Trends and 2050 Outlook of occupational low back pain in working-age men: A SHapley Additive exPlanations-enhanced global burden of disease study

Abstract

Objective

Quantify the burden of occupational ergonomic–attributable low back pain (LBP) in men aged 20–54 from 1990–2021 at global, regional and national levels to inform targeted prevention.

Methods

We extracted Global Burden of Disease (GBD) 2021 estimates of disability-adjusted life-years (DALYs) for LBP (ICD-10 M54.3–M54.5) related to occupational ergonomic risks. Age-standardized DALY rates (ASDRs) and estimated annual percentage change (EAPC) were computed by Socio-demographic Index (SDI) quintile, 27 GBD regions, 204 countries and seven 5-year age bands. Predictive models linking burden with time, age, SDI and geography were trained and interpreted using SHAP to reveal each predictor's direction and contribution. Reference-scenario forecasts of DALYs and ASDRs to 2050 were produced with 95% uncertainty intervals. All statistical analyses were performed using R software (version 4.3.1).

Results

From 1990 to 2021, total DALYs rose while ASDRs declined. The greatest ASDR decrease occurred in low-SDI settings; high-SDI settings showed the largest 2021 burden. Andean Latin America had the largest increase, South Asia the steepest decline, and Central Europe the highest 2021 rate. China, India and the United States had the largest national DALY totals; the 45–49 age group carried the heaviest burden. Forecasts indicate continued growth in absolute DALYs alongside declining age-standardized rates through 2050.

Conclusion

Absolute occupational LBP burden among men aged 20–54 increased despite falling ASDRs. SHAP-guided forecasts support prioritizing ergonomic interventions in high-burden settings and the 45–49 age cohort.