Epidemiology of Low Back Pain
Measurement of LBP includes prevalence (the presence at any point in a defined period), the incidence of symptoms (new episode in a time period) and incidence of accessing health care services. Studies indicate that the experience of back pain symptoms is common internationally and in New Zealand.
Studies use different definitions in terms of site of origin of pain and minimum duration of pain. In studies, set in Europe or Canada, for first ever back pain in the general adult population, the proportion experiencing LBP in the previous year ranged from 6.3% to 15.4% and when also considering recurrent pain between 19% and 36%. Across eight GP practices 36% had a one year prevalence for LBP of at least 24 hours duration. In a UK urban area annual incidence of LBP was 47/1000, for adults aged between 25 and 64 years.
A New Zealand telephone survey reported that in the previous seven days back or neck pain has been reported in 35% of New Zealand men and 42% of New Zealand women. Of the 46 conditions noted, back or neck pain was rated the 10th most intense. In various occupations, New Zealand studies have reported the annual prevalence of any low back symptom (pain, ache, discomfort, “complaints”) to be around 50−60%. Twelve month prevalence of reduced activities, due to low back symptoms, was 18% and absenteeism was 9% in a survey of 3000 working age New Zealanders.
Presentation to General Practice
Various UK-based studies have found consultation rates for GP practices for back pain to range from 3.7% per year for the working age population and up to 9% per year for older age groups. This was at the lower end (4%), when measuring lower back consults more specifically. Rates were National Health Committee – Low Back Pain: A Pathway to Prioritisation Page 35 lower for 0–14 year olds and higher for older adults (5 to 7%). A French-based study estimated the consultation rate at 4.5% per year. The mean number of primary care consultations, per patient for LBP, has been reported as approximately 1.7 per annum in the UK. Applying a presentation rate of 5% per year would mean that 170,000 New Zealand adults present acutely annually. The total acute ACC claimants for 2012/13 were 120,436 leaving an estimated balance of nearly 49,000 patients who would present with non-ACC-covered LBP.
The prevalence of chronic LBP has been estimated from the 2013/14 New Zealand Health Survey. Respondents were asked if they experienced chronic LBP, that had lasted or was expected to last for more than six months and that had been present almost every day but could be of variable intensity. The prevalence of chronic LBP is 9.1% (approximately 305,600 people) of New Zealand adults, aged 18 years and over. This is present in 9.7% of females and 8.5% of males. Chronic LBP increases with age; 5.2% in the 18-39 age-group, 10.0% in the 40-59 years age-group and 13.6% in the 60+ year group. Chronic LBP increases with increasing social deprivation, experienced by 7.6% of those living in the least deprived quintile and 11.0% of those living in the most deprived quintile. From the ACC dataset, 20,332 claimants were identified to have a prevalent claim lasting more than six months in 2012/13. This leaves 285,249 other people with chronic LBP.
In 2012/13, the most common service accessed by ACC claimants with chronic LBP was physiotherapy with 51% of patients accessing it with a median of 9 visits in 12 months. Other physical therapists accessed were osteopaths (18%), and chiropractors (28%). Diagnostic radiology was used in 34% of cases and a GP seen by 46% of cases. An orthopaedic surgeon was seen by 16%, musculoskeletal specialist by 6% and rehabilitation services by 7% of claimants. For the chronic patients, funded by ACC, the proportion seeing a physiotherapist is about the same as acute patients though the median number of sessions is marginally greater at 9 compared to 8 sessions. Contact with other manual therapists, orthopaedic and other specialists, rehabilitation and mental health services are more common.
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) .
|Condition||DALY count||Percentage of
|Coronary heart disease||89,159||9.3||1|
|Anxiety and depressive disorders||50,954||5.3||2|
|Colon and rectal cancers||24,012||2.5||8|
|Traumatic brain injury||21,728||2.3||9|
|*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.
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
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