High-BMI-related low back pain in China: a GBD-based observational study on sex-age trends and projections (1990-2021).

BACKGROUND

Low back pain (LBP), the leading global cause of disability, imposes severe burdens in China, where obesity (BMI ≥ 28 kg/m) quadruples LBP risk. Despite concurrent obesity and LBP epidemics, secular trends of BMI-related disability remain unquantified.

OBJECTIVE

Using data from the Global Burden of Disease (GBD) 2021 study, we conducted an observational, cross-sectional analysis of three-decade trends (1990-2021) in disability due to high-BMI-related LBP across China, stratified by age and sex. By comparing national and global trajectories, we inform targeted strategies addressing this dual epidemic.

METHODS

GBD 2021 data informed age-standardized years lived with disability (YLD) analyses of BMI-linked LBP disability (1990-2021) in China. Joinpoint regression identified trend inflection points, with annual percentage change and average annual percentage change (APC/AAPC) calculated using R and Joinpoint software for age-sex stratified burden quantification. Bayesian age-period cohort (BAPC) model was used to estimate the trend of burden of low back pain attributable to high BMI from 2022 to 2036.

RESULTS

Between 1999 and 2021, China's high-BMI-related LBP disability burden escalated disproportionately, with age-standardized YLD rates rising 116.5% versus 39.1% globally. Females exhibited persistently higher burdens (2021 age-standardized YLD rate (ASYR): 67.51 vs. male 37.45/100,000), while youth (< 30 years) saw accelerated male-dominant growth (20-24 years: 17.57% annual increase post 2015). Joinpoint analysis identified China's unique triphasic acceleration (AAPC = 2.54%, P < 0.05), contrasting with linear global trends. Aging populations showed widening gender gaps (e.g., 60-64 years: female YLD rates 2.67-fold males), highlighting urgent need for sex- and age-tailored interventions.

CONCLUSION

China's high-BMI-related LBP burden, though currently below global levels, is escalating disproportionately-accelerating in young males and persistently higher in females. Prioritizing sex- and age-specific interventions is critical to curb this dual metabolic-mechanical epidemic.

TRIAL REGISTRATION

This study was an observational study analysis based on the GBD database, and no clinical trial registration was performed.