In the pantheon of human aches, pains and killer diseases, few might think back pain merits much attention. But, in fact, lower back pain ranks above diabetes and heart disease worldwide when measured according to a common health metrics yardstick known as Years Lived with Disability (YLDs).
Low back pain may seem like a problem worth worrying about only in affluent countries, and it is indeed a popular topic in Western media and for advertising.
Yet consider how much more important a healthy back is to those living and working in the developing world. Most of the world’s poor make their meager living through physical labor such as subsistence farming. Lower back pain is not just an inconvenience; it may mean the difference between eating or going hungry, a healthy or sick child, even life or death.
This measure of health problems called YLDs, years lived with disability, quantifies the impact of health issues that impair mobility, hearing, or vision, or cause pain in some way but aren’t usually or directly fatal.
In most developed countries, low back pain is responsible for the highest rate of YLDs – above diabetes, near-sightedness, heart disease, asthma, or mental health disorders. In most developing countries, low back pain is one of the five most important nonfatal conditions. And in Bangladesh, China, El Salvador, Mozambique, Nepal, and Nigeria, low back pain is the leading disabling condition.
Low back pain keeps people awake at night everywhere in the world, from Brazil to Zambia. In fact, low back pain was in the top 10 causes of disability in every country in 2013. While not a lot is known about how best to prevent it, we do know that if we sit for too long, or stand with the wrong posture, or spend too much time in the car, it’s almost inevitable that we’ll experience back pain at some point in our lives.
Rate of years lived with disability (per 100,000) due to back pain, 2013
Nigeria had the fifth-highest rate of low back pain globally in 2013, with more than 15 people in 100 suffering. Bangladesh and Nepal were also among the countries with the highest rates of back pain, with 14 people out of 100 in each country suffering back pain. By comparison, in the United States the rate is below 12 people per 100.
The burden of YLDs from musculoskeletal disorders, which include low back and neck pain, osteoarthritis, rheumatoid arthritis, and other conditions such as gout, grew by 60% globally between 1990 and 2013. The number of people suffering from low back pain grew more than 50% from 1990 to 2013, to 651 million – and over two-thirds of them were in developing countries.
A major driver of this growth is changes in the makeup of the global population. More people everywhere are living longer – which means larger proportions of populations suffer from the various degenerations that come with growing old. Low back pain is similar to hearing loss and vision disorders, in that it is more likely to occur as one ages.
Rate of years lived with disability (per 100,000) from low back pain globally by age group, 2013
Interventions for other leading causes of disability – glasses or surgery to aid with vision disorders, hearing aids, even tools to control asthma and diabetes – are increasingly accessible in even the most resource-limited settings. But while disabling back pain has existed for as long as these other conditions, many fewer options are available for reducing or preventing it.
The prevalence of low back pain worldwide remains high, and without intervention of some sort the number of people suffering from it will continue to grow as the global population grows and ages. More knowledge about the burden of this disorder, and how it can be lessened, can help decision-makers determine what steps need to be taken to make low back pain less of an inevitability.