Analysis and comparison of the trends in burden of low back pain in China and worldwide from 1990 to 2021
Authors: Wei Yongcun , Xie Yanchun , Xuan Anwu , Gu Hongwen , Lian Yi , Wang Zening , Wang Hongwei , Yu Hailong 
Published: February 2025

Abstract

Background
Low back pain (LBP) substantially affects quality of life and functional capacity, ranking as a major global cause of disability. While the global burden of LBP has been extensively studied, China’s unique demographic, socioeconomic, and healthcare contexts warrant focused attention. As the world’s most populous nation undergoing rapid urbanization and aging, China presents a distinct landscape for LBP epidemiology. This study aims to chart the temporal shifts in the age- and sex-specific burdens of LBP in China from 1990 to 2021, encompassing incidence, prevalence, and disability-adjusted life years (DALYs). By benchmarking these trends against the worldwide disease burden, this research provides critical insights into how China’s experience aligns with or diverges from global patterns, offering valuable guidance for targeted public health strategies.

Methods
This study leveraged open-access data from the Global Burden of Disease (GBD) repository, spanning the years 1990 to 2021, to scrutinize the epidemiological profile of LBP in China and across the globe. The analysis encompassed fluctuations in LBP incidence, prevalence, and DALYs. The Joinpoint regression model was employed to determine the average annual percentage change (AAPC) and its associated 95% confidence interval (95% CI), thereby quantifying the trajectory of LBP burden. A multifaceted comparative evaluation was performed to elucidate disparities in LBP burden between China and other regions, examining various aspects such as age, gender, and temporal dynamics.

Results
From 1990 to 2021, both China and the world experienced a decline in age-standardized metrics related to LBP. In China, the age-standardized incidence rate (ASIR) decreased from 2,859.383 to 2,342.459 per 100,000, while globally, it fell from 3,534.988 to 3,176.63 per 100,000. Similarly, the age-standardized prevalence rate (ASPR) in China declined from 6,635.488 to 5,342.1 per 100,000, compared to a global reduction from 8,391.582 to 7,463.13 per 100,000. The age-standardized DALYs rate (ASDR) in China also dropped from 749.026 to 603.033 per 100,000, while globally, it decreased from 937.339 to 832.179 per 100,000. Notably, according to the AAPC results, China showed a more pronounced decrease in these metrics compared to the global averages, especially before 2015. Gender differences were evident, with women consistently exhibiting higher incidence, prevalence, and DALYs for LBP across all age groups and years. Age-related disparities were also significant: in 2021, the crude incidence rate (CIR), crude prevalence rate (CPR), and crude DALY rate (CDR) peaked in the 85–89 age group, reflecting the substantial burden of LBP among older adults. However, the highest number of incidence, prevalence, and DALYs was observed in the 55–59 age group, indicating a shift toward middle-aged individuals as a key affected population. Overall, while China’s LBP burden demonstrated a consistent decline, the gender and age patterns suggest a need for tailored public health interventions targeting middle-aged and elderly populations, as well as women who are disproportionately affected.

Conclusion
Although China’s LBP burden has declined, it remains significant among middle-aged and elderly populations, with women disproportionately affected. Public health efforts should focus on ergonomic improvements, promoting physical activity, and accessible nonpharmacological treatments. Integrating LBP care into primary healthcare is vital to mitigate its impact and support the aging population.