Back pain epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Population studies generally define low back pain by its location between the lower costal margin and the inferior gluteal folds, with or without leg pain.[1] The Global Burden of Disease (GBD) 2021 analysis defines low back pain as pain between the lower margin of the twelfth ribs and the lower gluteal folds, with or without referred leg pain, lasting at least one day.[2] These symptom-based estimates do not measure the prevalence of a confirmed mechanical pain source.

Approximately 80–90% of primary care presentations are classified as nonspecific.[3] In these presentations, routine clinical assessment cannot reliably identify a single pain-generating structure.[1]

Epidemiology and Demographics

Prevalence and incidence

Population and measure Estimate and interpretation
Global prevalence, 2020 An estimated 619 million people had low back pain (95% uncertainty interval [UI], 554–694 million). Age-standardized prevalence was 7,460 per 100,000 (95% UI, 6,690–8,370).[2]
Global prevalent and incident cases, 2021 A separate analysis of GBD 2021 data estimated 629 million prevalent cases and 267 million incident cases. The incident count does not represent the number of people experiencing their first-ever episode.[4]
Global point and one-month prevalence in population studies A systematic review of 165 studies from 54 countries reported unadjusted mean point and one-month prevalence of 18.3% and 30.8%, respectively. After adjustment to the GBD 2010 definition of activity-limiting low back pain, with or without leg pain, lasting at least one day, the estimates were 11.9% and 23.2%, respectively. Prevalence was higher in females and was highest between ages 40 and 80.[5]
Lifetime prevalence Hoy and colleagues reported a mean lifetime prevalence of 38.9%, which did not differ significantly from the mean one-year prevalence of 38.0%.[5] Other publications cite lifetime estimates of 50–80%, and the VA/DoD guideline cites estimates as high as 84%. These ranges and upper bounds are not pooled estimates.[6][7]
Annual incidence in population studies Annual incidence ranged from 0.024% to 7% across 13 studies with differing definitions and methods. A separate guideline reported one-year ranges of 6.3–15.3% for first-ever episodes and 1.5–36% for any episode. The ranges come from different studies and are not directly comparable.[8][9]
United States population surveys In the 2002 National Health Interview Survey (NHIS), 26.4% of adults reported low back pain lasting at least one full day in the preceding three months.[10] In the 2019 NHIS, 39.0% of adults reported back pain in the preceding three months (40.6% of women and 37.2% of men). The 2019 question did not restrict pain to the lower back, so the two surveys do not establish a trend in low back pain prevalence.[11]
Chronic impairing low back pain in North Carolina In household surveys, prevalence increased from 3.9% in 1992 to 10.2% in 2006. These estimates describe a regional population and apply to the surveys' definition of chronic impairing low back pain.[9]

Demographic and socioeconomic distribution

  • Age: The primary GBD 2021 analysis reported peak prevalence at approximately age 85.[2] Secondary analyses placed the peak prevalence rate in the 80–84 age group, while the number of cases peaked at ages 50–54.[12][4] Survey reviews have reported peak prevalence between ages 40 and 69, while severe low back pain becomes more common after age 65. Age patterns vary with the population, pain definition, and severity threshold studied.[8][13]
  • Children and adolescents: Reported low back pain prevalence is 1–6% at ages 7–10.[8] In reviews of pediatric back pain, prevalence increased from about age 11–12 and approached adult levels by the end of adolescence. Reported one-month estimates were approximately 18–24%.[14] A meta-analysis of studies in participants aged 18 years or younger estimated low back pain prevalence at 12.0% at a point in time (95% confidence interval [CI], 9.0–15.9%; 10 studies), 33.6% over 12 months (95% CI, 26.9–41.0%; 13 studies), and 39.9% over a lifetime (95% CI, 34.2–45.9%; 30 studies). Lifetime prevalence was higher in studies with an older mean participant age.[15] In a separate survey of 404,206 adolescents across 28 countries, 37.0% reported backache at least monthly over the preceding six months, ranging from 27.4% in the 11-year-old group to 46.7% in the 15-year-old group. The survey did not restrict backache to the lower back, and its measure of symptom frequency over six months differs from one-month prevalence.[16]
  • Sex and pregnancy: In 2020, global age-standardized prevalence was 9,330 per 100,000 in females (95% UI, 8,370–10,500) and 5,520 per 100,000 in males (95% UI, 4,930–6,190). The difference in age-specific prevalence was most marked after age 75.[2] Modeled prevalence was also higher in females in the United States.[17] The VA/DoD guideline reports that more than two-thirds of pregnant women experience low back pain. Estimates across pregnancy studies range from 24% to 90%; definitions vary and may overlap with pelvic girdle pain.[7][18]
  • Race and ethnicity: In the 2002 NHIS, reported low back pain prevalence was highest among American Indian and Alaska Native adults and lowest among Asian adults.[10] A US systematic review found higher prevalence in some White and American Indian or Alaska Native populations, while some studies, including military cohorts, reported higher incidence in Black populations. Findings varied by study population and outcome and do not establish biological explanations for group differences.[19]
  • Socioeconomic and working populations: In the 2002 NHIS, low back pain prevalence was lower among adults with higher education or income.[10] Socioeconomically disadvantaged groups are more likely to report persistent low back pain and substantial interference with daily functioning.[13][20] A US review reports that approximately one in four workers experiences low back pain.[21]

Geographic distribution

In 2020, among 21 GBD regions, age-standardized prevalence was highest in Central Europe (12,800 per 100,000), followed by Eastern Europe (11,200) and Australasia (11,100), and lowest in East Asia (5,430).[2] In a separate 2021 analysis, Asia had the largest number of cases, with China contributing a large share.[4] Within the United States, modeled age-standardized prevalence was highest in the East South Central division and lowest in New England.[17]

The association between the Socio-demographic Index and modeled low back pain burden was inverse in the US analysis and positive in a global analysis. These are population-level associations and do not estimate individual risk.[17][12]

Low back pain was the leading global cause of years lived with disability (YLDs) in 2020, accounting for an estimated 69.0 million YLDs (95% UI, 47.9–88.9 million), or 8.1% of all YLDs. From 1990 to 2020, age-standardized prevalence fell by 10.4% (from 8,330 to 7,460 per 100,000), and the age-standardized YLD rate fell by 10.5%, while the number of cases increased. The GBD study projected 843 million prevalent cases in 2050 (95% UI, 759–933 million), about 36.4% more than in 2020, largely reflecting population growth and aging.[2]

In the United States, modeled age-standardized point prevalence in 2021 was 10,670 per 100,000, about 7% lower than in 1990.[17] This GBD estimate measures low back pain at a point in time; the 2019 NHIS asked about back pain without a lower-back restriction over three months.[17][11] The age-standardized US YLD rate was 1,179 per 100,000 in 2021, about 8% lower than in 1990.[17] GBD analyses attributed 38.8% of global low back pain YLDs and approximately 43% of US low back pain YLDs to the combined effects of occupational ergonomic exposures, smoking, and high body mass index. These are modeled population estimates; individual associations are addressed in Risk factors.[2][17]

Care-seeking and health care use

A pooled estimate indicated that approximately 58% of people with low back pain sought care. Care-seeking was more common among women and among people with previous episodes, poorer health, or more disabling symptoms.[1] In a historical US analysis using 2002 survey data, low back pain accounted for 2.3% of physician visits, a proportion that had remained relatively stable since the early 1990s.[10]

References

  1. ↑ 1.0 1.1 1.2 Maher C, Underwood M, Buchbinder R (2017). "Non-specific low back pain". The Lancet. 389 (10070): 736–747. doi:10.1016/S0140-6736(16)30970-9.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 GBD 2021 Low Back Pain Collaborators (2023). "Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021". The Lancet Rheumatology. 5 (6): e316–e329. doi:10.1016/S2665-9913(23)00098-X. PMID 37273833 Check |pmid= value (help).
  3. ↑ Chiarotto A, Koes BW (2022). "Nonspecific Low Back Pain". New England Journal of Medicine. 386 (18): 1732–1740. doi:10.1056/NEJMcp2032396.
  4. ↑ 4.0 4.1 4.2 Fu J, Ye Y, Li Y; et al. (2026). "Epidemiological trends and geographic disparities in low back pain burden based on the 2021 GBD study: A cross-sectional analysis". Medicine. 105 (24): e49201. doi:10.1097/MD.0000000000049201. PMID 42299523 Check |pmid= value (help).
  5. ↑ 5.0 5.1 Hoy D, Bain C, Williams G; et al. (2012). "A systematic review of the global prevalence of low back pain". Arthritis & Rheumatism. 64 (6): 2028–2037. doi:10.1002/art.34347. PMID 22231424.
  6. ↑ Scaff SPS, Hancock MJ, da Silva Munhoz T, Maher CG, Saragiotto BT (2024). "Exercises for the prevention of non-specific low back pain". Cochrane Database of Systematic Reviews (Review protocol) (7): CD014146. doi:10.1002/14651858.CD014146. PMID 39041371 Check |pmid= value (help).
  7. ↑ 7.0 7.1 Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain. 2022.
  8. ↑ 8.0 8.1 8.2 Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP (2021). "Low back pain". The Lancet. 398 (10294): 78–92. doi:10.1016/S0140-6736(21)00733-9. PMID 34115979 Check |pmid= value (help).
  9. ↑ 9.0 9.1 Delitto A, George SZ, Van Dillen L; et al. (2012). "Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health". Journal of Orthopaedic & Sports Physical Therapy. 42 (4): A1–A57. doi:10.2519/jospt.2012.42.4.A1.
  10. ↑ 10.0 10.1 10.2 10.3 Deyo RA, Mirza SK, Martin BI (2006). "Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002". Spine. 31 (23): 2724–2727. doi:10.1097/01.brs.0000244618.06877.cd. PMID 17077742.
  11. ↑ 11.0 11.1 Lucas JW, Connor EM, Bose J (2021). "Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019". NCHS Data Brief (415): 1–8. PMID 34473621 Check |pmid= value (help).
  12. ↑ 12.0 12.1 Cheng M, Xue Y, Cui M; et al. (2025). "Global, Regional, and National Burden of Low Back Pain: Findings From the Global Burden of Disease Study 2021 and Projections to 2050". Spine. 50 (7): E128–E139. doi:10.1097/BRS.0000000000005265. PMID 39838749 Check |pmid= value (help).
  13. ↑ 13.0 13.1 Vlaeyen JWS, Maher CG, Wiech K; et al. (2018). "Low back pain". Nature Reviews Disease Primers. 4 (1): 52. doi:10.1038/s41572-018-0052-1.
  14. ↑ Kamper SJ, Yamato TP, Williams CM (2016). "The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews". Best Practice & Research Clinical Rheumatology. 30 (6): 1021–1036. doi:10.1016/j.berh.2017.04.003. PMID 29103547.
  15. ↑ Calvo-Muñoz I, Gómez-Conesa A, Sánchez-Meca J (2013). "Prevalence of low back pain in children and adolescents: a meta-analysis". BMC Pediatrics. 13: 14. doi:10.1186/1471-2431-13-14. PMID 23351394.
  16. ↑ Swain MS, Henschke N, Kamper SJ, Gobina I, Ottová-Jordan V, Maher CG (2014). "An international survey of pain in adolescents". BMC Public Health. 14: 447. doi:10.1186/1471-2458-14-447. PMID 24885027.
  17. ↑ 17.0 17.1 17.2 17.3 17.4 17.5 17.6 Jung R, Oh YS, Yon DK; et al. (2026). "The burden of low back pain in the United States, 1990 to 2021: An observational study based on the Global Burden of Disease Study 2021". Medicine. 105 (33): e50175. doi:10.1097/MD.0000000000050175. PMID 42601699 Check |pmid= value (help).
  18. ↑ Liddle SD, Pennick V (2015). "Interventions for preventing and treating low-back and pelvic pain during pregnancy". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001139.pub4.
  19. ↑ Burke CA, Fillipo R, Epplein M; et al. (2026). "Racial and Ethnic Disparities in the Incidence and Prevalence of Low Back Pain in the United States: A Systematic Review". Arthritis Care & Research. 78 (1): 141–153. doi:10.1002/acr.25665. PMID 41083919 Check |pmid= value (help).
  20. ↑ Hartvigsen J, Hancock MJ, Kongsted A; et al. (2018). "What low back pain is and why we need to pay attention". The Lancet. 391 (10137): 2356–2367. doi:10.1016/S0140-6736(18)30480-X. PMID 29573870.
  21. ↑ Cashin AG, Chou R, Weimer MB, McAuley JH (2026). "Low Back Pain: A Review". JAMA. 336 (2): 144–158. doi:10.1001/jama.2026.9631. PMID 42295944 Check |pmid= value (help).
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