Zhang Jiahao, Tian Yixin, Li Yangxiao, Wang Haotian, Yuan Lei, Zeng Yan, Li Weishi
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
J Orthop Translat. 2024 Apr 6;45:256-265. doi: 10.1016/j.jot.2024.02.006. eCollection 2024 Mar.
From 1990 to 2019, low back pain (LBP) was the leading cause of years lived with disability (YLDs) in China. However, the change patterns of LBP and its risk factors in China remain unclear.
Data from the Global Burden of Disease Study 2019 were used. We used the join-point regression model and age-period-cohort analysis to evaluate the time trends of attributable risk factors on the burden of LBP.
In 2019, the risk factors included in this analysis accounted for 4.36 million YLDs of LBP, representing 42.2% of all YLDs of LBP in China, with 2.86 million due to occupational ergonomic factors, 1.74 million due to smoking, and 0.46 million due to high body mass index (BMI). The age-standardized YLD rates of LBP showed downward trends during 1990-2019, while there was a faster decline between 1990 and 1994. The curves of local drifts, which reflected the average annual percentage change across age groups, showed an increasing trend with age for high BMI and smoking, and a downward trend for occupational ergonomic factors. The YLD rates for LBP increased dramatically with age for high BMI, while it reached a peak at 40-60 years old for occupational ergonomic factors, and 65-80 years old for smoking. The period and cohort rate ratios of LBP YLD decreased in the past 3 decades for occupational ergonomic factors and smoking, while increased for high BMI.
Our results provided strong evidence that there were diverse changing patterns for different risk factors, highlighting the need for risk-specific strategies.
China has the largest senior population and the fastest aging population in the world. Given that LBP typically occurs in the senior population, there would be an increasing LBP burden on China's health system. This suggests that effective strategies for LBP prevention should be strictly implemented in China, particularly in the senior population, which is of crucial translational potential.
1990年至2019年期间，腰痛是中国导致失能调整生命年（YLDs）的首要原因。然而，中国腰痛及其危险因素的变化模式仍不明确。
使用2019年全球疾病负担研究的数据。我们采用连接点回归模型和年龄-时期-队列分析来评估导致腰痛负担的危险因素的时间趋势。
2019年，本分析纳入的危险因素导致436万腰痛失能调整生命年，占中国所有腰痛失能调整生命年的42.2%，其中286万归因于职业工效学因素，174万归因于吸烟，46万归因于高体重指数（BMI）。1990年至2019年期间，腰痛的年龄标准化失能调整生命年率呈下降趋势，而1990年至1994年期间下降更快。反映各年龄组平均年变化百分比的局部漂移曲线显示，高BMI和吸烟随年龄呈上升趋势，职业工效学因素呈下降趋势。高BMI导致的腰痛失能调整生命年率随年龄急剧上升，而职业工效学因素在40至60岁达到峰值，吸烟在65至80岁达到峰值。在过去30年中，职业工效学因素和吸烟导致的腰痛失能调整生命年的时期和队列率比下降，而高BMI导致的则上升。
我们的结果提供了有力证据，表明不同危险因素存在多样的变化模式，突出了针对特定风险制定策略的必要性。
中国拥有世界上最大规模的老年人口且老龄化速度最快。鉴于腰痛通常发生在老年人群中，中国卫生系统的腰痛负担将不断增加。这表明中国应严格实施有效的腰痛预防策略，尤其是在老年人群中，这具有至关重要的转化潜力。
