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Measuring the global burden of low back pain

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Low back pain is a major cause of morbidity in high-, middle- and low-income countries, yet to date it has been relatively under-prioritised and under-funded. One important reason may be the low ranking it has received relative to many other conditions included in the previous Global Burden of Disease studies, due in part to a lack of uniformity in how low back pain is defined and a paucity of suitable data. We present an overview of methods we have undertaken to ensure a more accurate estimate for low back pain in the Global Burden of Disease 2005 study. This will help clinicians to contextualise the new estimates and rankings when they become available at the end of 2010. It will also be helpful in planning further population-based epidemiological studies of low back pain to ensure their estimates can be included in the future Global Burden of Disease studies.

Section snippets

Burden of disease studies

Burden of disease (BoD) estimates are one of the measures that governments and others may use when assessing health priorities, allocating resources and evaluating the potential costs and benefits of public health interventions. In BoD studies, diseases are ranked according to how much death and disability they cause. Since the introduction of BoD in the 1990s, largely non-fatal health problems such as mental disorders and sense organ disorders have been identified as global health priorities,

The prevalence of low back pain

The major indicators of morbidity at a population level are incidence (number of new cases of a disease in a given time period) and prevalence (number of individuals with existing disease at a given point in time) [17]. Estimating the incidence of low back pain is problematic as the cumulative incidence of first-ever episodes of low back pain is already high by early adulthood [9] and symptoms tend to recur over time [18]. Therefore, most epidemiological studies on low back pain have estimated

Previous estimates of the global burden of low back pain (Level A)

For the original GBD study (GBD 1990), no estimates were made for low back pain. Instead, all musculoskeletal conditions apart from osteoarthritis and rheumatoid arthritis were grouped in the category other musculoskeletal conditions’. For the GBD 2000–2004 updates, separate estimates were made for three health states of low back pain [14]:

  • i.

    Acute episode of low back pain resulting in moderate or greater limitations to mobility and usual activities;

  • ii.

    Episode of intervertebral disc displacement or

GBD 2005 methods for determining the global burden of low back pain

The remainder of this article details the steps we are taking to derive estimates of the global burden of low back pain for GBD 2005, including our rationale for the selected case definition, health states and lay descriptions (Fig. 5). We also briefly describe the methods for assigning disability weights to each of the health states across all diseases in the GBD project, and the parameters that will be used to estimate the disease burden.

Parameters for estimating burden

Estimates of the burden of disease for GBD 2005 will use DALYs, which are calculated by adding years of life lost in a population due to premature mortality (YLL) to healthy years of life lost in a population due to disability (YLD), i.e., DALY = YLL + YLD. YLL represents the number of cause-specific deaths multiplied by a loss function, which specifies the years lost as a function of the age at which death occurred [14]. YLD is calculated as the number of incident cases × the average duration

Acknowledgements

We would like to thank the following organisations for their financial support: the Bill and Melinda Gates Foundation (DH, TV) and the Australian Department of Health and Ageing (LM). DH is funded in part by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship and RB is funded in part by an NHMRC Practitioner Fellowship. Funders had no role in the collection, analysis and/or interpretation of data or in the writing of the article.

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