Low Back Pain in Chinese Adults Aged 45 Years and Older: Trends, Drivers, and Projections, 1990-2040

Background: Low back pain (LBP) is a major cause of disability in later life. We aimed to assess the population-level burden, demographic and epidemiological drivers, GBD-defined risk attribution, and future trajectory of LBP among Chinese adults aged 45 years and older. Methods: Using population-level estimates from the Global Burden of Disease Study 2023 (GBD 2023), we analyzed incidence, prevalence, and years lived with disability (YLDs) among Chinese adults aged 45 years and older from 1990 to 2023. We assessed temporal trends, decomposed changes in burden, evaluated age-period-cohort patterns, quantified YLDs attributable to three GBD-defined risk factors-high body mass index, occupational ergonomic factors, and smoking-and projected burden to 2040 using Bayesian age-period-cohort models. Results: In 2023, population-level GBD estimates indicated that LBP accounted for 30.29 million incident cases, 71.54 million prevalent cases, and 7.90 million YLDs among Chinese adults aged 45 years and older. Compared with 1990, these numbers increased by 101.54%, 97.08%, and 96.11%, respectively, despite declining age-restricted age-standardized incidence, prevalence, and YLD rates. Expansion of the population aged 45 years and older was the main driver of the increasing absolute burden, whereas favorable epidemiological change offset part of this increase. High body-mass index showed the largest increase in attributable burden and was the only risk factor with rising age-standardized attributable YLD rates. Model-based projections suggested that age-restricted age-standardized burden would continue to decline through 2040. Conclusions: LBP remains a growing absolute burden among middle-aged and older adults in China despite declining age-restricted age-standardized rates. Future disability reduction will require integrated strategies combining risk-factor control, rehabilitation, functional support, and age-sensitive care.