The Lancet: New study shows low back pain is the leading cause of disability around the world

By 2050, a 36.4% rise in low back pain cases is projected, with the highest increases in Asia and Africa. 

• In 2020, 619 million people suffered from lower back pain globally. 

• By 2050, 843 million people are projected to fall into this category. 

• Risk factors are work-related ergonomic factors, obesity, and smoking. 

• Study shows low back pain increases with age and the peak age impacted is 85. 

• Globally, low back pain is more prevalent in women than men in all age groups. 

• Regions with the highest occurrence of low back pain are Central Europe, Eastern Europe, and Australasia. 

• Increase in low back pain cases will be driven by population growth except in Asia and Latin America, where the main driver will be an aging population. 

A new study shows low back pain remains the leading cause of disability globally. In 2020, low back pain impacted 619 million individuals. That number is expected to increase in the next three decades to 843 million. The peer-reviewed study published today in The Lancet Rheumatology, was conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine as part of the Global Burden of Disease Study 2021.

The study shows older people are particularly at risk as the prevalence of low back pain increases with age. The peak impacted age is 85 years.

“From a health care perspective, clinical practice guidelines in most countries lack specific recommendations on how to care for an older person with low back pain. The elderly are the most vulnerable population to this condition,” says first author Prof. Manuela Ferreira, Global Burden of Disease study collaborator and Professor at Sydney Musculoskeletal Health, at the University of Sydney.

In 2020 globally, low back pain caused a total of 69 million years lived with disability (YLDs), a measurement of years lived in less-than-ideal health. This was a decrease from 1990 in the percentage of all-cause YLDs, but low back pain remained the main driver of YLDs globally.

The main risk factors for low back pain identified in the study are smoking, obesity, and occupational ergonomic factors – such as repetitive, fast movements or handling heavy loads at work. These risk factors make up almost 40% of years lived with disability within low back pain cases.

The number of low back pain cases varies by geographic region, causes, and age. The study covers local, regional, and national data from 1990 to 2020 in 204 countries and territories. The nations with the highest age-standardized rates of low back pain are Hungary and the Czech Republic. The countries with the lowest rates are Myanmar and the Maldives. The data suggest that the rate of population growth and aging in all countries  in the study may have impacted their rankings.

By 2050, the research projects a 36.4% increase to 843 million people impacted by low back pain, with the largest rise in Asia and Africa. Most of the increase will be driven by population growth except in East Asia, South Asia, Latin America, and the Caribbean, where aging is expected to be the main driver.

“The societal and economic impact from low back pain is enormous. We see loss of productivity from missed days at work and a reliance on medication to alleviate pain,” says Dr. Jaimie Steinmetz, managing research scientist at IHME. “The research shows the need for more public health prevention strategies, especially for the elderly. For working-age populations, low back pain forces more people out of the workplace than any other chronic health condition.”

The global data in the study can help policymakers and health care providers develop or improve prevention strategies targeting risk factors of ergonomics, obesity, and smoking.

The study was funded by Bill & Melinda Gates Foundation.

For interviews with Article authors, please email the IHME media team at [email protected] or the university of Sydney's media team at [email protected].

About the Institute for Health Metrics and Evaluation

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME is committed to transparency and makes this information widely available so that policymakers have the evidence they need to make informed decisions on allocating resources to improve population health.

About the Global Burden of Disease study

The Global Burden of Disease (GBD) study is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 9,600 collaborators from 162 countries and territories. IHME coordinates the study.