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ORIGINAL RESEARCH ARTICLE

Global, regional, and national burden of neck and low back pain from 1990 to 2021: Findings from the Global Burden of Disease Study 2021

Tianyu Liu1,2 Guanhua Hao1,2 Hanlin Zou1,2 Haibo Zou2*
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1 China–Japan Friendship Hospital, Capital Medical University, Beijing, China
2 Department of Orthopaedics, China–Japan Friendship Hospital, Beijing, China
Received: 12 June 2026 | Revised: 6 July 2026 | Accepted: 8 July 2026 | Published online: 30 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Neck pain (NP) and low back pain (LBP) are the leading causes of years lived with disability (YLDs) worldwide. We aim to estimate the latest burden, trends, inequalities, and risk factors of NP and LBP. We retrieved data from the Global Burden of Disease Study 2021 on the incidence, prevalence, and YLDs of NP and LBP from 1990 to 2021 in 21 regions and 204 countries and territories. Temporal trends were assessed using estimated annual percentage changes and joinpoint regression analysis. We quantified health inequalities and demonstrated the potential to reduce the burden. Finally, we assessed the disease burden of LBP attributable to modifiable risk factors. The global burden of NP and LBP has increased by more than 70% and 60%, respectively, from 1990 to 2021. The primary drivers of this rise are population growth and aging. While the age-standardized rates (ASRs) of NP have remained stable, those for LBP have decreased. Regionally, North Africa and the Middle East bear the highest burden of NP, while Central Europe has the highest burden of LBP. A significant positive correlation exists between ASRs of LBP and the sociodemographic index (SDI), with the highest burdens of NP and LBP observed in regions with middle and high-middle SDI. Occupational ergonomic factors remain the leading cause of YLDs. The global burden of NP and LBP is increasing, especially in high-risk regions and among vulnerable populations. We urgently need public health interventions targeting modifiable risk factors to reduce the increasing disability associated with spinal pain.

Keywords
Neck pain
Low back pain
Global Burden of Disease
Cross-country inequalities
Risk factors
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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