Disease burden of low back pain in middle-aged and older women (≥55 years) attributable to three factors: A comparative analysis from GBD 2023

Background Low back pain (LBP) is a leading cause of global disability, with a heavier burden in low and low-middle Socio-Demographic Index (SDI) regions. Women aged ≥55 years are vulnerable due to dual labor loads, yet LBP burden attributed to occupational ergonomic factors, smoking, and high Body Mass Index (BMI) in this subgroup remains understudied. Objective This study analyzed the 30-year LBP burden and its drivers in this population to inform targeted prevention. Method Using Global Burden of Diseases (GBD) 2023 data (1992–2023), we employed Joinpoint regression, decomposition, and frontier analyses to assess LBP-related disability-adjusted life years (DALYs) across low/low-middle SDI regions. Result Absolute DALYs increased consistently across all risk factors; age-standardized DALY rates (ASDR) declined with age, peaking at 55–59 years. Population growth was the primary driver which contributed >100%. High BMI-associated LBP grew most prominently with 579% in low-middle SDI regions, and ASDR rises in low SDI regions. Decomposition and frontier analyses revealed unique regional contribution patterns and intercountry disparities. Conclusion This study indicates that the burden of LBP attributable to three factors may be increasing in low and low-middle SDI regions, with population growth and aging likely acting as primary drivers. Occupational ergonomic factors emerge as the most pressing risk factors, while high BMI is potentially the fastest-growing contributor. Notable intercountry disparities within each SDI tier underscore both challenges and opportunities for targeted prevention.