ArticleTobacco induced diseases2026
Smoking-attributable low-back pain disability in China versus high income countries among adults aged 20-54 years, 1990-2023: A secondary dataset analysis of GBD 2023.
Article in Tobacco induced diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionLow-back pain (LBP) is a leading cause of disability. This study compared temporal trends in working-age LBP burden and smoking-attributable disability between China and the GBD aggregate 'High-income countries' from 1990 to 2023, with high body-mass index (BMI) and occupational ergonomic exposures as contextual risk factors.
methodsThis secondary analysis used Global Burden of Disease (GBD) 2023 estimates for adults aged 20-54 years in China and high-income countries. Annual incidence, prevalence and years lived with disability (YLD) were extracted as counts and age-standardized rates per 100000 population (95% uncertainty intervals [UI]). Trend magnitude was summarized using joinpoint regression (average annual percent change [AAPC], 95% confidence interval [CI]) applied to annual point estimates. Risk-attributable YLD rates and population attributable fractions (PAFs) for smoking, high BMI and occupational ergonomic exposures were obtained from the GBD comparative risk assessment.
resultsIn 2023, age-standardized incidence and YLD rates were higher in high-income countries (5115.98 per 100000, 95% UI: 4396.74-5819.09; 1396.92 per 100000, 95% UI: 993.01-1842.94) than in China (2497.71 per 100000, 95% UI: 2086.63-2942.72; 656.08 per 100000, 95% UI: 448.25-884.77). Rates declined in both settings, faster in China (incidence AAPC= -0.46%, 95% CI: -0.55 - -0.38; YLD AAPC -0.45%, 95% CI: -0.54 - -0.36) than in high-income countries (incidence AAPC= -0.12%, 95% CI: -0.13 - -0.11; YLD AAPC= -0.13%, 95% CI: -0.16 - -0.10). Smoking-attributable PAF decreased in high-income countries from 24.05% (95% UI: 16.04-32.23) to 19.60% (95% UI: 12.70-27.14) but rose slightly in China from 16.61% (95% UI: 11.33-21.74) to 18.27% (95% UI: 12.85-23.88).
conclusionsWorking-age LBP rates declined in both settings, with larger reductions in China. Smoking-attributable burden also declined, but smoking's proportional contribution decreased in high-income countries and rose slightly in China. These model-based patterns may inform population-level prevention priorities alongside rising BMI-related and work-related risks.
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