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. 2025 May 5;26(1):441.
doi: 10.1186/s12891-025-08704-x.

Low back pain among the working-age population: from the global burden of disease study 2021

Yao-Kan Zhang  1   2 , Jia-Xuan Wang  3 , Yi-Zhou Ge  1   2 , Ze-Bin Wang  1   2 , Feng Chang  4
Affiliations

Low back pain among the working-age population: from the global burden of disease study 2021

Yao-Kan Zhang et al. BMC Musculoskelet Disord. .

Abstract

Background: The burden of low back pain in the global working-age population (WAP) is substantial and exhibits unique characteristics. This study aimed to evaluate global, regional, and national trends in low back pain prevalence among the WAP over a 32-year period.

Methods: We utilized data from the 2021 Global Burden of Disease (GBD) study to evaluate the global impact of low back pain in the WAP from 1990 to 2021. A secondary analysis focused on temporal trends and a decomposition analysis of low back pain.

Results: From 1990 to 2021, there was a continuous decrease in the rate of low back pain among the global WAP. The age-standardized incidence rate (ASIR) decreased from 4,111 (95% uncertainty interval [UI]: 2,682-5,619) to 3,676 (95% UI: 2,563-5,021), with an annual average percentage change (AAPC) of -0.36. The age-standardized prevalence rate (ASPR) decreased from 9,731 (95% UI: 7,061-12,970) to 8,632 (95% UI: 6,296-11,517), with an AAPC of -0.39. The age-standardized disability-adjusted life years (DALYs) rate (ASDR) decreased from 1,108 (95% UI: 686-1,650) to 982 (95% UI: 608-1,460), with an AAPC of -0.39. However, the number of low back pain cases in the global WAP continued to increase. Regions with a middle Socio-demographic Index (SDI), South Asia, China, and India carried a heavier burden of low back pain in the WAP. The burden was also greater among females, with the gender gap continuing to widen. Decomposition analysis revealed that population growth and population aging were the predominant driving factors.

Conclusions: Despite the overall reduction in the ASIR, ASPR, and ASDR of low back pain among WAP, it remained a leading cause of disability worldwide. More attention needs to be paid to the low back pain burden among WAP in middle-SDI regions, countries with a large population base, and females. Significant gender and regional disparities persist within WAP, highlighting the necessity for targeted preventive and therapeutic interventions to alleviate the burden of low back pain and reduce the risks of disability.

Keywords: Epidemiology; Global disease Burden 2021; Low back pain; Working-age population.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The GBD follows the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Since GBD information is entirely anonymized and does not include personal data, this analysis did not require approval from a research ethics committee. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Joinpoint regression analysis of the global ASIR (A), ASPR (B), and ASDR (C) for low back pain in WAP from 1990 to 2021. Abbreviations: WAP, working-age population; AAPC, average annual percent change; APC, annual percentage change; DALYs, disability-adjusted life-years; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized DALYs rate
Fig. 2
Fig. 2
Joinpoint regression analysis of the global ASIR, ASPR, and ASDR for low back pain by gender in WAP, for males (A, C, E) and females (B, D, F), from 1990 to 2021. Abbreviations: WAP, working-age population; AAPC, average annual percent change; APC, annual percentage change; DALYs, disability-adjusted life-years; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized DALYs rate
Fig. 3
Fig. 3
Correlations between ASIR, ASPR, and ASDR of global low back pain among WAP and SDI at the regional level. Notes: ASIR of low back pain among WAP at the global level and 21 regions, by SDI, from 1990 to 2021 (A). ASDR of low back pain among WAP at the global level and 21 regions, by SDI, from 1990 to 2021 (B). ASPR of low back pain among WAP at the global level and 21 regions, by SDI, from 1990 to 2021 (C). Abbreviations: SDI, socio-demographic index; DALYs, disability-adjusted life-years; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized DALYs rate
Fig. 4
Fig. 4
Correlations between ASIR, ASPR, and ASDR of low back pain among WAP and SDI at the national level. Notes: In 2021, ASIR of low back pain among WAP in 204 countries, by SDI, the total population (A), males (B), and females (C). In 2021, ASDR of low back pain among WAP in 204 countries, by SDI, the total population (D), males (E), and females (F). In 2021, ASPR of low back pain among WAP in 204 countries, by SDI, the total population (G), males (H), and females (I). Abbreviations: SDI, socio-demographic index; DALYs, disability-adjusted life-years; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized DALYs rate
Fig. 5
Fig. 5
Decomposition analysis of changes in low back pain among WAP incident cases (A), prevalent cases (B), and DALYs (C) at global level, SDI level, and regional level, 1990 to 2021. Notes:The black dots denote the sum of contribution to the changes in all 3 components. For each component, the magnitude of a positive value indicated a positive contribution; the magnitude of a negative value indicates a negative contribution. Abbreviations: WAP, working-age population; DALYs, disability-adjusted life-years; SDI, socio-demographic index
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