The burden of low back pain in the United States, 1990 to 2021

Low back pain (LBP) is a major global health concern and remains a leading contributor to healthcare expenditure in the United States (US). Few recent studies have systematically analyzed the temporal, geographic, and demographic patterns of LBP burden and its associated risk factors in the US. This study aimed to examine the burden of LBP and its risk factors in the US from 1990 to 2021. We conducted a systematic analysis of LBP in the US from 1990 to 2021 using the Global Burden of Disease 2021 dataset. Estimates of LBP burden, including prevalence, incidence, and years lived with disability (YLDs), were analyzed along with attributable risk factors. Disease burden estimates were generated using DisMod-MR 2.1, a Bayesian meta-regression tool. Age-standardized rates were stratified by age group, sex, region, and sociodemographic index. Age–period–cohort effect analysis was used to examine the temporal dynamics. In 2021, the age-standardized LBP prevalence and YLD rates in the US were 10,670 and 1179 per 100,000, respectively, representing decreases of 7% and 8% compared with 1990. Geographic disparities were evident, with the East South Central exhibiting the highest prevalence and YLD rates, whereas New England demonstrated the lowest. At the regional level, the Midwest exhibited the highest burden, while the Northeast had the lowest. LBP prevalence was consistently higher in females than in males, across all age groups. Additionally, YLD rates were inversely correlated with sociodemographic index both nationally and across the 9 Census divisions (ρ = −0.583, P < 0.001). Age–period–cohort analysis showed that LBP burden increased with advancing age and in more recent periods. Among modifiable risk factors, high body mass index, smoking, and occupational ergonomic factors collectively accounted for 43% of LBP-related YLDs. LBP has remained a leading cause of disability in the US for over 3 decades, disproportionately affecting women and older adults and showing pronounced regional and demographic disparities. Strengthening subnational surveillance is essential to facilitate integrated, evidence-based LBP prevention and multidisciplinary management, particularly for high-burden populations and regions. Future research should evaluate scalable interventions targeting modifiable risk factors (e.g., obesity and smoking) to reduce inequities.