Growing burden of low back pain in China, 1990–2021, and projections to 2041: A population-based observational study using global burden of disease study 2021 data
Jiaming Wei, Wenlong Qiu, Xinyang Li, Kai Sun, Penghui Li, Kexin Yang, Xunlu YinBackground
Low back pain (LBP) is the leading cause of years lived with disability worldwide, and population ageing in China may increase its burden.
Objectives
To describe trends in LBP incidence, prevalence and disability-adjusted life years (DALYs) in China from 1990 to 2021 by age and sex, decompose changes in case numbers and project rates to 2041.
Design
Population-based observational study using modelled estimates from the Global Burden of Disease Study 2021.
Methods
Trends were assessed with estimated annual percentage changes (EAPCs), Joinpoint regression and age-period-cohort models; Das Gupta decomposition partitioned the change in case numbers into population ageing, population growth and epidemiological change; and Bayesian age-period-cohort models, validated out of sample, projected rates to 2041.
Results
In 2021, China had 43.37 million (95% uncertainty interval [UI] 37.49–49.16 million) incident cases, 100.09 million (87.13–113.01 million) prevalent cases and 11.30 million (7.93–15.33 million) DALYs due to LBP, increases of 45.3–46.6% since 1990. Age-standardised incidence, prevalence and DALY rates fell by 18.08%, 19.49% and 19.49%, with EAPCs of −0.47% (95% confidence interval [CI] −0.56 to −0.37), −0.50% (−0.60 to −0.39) and −0.49% (−0.60 to −0.39). Rates were higher in females at every age, with the highest female-to-male ratio at 45–69 years. Population ageing (92.86% of the net change) and population growth (63.30%) drove the increase of 13.53 million incident cases, partly offset by declining age-specific rates (−56.16%). By 2041, the age-standardised incidence rate for both sexes was projected at 2,331.32 per 100,000 (95% credible interval 1,002.45–3,660.20).
Conclusion
Age-standardised rates of LBP in China declined modestly between 1990 and 2021, but the number of people affected rose by about 45%, mainly because of population ageing. Planning for primary care, rehabilitation and prevention should anticipate a persistently high burden in middle-aged and older adults, particularly women.
Registration
Not applicable.