An additional 9.1% of the global low back pain burden could be avoided if all countries had the same health care access as Iceland, according to a recent study.
Low back pain, the leading cause of disability globally, often has its severity uniformly assessed as a result of limited data across the world.
In a recent study within the Global Burden of Diseases (GBD) framework, published in The Lancet Rheumatology, investigators assessed the impact of health care access on low back pain severity across different countries. The investigators proposed a novel method to estimate the impact of health care interventions on low back pain severity by country and over time.
They analyzed treatment the efficacy of 10 low back pain interventions from 210 trials included in 36 Cochrane systematic reviews. These effects were combined with data from the U.S. Medical Expenditure Panel Surveys to estimate hypothetical severity without treatment in the United States. Severity across countries was then evaluated using the Health Access and Quality Index, estimating averted and avoidable burdens under various treatment scenarios.
The hypothetical average disability weights without treatment were 0.228 for low back pain with leg pain and 0.132 for low back pain without leg pain. With full use of optimal treatment, the estimated disability weights were 0.143 for patients with leg pain and 0.0776 for those without leg pain.
The investigators found that the combination of psychological and physical interventions was most effective, with a standardized mean difference of –0.460 (95% uncertainty interval [UI] = –0.606 to –0.309). In 2020, access to treatment averted an estimated 17.6% (95% UI = 14.8% to 23.8%) of the global low back pain burden. Despite optimal treatment access, 65.9% of the burden remains unavoidable, suggesting that current interventions have limited effectiveness.
Full access to the most effective treatments could reduce the untreated burden by 7.4% (95% UI = 6.4% to 9.1%), but a portion of the burden would remain. The smallest differences in mean disability weights for low back pain between the treatment-invariant weights used in GBD 2021 and the new treatment-specific disability weights were found in high-income regions, whereas the largest differences were observed in low-income regions such as central sub-Saharan Africa—where the disability weight increased by 16.7%.
The findings addressed a gap in the GBD by accounting for variations in low back pain severity caused by differences in health care access. The findings indicated a need for improved access to effective treatments and additional research to develop new interventions.
Full disclosures can be found in the original study.
