Smoking-attributable low-back pain disability in China versus high income countries among adults aged 20-54 years, 1990-2023: A secondary dataset analysis of GBD 2023.

INTRODUCTION

Low-back pain (LBP) is a leading cause of disability. This study compared temporal trends in working-age LBP burden and smoking-attributable disability between China and the GBD aggregate 'High-income countries' from 1990 to 2023, with high body-mass index (BMI) and occupational ergonomic exposures as contextual risk factors.

METHODS

This secondary analysis used Global Burden of Disease (GBD) 2023 estimates for adults aged 20-54 years in China and high-income countries. Annual incidence, prevalence and years lived with disability (YLD) were extracted as counts and age-standardized rates per 100000 population (95% uncertainty intervals [UI]). Trend magnitude was summarized using joinpoint regression (average annual percent change [AAPC], 95% confidence interval [CI]) applied to annual point estimates. Risk-attributable YLD rates and population attributable fractions (PAFs) for smoking, high BMI and occupational ergonomic exposures were obtained from the GBD comparative risk assessment.

RESULTS

In 2023, age-standardized incidence and YLD rates were higher in high-income countries (5115.98 per 100000, 95% UI: 4396.74-5819.09; 1396.92 per 100000, 95% UI: 993.01-1842.94) than in China (2497.71 per 100000, 95% UI: 2086.63-2942.72; 656.08 per 100000, 95% UI: 448.25-884.77). Rates declined in both settings, faster in China (incidence AAPC= -0.46%, 95% CI: -0.55 - -0.38; YLD AAPC -0.45%, 95% CI: -0.54 - -0.36) than in high-income countries (incidence AAPC= -0.12%, 95% CI: -0.13 - -0.11; YLD AAPC= -0.13%, 95% CI: -0.16 - -0.10). Smoking-attributable PAF decreased in high-income countries from 24.05% (95% UI: 16.04-32.23) to 19.60% (95% UI: 12.70-27.14) but rose slightly in China from 16.61% (95% UI: 11.33-21.74) to 18.27% (95% UI: 12.85-23.88).

CONCLUSIONS

Working-age LBP rates declined in both settings, with larger reductions in China. Smoking-attributable burden also declined, but smoking's proportional contribution decreased in high-income countries and rose slightly in China. These model-based patterns may inform population-level prevention priorities alongside rising BMI-related and work-related risks.