Lower back pain may impact more than 800 million people globally by 2050

Anu Sharma, MD, FACP, FACR

Low back pain is the leading cause of disability in most countries, and it is anticipated that both total disability burden and disease-related costs related to low back pain will continue to increase in the coming years. In 2020, low back pain affected 619 million people globally and is expected to affect 843 million people by 2050. This study identifies evidence-based risk factors and high-risk populations globally, nationally and regionally, categorizing them by age, sex and race, in an effort to provide actionable information that will steer policy and practice guidelines.

In 2020, there were more than half a billion prevalent cases of low back pain worldwide, representing more than 7.7% of all years lost to disability. This is the greatest contributor to the world’s burden of disability. It is expected that by 2050, this number will increase by 36.4%, with the most substantial increases expected in Asia and Africa. 

The social and economic impact of disability related to low back pain is particularly important to understand because of its high prevalence in working-age people, as well as seniors. This global trend is not exclusive to high income countries, but the study was better able to quantify the cost and the disability issues surrounding low back pain in more developed countries.

In the United States, for example, 15.4% of the workforce reported an average of 10.5 lost workdays per year due to chronic low back pain. This is equivalent to approximately 264 million workdays lost. In addition to absenteeism, chronic low back pain can force workers to retire prematurely, further adding to overall loss of productivity. The estimated cost of low back pain in the United States alone is estimated at over $2.2 billion.

Studies suggest that more emphasis should be placed on integrated and early return to work interventions. These interventions include cognitive behavioral therapy, problem-solving skills and ergonomics. The expectation is that such interventions will lead to fewer disability days, a higher percentage of early return to work, and reductions in the use of health care.

In 2018, The Lancet published a three-part series on management and treatment of low back pain that emphasized the role of advice and education that supports self-management as well as physical and psychological interventions.

However, in practice, these recommendations have not been adopted and there is still an inappropriately high usage of imaging, prescribed bed rest, opioids, spinal injections and other invasive interventions of questionable efficacy worldwide. It is also noted that the use of these inappropriate interventions can delay recovery and potentially increase the risk for long-term back related disability.

Although there is some regional variation, global case numbers of people with low back pain continue to rise because of population growth and an aging population. Low back pain remains the leading cause of years lived with disability globally. The results of this study highlight the urgent need for more high-quality data on both prevalence and severity distributions of low back pain. This is needed to drive health policy and to identify factors that monitor change as influenced by health care and health policy intervention.