The burden of low back pain and predictions in Asia–Pacific region, 1990–2021: a comparative analysis of China, Japan, Thailand, and Pakistan

Objective: Low back pain (LBP) is a leading cause of disease burden, imposing substantial societal costs. However, compared to infectious diseases, it receives insufficient attention in the Asia-Pacific region, with limited research and resource allocation. This study examines the characteristics of LBP disease burden in representative Asia-Pacific countries-China, Japan, Thailand, and Pakistan-from 1990 to 2021, and projects trends to 2050, aiming to inform evidence-based health policies. Methods: Utilizing Global Burden of Disease (GBD) 2021 data, we analyzed LBP incidence, prevalence, and years lived with disability (YLDs). Country comparisons employed age-standardized rates (ASRs), stratified by age groups. Joinpoint regression assessed trends during 1990-2021 and compared cross-national variations. The BAPC model was used to predict future LBP disease burdens from 2022 to 2050. Decomposition analysis quantified contributions from population aging, population growth, and epidemiological changes. Results: In 2021, Japan exhibited the highest ASRs, followed by China, Thailand, and Pakistan. Case counts peaked in the working-age population, while ASR peaks concentrated in middle-aged and older adult groups. Females consistently bore a higher burden than males. From 1990 to 2021, China and Japan showed declining ASR trends, whereas Thailand and Pakistan demonstrated upward ASR trends; all countries saw rising case counts. BAPC projections indicated increasing ASR burdens for Chinese males and Japanese females by 2050, with declines in other groups. Decomposition analysis revealed divergent drivers across countries. Conclusion: LBP remains a major public health challenge in these representative Asia-Pacific countries, with age, gender, and national heterogeneity shaping burden dynamics. Tailored policies addressing country-specific, gender-specific, and age-specific disparities are urgently needed to mitigate the disease burden of LBP.