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