Epidemiology of Low Back Pain

Back conditions are associated with a significant burden of health loss across the population. The Global Burden of Disease 2010 ranked LBP as the third biggest contributor to health loss in New Zealand, as measured in disability-adjusted life-years (DALYs) . Disability-adjusted life-years combine both fatal and non-fatal outcomes such that one DALY is equivalent to loss of one year of healthy life. Using different definitions, the New Zealand Burden of Disease Study (NZBDS) estimated that back disorders were associated with 27,112 DALYs in the New Zealand population in 2006 (2.8% of all DALYs) and ranked seventh (Table) .

Top ten conditions accounting for DALYs in the total New Zealand population in 2006

Condition	DALY count	Percentage of total DALYs	Rank
Coronary heart disease	89,159	9.3	1
Anxiety and depressive disorders	50,954	5.3	2
Stroke	37,688	3.9	3
COPD	35,339	3.7	4
Diabetes	8,808	3.0	5
Lung cancer	28,570	3.0	6
Back disorders*	27,112	2.8	7
Colon and rectal cancers	24,012	2.5	8
Traumatic brain injury	21,728	2.3	9
Osteoarthritis	20,738	2.2	10
*Including lumbago (low back pain), sciatica, other chronic back pain and chronic neck pain, and vertebral or disc related diseases e.g. spinal stenosis and spondylosis, but excluding spinal cord injury and spinal fracture (further described in Appendix 1)

The NZBDS estimated for 2006 that 10% of the New Zealand population, or around 437,000 people, had a back condition (Condition self-reported as diagnosed by a doctor and at least some pain or interference with normal work or housework in the previous 4 weeks). Prevalence increased with age such that 20% of those aged over 65 years were affected. However, back conditions are rarely a primary cause of death, with only 12 deaths reported in 2006. Of note, the NZBDS considered “back conditions” as a group of conditions associated with disorders of spinal structure (excluding spinal cord injury and spinal fracture). Thus the definition is broader than low back pain. It also considered back pain from the context of chronic pain rather than acute episodes.

Nevertheless, it has been acknowledged that the estimation of DALYs for back conditions in the NZBDS may not be robust and likely underestimates the burden of back disorders (especially non-specific low back pain), most probably due to undercounting of cases.

The Global Burden of Disease 2010 study shows that globally LBP was ranked sixth for health loss measured by DALYs. For the Australasian, European and North American regions the DALYs loss for LBP is in the top three rankings. When considered from the perspective of health loss associated with living with disability LBP is the highest ranked loss globally and for the above regions.

LBP is the leading cause of activity limitation and work absence throughout much of the world, imposing a high economic burden on individuals, families, communities, industry, and governments. In the United Kingdom, low back pain was identified as the most common cause of disability in young adults, with more than 100 million workdays lost per year. In the United States two-thirds of the total cost of LBP is due to lost wages and lower productivity.

References

Part or all of this article or section is derived from National Health Committee Low Back Pain: A Pathway to Prioritisation by Ministry of Health, used under CC-BY