Global Trends in Risk Factors for Low Back Pain: An Analysis of the Global Burden of Disease Study Data From 1990 to 2021

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OBJECTIVE: The increasing burden associated with low back pain (LBP) is a critical issue. This is a novel analysis of trends in risk factors for LBP aiming to identify risk factors that require further attention or consideration in global policies to reduce the burden of LBP. METHODS: The Global Burden of Disease study metadata were used to describe the trends in three modifiable categories of risk factors that contribute to the burden associated with LBP. The trends in occupational/ergonomic, behavioral (smoking), and metabolic (high body mass index [BMI]) risk factors for LBP between 1990 and 2021 have been described with attention to global areas, high sociodemographic index (SDI) areas, and low SDI areas. RESULTS: The number of years lived with disability (YLDs) caused by LBP increased globally, in high and low SDI areas between 1990 and 2021. The impact of smoking and occupational/ergonomic risk factors have decreased; however, the impact of high BMI has increased markedly in the same time frame, with a particularly concerning impact in high SDI areas and on women. CONCLUSION: The burden of LBP is increasing globally, with a significant proportion of the YLDs caused by LBP attributed to three modifiable lifestyle factors: occupation/ergonomics, smoking, and high BMI. Of significant concern is the rapidly increasing impact of high BMI on YLDs caused by LBP, with the greatest impact seen among women in low and high SDI areas. The role of additional risk factors (eg, physical inactivity) still needs to be determined in the context of the global burden of LBP.