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

Background: Low back pain is highly prevalent and the number one 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 2021 Study. Methods: Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, USA claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2021, 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.Findings: Globally, in 2020, low back pain affected 619 million (95% UI 554–694) people, with a projection of 843 million (757–933) 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% (10.9–9.97) 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 body-mass index. Interpretation: 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. Funding Information: The GBD study is funded by the Bill and Melinda Gates Foundation. Funders were not involved in the preparation or interpretation of this manuscript. MLF holds a National Health and Medical Research Council of Australia Investigator Grant. MJC’s role is funded by the Global Alliance for Musculoskeletal Health Bone and Joint Foundation.Declaration of Interests: The author declare no conflict of interest.