Neck and Low Back Pain in China and Globally: Divergent Trends Among Women of Reproductive Age-An Analysis of the Global Burden of Disease Study 2023.

OBJECTIVE: To evaluate global and China-specific spinal pain burden and trends among women aged 15-49 years from 1990 to 2023 and to examine regional and Socio‑demographic Index (SDI) variations. METHODS: Using the Global Burden of Disease (GBD) 2023 data, we retrieved data on the incidence and years lived with disability (YLDs) of low back pain (LBP) and neck pain among women aged 15-49 years in 204 countries and territories from 1990 to 2023. Estimated annual percentage changes (EAPC) in the age‑standardized incidence and YLDs rates were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the relationship between age‑standardized rates and the SDI. Bayesian age‑period‑cohort models with integrated nested Laplace approximations were applied to project incidence trajectories through 2040. RESULTS: From 1990 to 2023, the absolute burden of LBP and neck pain increased globally, with divergent trends across regions. Globally, the age‑standardized incidence rate declined for LBP [EAPC -6.0% (95% CI, -8.1 to -3.3)] but increased for neck pain [EAPC 6.2% (95% CI, 0.5 to 13.9)]. The age‑standardized YLDs rate followed a similar directional pattern for each condition. In 2023, the age‑standardized incidence of LBP was highest in high‑SDI regions, while the age‑standardized incidence of neck pain was most pronounced in the Middle East and North Africa. Correlation analyses revealed a significant positive association between LBP and SDI at both the regional (incidence: r=0.673, p<0.0001; YLDs: r=0.678, p<0.0001) and national levels (incidence: r=0.664, p<0.0001; YLDs: r=0.653, p<0.0001). In contrast, no such correlation was observed for neck pain. China showed a distinct pattern: it achieved the steepest global decline in both LBP incidence [EAPC -20.9% (95% CI, -26.4 to -15.0)] and YLDs [EAPC -21.7% (95% CI, -26.6 to -16.0)], yet its neck pain YLDs rate rose sharply [EAPC 17.6% (95% CI, 2.5 to 37.1)]. Projections to 2040 suggest that while age‑standardized rates for both conditions will continue to decline globally and in China, the absolute number of cases and YLDs will remain substantial. CONCLUSION: This study reveals divergent global trends in spinal pain among women of reproductive age-LBP declining, neck pain rising-with striking geographical heterogeneity. Australasia recorded the highest LBP rates alongside the lowest neck pain rates worldwide, while China achieved one of the steepest global declines in LBP but experienced one of the sharpest rises in neck pain‑related disability. These divergent patterns underscore substantial regional health inequalities in spinal pain burden and highlight the need for tailored, population‑specific prevention strategies, with implementation research urgently needed to evaluate context‑specific effectiveness, particularly in resource‑limited settings.