Socio-Demographic Inequalities in the Burden of Low Back Pain Across Development Strata: Sex-Specific, Age-Standardized Trends in Prevalence, Incidence and Disability from the Global Burden of Disease Study 2023, 2003–2023

Mohammed M Alshehri,1 Mohammad Abu Shaphe,1 Rashid Ali Beg,1 Aafreen Aafreen,2 Shahul Hameed Pakkir Mohamed,2 G Shankar Ganesh,3 Abdur Raheem Khan,4 Monira I Aldhahi51Department of Physical Therapy, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Health Rehabilitation Sciences, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia; 3Department of Physiotherapy, Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India; 4Department of Physiotherapy, Faculty of Medical & Health Sciences, Integral University, Lucknow, Uttar Pradesh, India; 5Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Abdur Raheem Khan, Department of Physiotherapy, Faculty of Medical & Health Sciences, Integral University, Lucknow, Uttar Pradesh, India, Email [email protected] G Shankar Ganesh, Department of Physiotherapy, Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India, Email [email protected]: Low back pain (LBP) is a leading contributor to non-fatal disability and rehabilitation needs worldwide. Monitoring trends across sociodemographic strata is important for understanding whether the disability burden is changing equitably across health systems.Purpose: To examine temporal trends and socio-demographic inequalities in the burden of LBP across Socio-demographic Index (SDI) groups from 2003 to 2023 using Global Burden of Disease Study 2023 estimates.Methods: GBD 2023 estimates for LBP prevalence, incidence and years lived with disability (YLDs) were analysed across High, High-middle, Middle, Low-middle and Low SDI groups. Age-standardized rates, all-age numbers, percentage changes and estimated annual percentage changes were calculated. Sex-specific, age-specific and inequality analyses were conducted. The change in all-age YLDs was also partitioned approximately into demographic (population growth and ageing) and epidemiological (age-standardized rate) components.Results: Age-standardized prevalence, incidence, and YLD rates declined modestly across all SDI groups between 2003 and 2023. The greatest decline in age-standardized YLD rates occurred in High SDI countries (− 6.2%), whereas Low-middle SDI countries showed the smallest reduction (− 2.5%). Despite declining rates, all-age YLD numbers increased in every SDI group, with the largest increase in Low SDI group (+65.2%). In 2023, High SDI had the highest age-standardized YLD rate, followed by Low SDI. Female YLD rates exceeded male rates in all SDI groups, and age-specific YLD rates rose steadily with age. Demographic change alone would have increased YLDs by 28.4% in High SDI and by 51.6– 73.9% in the other groups; falling age-standardized rates offset 28.1% of this demographic increase in High SDI but only 7.1– 14.1% elsewhere.Conclusion: The age-standardized rates of LBP declined modestly, but the absolute disability burden increased substantially, particularly in lower-SDI settings. Persistent SDI, sex, and age inequalities indicate the need for scalable, gender-sensitive, and context-responsive rehabilitation services. Outside High SDI settings, improvements in age-standardized rates offset only a small share of demographically driven growth in disability.Keywords: low back pain, global burden of disease, socio-demographic Index, rehabilitation, years lived with disability, health inequalities