Burden and Trends of Low Back Pain in Pakistan: A Global Burden of Disease Study, 1990-2021

Background and aim Low back pain (LBP) is a major contributor to disability globally, yet national and provincial trends in Pakistan remain inadequately explored. This study aimed to quantify the national and provincial trends in the prevalence of low back pain (LBP) in Pakistan from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 data, assess the trends in years lived with disability (YLDs) attributable to LBP over the same period, and identify temporal changes using Joinpoint regression and highlight regional and gender disparities in the burden of LBP. Methods Age-standardized rates of prevalence and YLDs per 100,000 population due to LBP were analyzed for Pakistan and its provinces. Temporal patterns were evaluated using Joinpoint regression analysis to estimate the annual percent changes (APC) with 95% confidence intervals. Results In 1990, the prevalence of LBP in Pakistan was 6,500 (95% uncertainty interval (UI): 5,466-7,638) per 100,000, which increased to 7,462 (95% UI: 6,300-8,763) in 2021, reflecting a 14.8% rise. The highest prevalence in 2021 was observed in Gilgit-Baltistan (8,302; 95% UI: 7,260-9,322), while Punjab and Islamabad Capital Territory showed the largest relative increases (+14.8% and +11.8%, respectively). YLDs also rose from 605 (95% UI: 503-713) per 100,000 in 1990 to 720 (95% UI: 609-842) in 2021. Joinpoint regression revealed four phases: a gradual increase (1990-2001; APC 0.08%, p<0.001), moderate growth (2001-2010; APC 0.27%, p<0.001), sharp escalation (2010-2015; APC 1.86%, p<0.001), and a decline thereafter (2015-2021; APC -0.44%, p<0.001). Conclusions The burden of LBP in Pakistan has increased substantially over the past three decades, with notable regional disparities. These findings emphasize the need for targeted preventive, clinical, and rehabilitative interventions to reduce disability related to LBP.