Comprehensive Analysis of Modifiable Global Risk Factors for Low Back Pain

Low back pain(LBP) has become a major public health problem worldwide. Assessing the attributable contribution of modifiable risk factors in the burden of LBP and its epidemiological trends is crucial for designing effective interventions and public health strategies.

This study comprehensively analyzes the global burden of LBP attributable to modifiable risk factors from 1990 to 2021 and projects trends to 2041, using data from the GBD study, the CHARLS, and GWAS. Age‑sex analyses, cohort‑based non‑linear relationship analyses, and two‑sample Mendelian randomization were also performed.

Based on the GBD analytical framework, our results identify environmental/occupational risks, smoking, and high body mass index as the top contributors to LBP-attributable burden. Projections indicate a rising burden of LBP attributable to high BMI globally, particularly in middle and low SDI regions, while the burden from smoking is declining. Age‑sex analyses reveal the highest burden among middle‑aged and older adults, with a higher prevalence in females. Analyses within the CHARLS cohort demonstrated a significant non‑linear relationship between BMI and LBP risk. Two‑sample Mendelian randomization further provided evidence consistent with a causal effect of high BMI on LBP.

These results underscore the urgent need for targeted public health strategies addressing these modifiable risks across different regions, ages, and sexes to mitigate the growing global burden of LBP.