Economic Burden of Work-Related Low Back Pain in Indonesia Before and During the COVID-19 Era, 2019-2021: Analysis of Global Burden of Disease Estimates.

INTRODUCTION

Occupational ergonomic risk factors are a major contributor to musculoskeletal disorders and productivity loss, yet their welfare implications remain underexplored in low- and middle-income settings. This study aimed to quantify the health and economic burden of ergonomic risks across Indonesian provinces using the Value of Lost Welfare (VLW) framework.

METHODS

Disability-adjusted life years (DALYs) attributable to ergonomic risks were obtained from the Global Burden of Disease 2019-2021 estimates. VLW was calculated by multiplying DALYs with the Value of a Statistical Life Year (VSLY), derived from GDP per capita and adjusted for purchasing power parity. Both absolute VLW (International Dollar, Int$) and the VLW-to-GDP ratio were computed at national and provincial levels. Socioeconomic inequality was assessed using the slope index of inequality (SII) and relative index of inequality (RII).

RESULTS

National VLW increased from Int$ 44.6 billion in 2019 to Int$ 48.5 billion in 2021, with the largest contributions observed in East Java (Int$ 7.3 billion) and West Java (Int$ 6.1 billion), while smaller provinces such as Gorontalo and North Maluku contributed less than Int$ 200 million. Despite a steady rise in DALYs, the VLW-to-GDP ratio followed the economic cycle, increasing during the 2020 downturn (1.47%) and declining to 1.36% in 2021 as GDP rebounded. Socioeconomic inequality in the VLW-to-GDP ratio was statistically significant, with SII of -0.00165 (95% CI: -0.00255 to -0.00074) and RII of -0.118 (95% CI: -0.183 to -0.053).

DISCUSSION: Occupational ergonomics imposes a substantial and persistent health-economic burden in Indonesia, amounting to nearly Int$ 50 billion annually. The observed socioeconomic gradient indicates that lower-GDP provinces experience disproportionately greater welfare losses relative to their economic capacity, underscoring the need for sustained workplace interventions and targeted regional policies, particularly in lower-GDP regions.