest that by 2050, 843 million people will be affected by the condition, largely due to population growth and the aging of the population.
The continued lack of a consistent approach to treating back pain and limited treatment options has researchers concerned that this will lead to a healthcare crisis, as low back pain is the leading cause of disability in the world. .
In Australia, there will be a nearly 50 per cent increase in cases by 2050. The landscape of back pain cases will change, with the largest increases in back pain cases in Asia and Africa.
The findings are published in Lancet Rheumatology and are the new Global Burden of Disease (GBD) study.
“Our analysis paints a picture of rising cases of low back pain around the world, putting enormous pressure on our healthcare system. “We need to establish a national, consistent approach to managing low back pain that is based on research,” says lead author Professor Manuela Ferreira from Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Local Health District and the North Sydney Local Health Department. District.
“Currently, the way we have been responding to back pain has been reactive . Australia is a world leader in back pain research; “We can be proactive and lead by example in preventing back pain,” said Professor Ferreira, who works at the Kolling Institute in Sydney.
The study reveals several milestones in back pain cases. Since 2017, the number of low back pain cases has increased to more than 500 million people.
In 2020, there were approximately 619 million cases of back pain.
At least one-third of the disability burden associated with back pain was attributable to occupational factors, smoking, and overweight .
A widespread misconception is that low back pain primarily affects working-age adults. But researchers say this study has confirmed that low back pain is more common among older people. Cases of low back pain were also higher among women compared to men.
These are the most comprehensive and up-to-date data available, including for the first time global projections and the contribution of GBD risk factors to low back pain. The work was made possible through the joint efforts of the University of Sydney, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine (healthdata.org), IHME international collaborators, and the Global Alliance for Musculoskeletal Health. (gmusc.com).
“We also know that most of the available data comes from high-income countries, which sometimes makes it difficult to interpret these results for low- and middle-income countries. We urgently need more population-based musculoskeletal and back pain data from low- to middle-income countries,” said lead author Professor Lyn March from Sydney Musculoskeletal Health and the Kolling Institute.
The study analyzed GBD data from 1990 to 2020 from more than 204 countries and territories to map the landscape of back pain cases over time. The GBD is the most complete picture of mortality and disability across countries, time, age and is also the first study to be used to model the future prevalence of back pain cases.
"Health systems must respond to this enormous and growing burden of low back pain affecting people around the world. Much more needs to be done to prevent low back pain and ensure timely access to care, as there are effective ways of helping people in pain,” said Professor Anthony Woolf, co-chair of the Global Alliance for Musculoskeletal Health, which calls for priority to be given to addressing the growing burden of musculoskeletal diseases.
“Health ministries can no longer ignore the high prevalence of musculoskeletal conditions, including low back pain. These conditions have important social and economic consequences, especially considering the cost of care. Now is the time to learn about effective strategies to address the high burden and take action,” said Dr. Alarcos Cieza, Head of Unit, World Health Organization, Headquarters, Geneva.
National guidelines will form the basis of back pain prevention. In 2018, experts (independent of this study) expressed their concerns in The Lancet and gave recommendations, especially related to exercise and education, about the need for a change in global policy on how best to prevent and manage pain lumbar to stop the increase in inappropriate treatments .
However, since then, there has been little change. Common treatments recommended for low back pain have been found to be of unknown or ineffective efficacy; this includes some surgeries and opioids.
Professor Ferreira says there is a lack of consistency in the way health professionals handle back pain cases and how the health system needs to adapt. It may surprise some that current clinical guidelines for the treatment and management of back pain do not provide specific recommendations for older people.”
“Older people have more complex medical histories and are more likely to be prescribed strong medications, including opioids for back pain management, compared to younger adults. But this is not ideal and can have a negative impact on your function and quality of life, especially because these pain relievers can interfere with your other existing medications. “This is just one example of why we need to update clinical guidelines to support our healthcare professionals.”
Co-author Dr Katie de Luca, from CQUniversity, said if the right measures are not taken, low back pain can become a precursor to chronic health conditions such as diabetes, cardiovascular disease and mental health conditions, invasive medical procedures and significant disability.
“Low back pain remains the largest cause of disability burden worldwide.
“There are significant socioeconomic consequences of this condition, and the physical and personal impact directly threatens healthy aging.”
Research in context
Evidence before this study
The Global Burden of Diseases, Injuries and Risk Factors (GBD) study is a source of estimates of the burden of disease at global, regional and national levels over time. Input data is identified through a systematic review in addition to US medical claims data. In 2017, it was estimated that more than 551 million people suffered from low back pain, which was ranked as the largest contributing factor to the burden of disability around the world. To date, there is no published projection of the global prevalence of low back pain.
Added value of this study
The current analysis includes estimates from 1990 to 2020 with updated bias adjustments and prevalence projections through 2050. In 2020, an estimated 619 million (95% uncertainty interval 554 to 694) people reported having low back pain worldwide. Between 1990 and 2020, there was a decline in age-standardized prevalence rates (-10.4%; -10.9 to -10.0) and years lived with disability (-10.5%; -11.1 to –10·0).
Modifiable risk factors for GBD, including occupational ergonomic factors, smoking, and high BMI, accounted for 38.8% (28.7 to 47.0) of years lived with disability. Low back pain prevalence projections suggest that in 2050 there will be 843 million (759 to 933) people worldwide with low back pain, an increase of 36.4% (29.9 to 43.2) from 2020.
Implications of all available evidence
Low back pain remains the largest cause of disability burden worldwide, and two-fifths of this burden is attributed to modifiable risk factors. The decade 2020–30 has been designated as the “United Nations Decade of Healthy Aging,” and this initiative provides a strong platform to strengthen national, regional and global health initiatives to decrease the burden of low back pain through public awareness campaigns and recommendations to stay active .
Final message In conclusion, in 2020, there were more than 500 million prevalent cases of low back pain worldwide, and by 2050 this is projected to increase to more than 800 million prevalent cases. Age-standardized rates have decreased slightly over the past three decades, but the number of cases continues to increase due to population growth and aging, particularly in Asia and Africa. Low back pain remains the leading cause of years lived with disability worldwide. The prevalence and years lived with disability due to low back pain increase with age, with a peak at age 85, and compromise the prospect of healthy aging. Our results highlight the urgent need for more high-quality, country-level primary data on prevalence and severity distributions to improve accuracy and monitor change as high-value health and care policies are implemented. |
