Evaluation of three decades of the burden of low back pain in China before COVID-19: Estimates from the Global Burden of Disease Database 2019

Abstract

Background: Low back pain (LBP) is reported as an urgent public-health concern globally because it occurs in all age groups and is now the leading cause of disability, with health systems unable to cope with this burden. We present China's burden of LBP by estimating its prevalence and years lived with disability (YLDs) from 1990 to 2019.

Methods: We obtained the data relating to LBP from the Global Burden of Disease Database (GBD) 2019. Then we calculated years lived with disability caused by LBP by multiplying the prevalence of LBP sequelae by their corresponding disability weights. We performed an analysis of the age-, sex-, and province-specific prevalence and YLDs of 33 provinces/regions in China, as well as their relationship with the sociodemographic index (SDI).

Results: China has the largest numbers of people with LBP (91.3 million) and YLDs (8.6 million) globally, and LBP is the leading cause of YLDs. The age-standardised prevalence was 7.25% in 1990, and this decreased to 5.13% in 2019. The age-standardised YLD rate was 579/100 000 in 2019, having decreased by 28.97%. Both measurements increased with age, being higher in women and varying across the 33 provinces/regions. For the 5-to-14-year age group, the prevalence (4.50%) and YLD rate (4.51%) increased in 2019 from 1990 (3.21% and 3.21%, respectively) when compared to the elderly group. Age-standardised YLD rates experienced decreases with increasing SDI, while there was an increasing tendency as SDI increased further; the changes for women were more obvious.

Conclusions: Over the three decades considered, China has continued to have the largest number of people with LBP in the world, even though the age-standardised prevalence has decreased. YLDs were found to decrease as SDI increased, but they subsequently increased again. LBP still presents a burden, particularly for children and postmenopausal women.

Figure 1

Thirty-year trends in prevalence and YLDs caused by LBP in China. Panel A. Estimated prevalence and age-standardised point prevalence of people with LBP from 1990 to 2019 by gender. Panel B. Estimated prevalence and age-standardised point prevalence of YLDs caused by LBP from 1990 to 2019 by gender. The dotted lines indicate the upper uncertainty interval (UUI) and lower uncertainty interval (LUI). LBP – low back pain, YLDs – years lived with disability

Figure 2

Prevalence and YLDs caused by LBP for different age groups in China. Panel A. Estimated prevalence and point prevalence rate of LBP in 1990 by gender. Panel B. Estimated prevalence and point prevalence rate of LBP in 2019 by gender. Panel C. Estimated prevalence and point prevalence rate of YLDs caused by LBP in 1990 by gender. Panel D. Estimated prevalence and point prevalence rate of YLDs caused by LBP in 2019 by gender. The dotted lines indicate UUI and LUI. LBP – low back pain, LUI – lower uncertainty interval, UUI – upper uncertainty interval, YLDs – years lived with disability

Figure 3

Maps of the age-standardised prevalence and LBP-related YLDs in China. Panel A. Age-standardised point prevalence of LBP in 2019. Panel B. Age-standardised point prevalence of LBP with 30-year change (1990–2019). Panel C. Age-standardised YLDs caused by LBP in 2019. Panel D. Age-standardised YLDs caused by LBP with 30-year change (1990–2019). LBP – low back pain, YLDs – years lived with disability.)

Figure 4

Point prevalence and LBP-related YLDs in the various age groups (5–14, 15–49, 50–69, and ≥70) in different provinces/regions in China. Panel A. Point prevalence of LBP in 1990 and 2019. Panel B. LBP-related YLDs in 1990 and 2019. LBP – low back pain, YLDs – years lived with disability

Figure 5

Relationship between YLDs and SDI in China. Panel A. Co-evaluation of age-standardised YLDs caused by LBP as functions of SDI in China and for 33 provinces/regions, 1990–2019. Panel B. Respective evaluation of relationship between YLDs and SDI in 1990 and in 2019. Panel C. Relationship between YLDs and SDI in the eastern, central, and western regions of China, 1990–2019. LBP – low back pain, SDI – socio-demographic index, YLDs – years lived with disability