Association of chronic low back pain with labor force participation and absenteeism among U.S adults

Background

Chronic low back pain (CLBP) is a leading cause of disability worldwide, with substantial economic implications. However, limited evidence exists on its association with labor force participation using post-pandemic, nationally representative U.S. data.

Objectives

To examine the economic burden of CLBP on labor force participation (LFP), work limitation, and work absenteeism among working-age U.S. adults.

Methods

We conducted a cross-sectional analysis of 19,158 working-age adults (18-64 years) from the 2023 National Health Interview Survey (NHIS). CLBP was defined as pain on most days or every day in the past three months. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) for LFP and work limitation. A negative binomial model was used to estimate incidence rate ratios (IRRs) for missed workdays. Analysis was survey-weighted and models were adjusted for age, sex, education, and race/ethnicity.

Results

The weighted prevalence of CLBP was 20.9%. After adjustment, CLBP was significantly associated with 46% lower odds of LFP (AOR = 0.54; 95% CI: 0.46-0.64, p < 0.001). Among employed adults, workers with chronic low back pain had lower odds of reporting that pain limited their work activities compared with employed adults without CLBP (AOR = 0.30; 95% CI: 0.23-0.39, p < 0.001). However, within this same employee sample, workers with CLBP had a higher expected number of missed workdays (IRR = 1.75; 95% CI: 1.37-2.23, p < 0.001).

Conclusions

The economic burden of CLBP operates through two distinct pathways: a substantial reduction in labor force participation (workforce detachment) and, among those who remain employed, a high rate of absenteeism. These findings highlight the need for both workplace accommodations to prevent workforce exit and targeted clinical interventions to manage acute flare-ups.

Key messages

• Chronic low back pain is a major driver of U.S. workforce exit and high absenteeism, reducing labor force participation odds by 46%. Highlighting the need for workplace measures to reduce this burden.

• Analysis of the 2023 NHIS data reveals chronic low back pain causes both workforce detachment and a 75% increase in missed workdays. Highlighting the need for interventions to ensure stability.