Abstract
Background
Neck pain is a growing public health concern, no recent research has comprehensively examined its incidence and years lived with disability (YLDs) across different regions and genders. For the first time, this study aims to provide the most recent estimates on the global burden of neck pain between 1990 and 2021 obtained from the 2021 global burden of disease (GBD) database, focusing on regional and gender inequalities. We also predict future trends, highlighting its increasing impact on public health.
Materials and methods
The study was conducted retrospectively using publicly available data from the GBD 2021 database, acquired on August 20, 2024. The incidence and burden of neck pain were assessed using DisMod-MR 2.1. Data on incidence and years lived with disability (YLDs) rates per 100,000 people were obtained for countries, regions, ages, and sexes globally.
Results
In 2021, the global age-standardized rates for incidence, and YLDs of neck pain per 100,000 population was 519 (95% uncertainty interval, 408—633), and 242 (163—343) per 100,000 population, respectively. Joinpoint regression showed both rates demonstrated an overall increasing trend from 1990 to 2021 worldwide. Projections suggest a slight decline in these rates for the coming years. Women consistently showed a higher burden than men across all age groups. Regional analyses indicated that the Islamic Republic of Iran had the highest rates, whereas New Zealand had the lowest. Negative correlations were observed between the Estimated Annual Percentage Change (EAPC) and both the age-standardized rates and the Sociodemographic Index (SDI). Low-SDI countries generally exhibited higher incidence and YLDs rates, whereas high-SDI countries maintained higher YLDs rates despite relatively lower incidence rates.
Conclusion
The global burden of neck pain increased between 1990 and 2021, but future projections indicate a potential mild decrease. Gender and regional inequalities persist, underscoring the need for targeted policy interventions focusing on women and low-SDI regions to alleviate the burden of neck pain.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12891-025-08331-6.
Keywords: Neck pain, Public health, Incidence, Inequalities
Introduction
Neck pain is a highly widespread condition, with an age-standardized incidence of 807 per 100,000 globally in 2017 [1]. Neck pain can cause substantial pain, disability, and economic costs, resulting in significant economic and social burdens across the globe [2]. In 2016, low back and neck pain had the highest healthcare expenditures in the United States of 154 diseases, at approximately $134.5 billion [3]. In China, 2019 data indicate that neck pain is among the top five causes of disability, second only to low back pain, age-related hearing loss, headache disorder, and depression [4]. Similarly, in Brazil, neck pain constitutes 7.2% of disability pensions for workers with musculoskeletal disorders [5].
The Global Burden of Disease, Injury, and Risk Factor Study (GBD) systematically assesses health losses owing to a diverse range of diseases and injuries across different ages, sexes, years, and geographic regions [6]. Several GBD studies over various years and regions have highlighted neck pain as a severe public health problem that has increased over the past few decades [4, 7, 8]. Studies have reported gender differences in neck pain and prevalence between regions [9]. Nonetheless, no recent studies have comprehensively detailed the incidence of neck pain and years lived with disability (YLDs) in different regions and genders using the latest GBD data GBD 2021.
Risk factors for neck pain include genetics, psychopathology, smoking, obesity, sedentary lifestyle, trauma, and back pain [10]. Neck pain has no definitive therapy; thus, prevention is important [9]. Based on the most recent estimates from the GBD 2021, this study aims to extend and update previous research by providing comparable and comprehensive information on the global burden of Neck pain from 1990—2021. We analyze disease burden from gender and inter-regional inequality perspectives which will help healthcare policymakers and clinicians prevent and control neck pain. Furthermore, we predict future trends in neck pain development up to the year 2050.
Materials and methods
Data sources
Data and uncertainty intervals (UI) for neck pain in different countries, regions, ages, and sexes were obtained from the GBD 2021 database (https://ghdx.healthdata.org/gbd-results-tool, Released date: 16 May 2024, Acquired date 20 Aug 2024) [11]. The website is freely publicly available, and data are obtained through conditional searches. The search criteria for this study were: GBD Estimate condition—cause of death or injury. Measure condition—prevalence, incidence. Cause condition—neck pain. Geographical location—21 GBD region, 5 Sociodemographic Index (SDI) regions, and global. Age—total and ASR. Gander—male, female, and total. Year—1990 to 2021.
Neck pain definition
Neck pain is a pain (with or without referral in the upper limb [or limbs]) that lasts for at least one day [10]. The ICD-9 code is 723.1, and the ICD-10 code is M54.2.
Age-Standardized rate
Neck pain-related rates were expressed using the age-standardized rate (ASR), including the age-standardized incidence rate (ASIR), and age-standardized YLDs rate (ASYLDsR). The GBD database uses the IHME Bayesian regression tool DisMod MR 2.1 to analyze, model, and estimate the above indicators, standardize the world population, and report age-standardized incidence, as well as DALYs rates per 100,000 population. ASR was calculated as follows:
In this formula, αi is the age-specific rate in the ith age group, ωi is the number (or weight) of the population in the corresponding age subgroup of i in the selected reference standard population, and A is the number of age groups. Notably, 500 sampling times at each step in the calculation process produced 500 average estimates, and the final estimate was computed accordingly. The 25th and 975th of the 500 estimates are designated to form 95% UI of each average.
Disability-adjusted life years and years lived with disability
Disability-adjusted life years (DALYs) and standardized rates are often used to comprehensively assess disability burden caused by neck pain in individuals of different genders and ages. DALYs are the total healthy life years lost from morbidity to mortality, which is the sum of years lived with disability (YLDs) and years of life lost (YLLs) due to death, and comprehensively reflects the morbidity, disability, and death of the disease, i.e., the gap between the current health status and ideal health status. The calculation formula is DALYs = YLDs + YLLs. Given that neck pain does not directly lead to death, YLLs = 0, hence DALYs = YLDs. Therefore, this study used YLDs instead of DALYs.
Sociodemographic index
The SDI, a composite measure of developmental status strongly associated with health outcomes, was developed by GBD researchers, and used to generate these estimates. This is the geometric mean of 0 to 1 index of the total fertility rate under the age of 25, mean education for those aged 15 and older, and lag-distributed income per capita. As a composite, a location with an SDI of 0 has a theoretical minimum level of development relevant to health, whereas a location with an SDI of 1 has a theoretical maximum level. According to the SDI, countries and regions were divided into five, i.e., low, low-medium, medium, high-medium, and high.
Statistical analysis
Statistical analyses were performed using R version 4.3.2. The Estimated annual percentage change (EAPC) is a broadly accepted measure for summarizing ASR trends over specific intervals. The regression line was fitted to the natural logarithm of the ASR ratio, i.e., y = α + βx + ɛ, where y = ln (ASR) and x = calendar year [12]. EAPC was calculated as 100 × (exp (β) -1), with its 95% confidence interval (CI) derived from a linear regression model [13]. The ASRs were considered increasing if both the EAPC estimate and the lower limit of its 95% CI were > 0. Conversely, ASRs were deemed to be decreasing if the upper limit of both the EAPC estimate and its 95% CI were < 0. Otherwise, ASRs were considered stable over time.
Trend analysis of ASIR and ASYLDsR was conducted using Joinpoint 4.7, developed by the National Cancer Institute (https://surveillance.cancer.gov/joinpoint/download). The core principle of Joinpoint regression is to analyze whether APC and AAPC values are significant by identifying the inflection points or join points, in the model. These inflection points segment the long-term trend of ASIR and ASYLDsR into several intervals, each described by APC and AAPC, thereby revealing the change patterns of ASIR and ASYLDsR over time.
The Pearson correlation method was used to analyze the correlation. Predicted images were drawn by the following method. Standard-age population data [14] and predicted population data for 2100 [15] were obtained from the relevant literature. Standard-age population data along with incident case and DALY data for each age group from 1990 to 2021, were compiled and projected using R version 4.3.2. The age-specific rate function of the BAPC package was employed for the projections. The BAPC package uses the integrated nested Laplacian approximation for complete Bayesian inference. Image rendering was performed using the plot BAPC function within the BAPC package of R. P < 0.05 was considered significantly different.
Results
In 2021, 206 (95% UI: 162—253) million people globally were affected by neck pain (Supplementary material online, Table S1), including 42 (34—53) million incident cases with an ASIR of [519 (408—633) per 100,000 people] (Table 1). In 1990, 115 (89—142) million people globally were affected by neck pain (Supplementary material online, Table S1), with 25 (20—31) million incident cases and an ASIR of [513 (404—630) per 100,000 people] (Table 1). The number of neck pain-related YLDs globally in 2021 was 20 (14—29) million with an ASYLDsR of [242 (163—343) per 100,000 people]. In contrast, whereas 11 (8—16) million in 1990 were affected with an ASYLDsR of [242 (162—344) per 100,000 people] (Table 2).
Table 1.
The incidence of neck pain in 1990 and 2021 for both sexes in regions, with EAPC from 1990 and 2021
| Location | 1990 counts | 1990 ASR per 100,000 people | 2021 counts | 2021 ASR per\ 100 000 people | EAPC in ASR 1990–2021 |
|---|---|---|---|---|---|
| Global | 24,903,379 (19,628,380—30,674,274) | 513 (404—630) | 43,286,061 (33,941,594 – 52,883,959) | 519 (408—633) | 0% (-0.07—0.07) |
| SDI quintiles | |||||
| High-middle SDI | 5,961,103 (4,692,972 – 7,403,836) | 553 (436—681) | 8,961,321 (7,024,439 – 11,153,757) | 560 (440—684) | 0.04% (0.01—0.07) |
| High SDI | 4,803,012 (3,796,045 – 5,886,455) | 498 (393—609) | 6,593,066 (5,197,608 – 8,088,413) | 505 (401—616) | -0.03% (-0.11—0.05) |
| Low-middle SDI | 4,150,652 (3,283,738 – 5,073,481) | 455 (357—555) | 8,420,360 (6,611,918 – 10,391,026) | 463 (364—566) | -0.06% (-0.21—0.1) |
| Low SDI | 1,760,982 (1,394,425 – 2,154,616) | 486 (381—596) | 4,298,818 (3,390,096 – 5,287,328) | 495 (388—608) | -0.01% (-0.11—0.09) |
| Middle SDI | 8,202,725 (6,465,482 – 10,143,219) | 551 (433—678) | 14,977,034 (11,768,991 – 18,524,086) | 555 (437—679) | 0.01% (-0.05—0.06) |
| GBD regions | |||||
| Andean Latin America | 167,197 (126,712—203,620) | 517 (408—640) | 345,373 (272,400—430,198) | 516 (408—639) | 0% (0—0) |
| Australasia | 61,542 (48,280—76,189) | 284 (223—351) | 103,283 (81,232—127,518) | 284 (223—350) | -0.06% (-0.13—0) |
| Caribbean | 170,622 (133,224—208,749) | 517 (408—640) | 259,154 (203,944—320,946) | 517 (408—640) | 0% (0—0) |
| Central Asia | 298,396 (229,860—367,799) | 492 (386—600) | 467,832 (363,107—579,771) | 491 (386—599) | -0.01% (-0.01—-0.01) |
| Central Europe | 709,579 (552,175—866,303) | 527 (417—646) | 744,418 (581,386—921,023) | 531 (420—650) | 0.02% (0.02—0.02) |
| Central Latin America | 807,798 (620,127—988,556) | 581 (460—716) | 1,536,844 (1,217,694 – 1,897,649) | 582 (460—716) | 0% (-0.01—0) |
| Central Sub-Saharan Africa | 209,069 (161,103—258,847) | 528 (415—657) | 555,332 (426,777—689,712) | 526 (414—654) | -0.01% (-0.01—-0.01) |
| East Asia | 6397,494 (4,941,455 – 8,008,679) | 557 (440—691) | 10,613,336 (8,334,296 – 13,406,844) | 565 (447—696) | 0.08% (0.05—0.1) |
| Eastern Europe | 1471,440 (1,145,134 – 1,810,964) | 600 (477—741) | 1481,278 (1,167,725—1828,754) | 600 (477—741) | 0% (0—0) |
| Eastern Sub-Saharan Africa | 619,440 (488,847—757,767) | 480 (378—590) | 1,521,451 (1,202,901—1871,426) | 481 (378—590) | -0.02% (-0.06—0.02) |
| High-income Asia Pacific | 947,130 (739,819—1171,858) | 492 (387—602) | 1,131,236 (884,686—1402,515) | 479 (377—586) | -0.09% (-0.09—-0.08) |
| High-income North America | 1,503,141 (1,193,138—1847,002) | 496 (390—601) | 2,074,654 (1,628,564—2529,690) | 495 (390—602) | -0.22% (-0.42—-0.01) |
| North Africa and Middle East | 1,886,223 (1,479,002 – 2,305,643) | 724 (565—889) | 4,430,711 (3,432,716 – 5,548,218) | 720 (562—884) | -0.02% (-0.03—-0.02) |
| Oceania | 24,446 (19,111—30,296) | 497 (387—610) | 57,950 (45,262—72,445) | 498 (387—611) | 0% (0—0) |
| South Asia | 3,181,499 (2,497,508 – 3,910,574) | 369 (291—453) | 6,649,056 (5,186,404 – 8,158,064) | 370 (291—455) | -0.2% (-0.58—0.18) |
| Southeast Asia | 1,953,984 (1,543,255 – 2,424,887) | 520 (407—641) | 3,856,591 (3,020,921 – 4,802,852) | 522 (408—643) | 0% (0—0.01) |
| Southern Latin America | 199,021 (153,510—242,828) | 410 (316—502) | 303,381 (237,724—371,681) | 410 (316—501) | 0% (0—0) |
| Southern Sub-Saharan Africa | 263,430 (205,085—321,441) | 628 (495—778) | 486,456 (380,448—609,361) | 627 (494—778) | 0% (-0.01—0.01) |
| Tropical Latin America | 860,501 (667,164 – 1,058,703) | 627 (4923—766) | 1,555,607 (1,219,132 – 1,921,961) | 627 (493—766) | -0.16% (-0.26—-0.07) |
| Western Europe | 2,244,060 (1,754,093 – 2,732,589) | 515 (405—625) | 2,657,509 (2,051,802—3281,593) | 504 (395—614) | -0.13% (-0.21—-0.06) |
| Western Sub-Saharan Africa | 927,370 (727,208 – 1,141,614) | 653 (511—809) | 2,454,607 (1,907,949 – 3,032,757) | 664 (519—824) | 0.08% (0.07—0.08) |
Data in parentheses are 95% uncertainty interval unless specifically noted
ASIR Age Standardized Incidence Rate, EAPC Estimated Annual Percentage Change, CI Confidence interval, SDI Sociodemographic Index
Table 2.
YLDs of Neck Pain in 1990 and 2021 for both sexes in regions, with EAPC from 1990 and 2021
| Location | 1990 counts | 1990 ASR per 100,000 people | 2021 counts | 2021 ASR per 100,000 people | EAPC in ASR 1990–2021 |
|---|---|---|---|---|---|
| Global | 11,442,356 (7,608,943 – 1,6334,313) | 242 (163—344) | 20,415,497 (13,638,705 – 28,856,643) | 242 (163—343) | -0.04% (-0.12—0.03) |
| SDI quintiles | |||||
| High-middle SDI | 2,816,833 (1,894,235 – 3,982,855) | 263 (177—370) | 4,383,938 (2,896,189 – 6,144,813) | 263 (177—374) | 0% (-0.05—0.05) |
| High SDI | 2,519,671 (1,689,769 – 3,562,298) | 256 (171—363) | 3,510,370 (2,374,175 – 4,868,137) | 255 (170—360) | -0.11% (-0.19—-0.03) |
| Low-middle SDI | 1,786,018 (1,174,592 – 2,570,856) | 205 (136—291) | 3,750,146 (2,476,083 – 5,396,702) | 210 (139—298) | -0.05% (-0.21—0.11) |
| Low SDI | 760,136 (502,271 – 1,096,920) | 224 (149—317) | 1,866,847 (1,233,277 – 2,699,923) | 229 (152—325) | 0.01% (-0.09—0.11) |
| Middle SDI | 3,547,918 (2,334,227 – 5,153,758) | 248 (166—353) | 6,886,927 (4,532,447 – 9,780,164) | 251 (168—357) | 0.03% (-0.03—0.09) |
| GBD regions | |||||
| Andean Latin America | 75,402 (48,873—108,725) | 247 (163—353) | 164,480 (108,206—236,712) | 247 (164—353) | 0% (0—0.01) |
| Australasia | 29,414 (19,380—41,629) | 134 (88—192) | 50,411 (33,319—70,693) | 135 (87—193) | -0.08% (-0.16—0) |
| Caribbean | 78,785 (51,587—112,248) | 247 (164—351) | 125,237 (83,929—178,140) | 246 (163—351) | -0.01% (-0.01—-0.01) |
| Central Asia | 137,702 (90,065—197,378) | 234 (156—336) | 223,849 (147,519—326,118) | 233 (155—335) | 0% (0—0) |
| Central Europe | 332,029 (222,274—471,987) | 243 (162—347) | 357,967 (239,893—500,521) | 244 (163—351) | 0.03% (0.02—0.03) |
| Central Latin America | 349,608 (229,484—512,985) | 266 (180—380) | 706,882 (474,616 – 1,011,683) | 266 (180—380) | 0% (0—0) |
| Central Sub-Saharan Africa | 92,806 (61,290—134,602) | 253 (169—356) | 248,614 (164,060—359,441) | 254 (170—359) | 0.01% (0.01—0.02) |
| East Asia | 2,780,263 (1,809,574—4070,913) | 249 (164—354) | 4,988,273 (3,275,346 – 7,148,481) | 255 (168—358) | 0.12% (0.1—0.15) |
| Eastern Europe | 665,125 (447,362—962,294) | 265 (178—380) | 678,410 (453,718—952,947) | 265 (177—380) | 0.01% (0.01—0.02) |
| Eastern Sub-Saharan Africa | 260,408 (170,715—379,593) | 218 (145—310) | 645,331 (422,229—948,426) | 219 (145—311) | 0.01% (-0.03—0.05) |
| High-income Asia Pacific | 456,231 (302,380—653,538) | 233 (155—335) | 565,175 (376,372—797,429) | 228 (152—326) | -0.06% (-0.07—-0.05) |
| High-income North America | 728,234 (480,209—1049,166) | 237 (158—341) | 1,016,721 (685,078 – 1,432,776) | 234 (156—338) | -0.29% (-0.49—-0.1) |
| North Africa and Middle East | 899,658 (593,857 – 1,298,606) | 373 (248—531) | 2,216,324 (1,482,658 – 3,190,401) | 369 (245—524) | -0.04% (-0.04—-0.03) |
| Oceania | 10,963 (7,286—15,797) | 239 (160—340) | 26,663 (17,569—38,820) | 239 (161- 341) | 0% (0—0.01) |
| South Asia | 1295,542 (855,164 – 1,876,044) | 155 (103—222) | 2,785,641 (1,833,506 – 4,022,446) | 156 (103—224) | -0.22% (-0.65—0.2) |
| Southeast Asia | 852,104 (563,481 – 1,239,548) | 238 (159—337) | 1,774,374 (1,172,335 – 2,559,661) | 239 (159—341) | 0.02% (0.02—0.02) |
| Southern Latin America | 100,857 (65,886—145,585) | 210 (138—302) | 158,389 (105,222—225,484) | 209 (138—300) | -0.01% (-0.01—0) |
| Southern Sub-Saharan Africa | 112,733 (74,456—163,615) | 284 (189—408) | 213,569 (142,595—308,927) | 281 (187 – 402) | -0.03% (-0.04—-0.03) |
| Tropical Latin America | 365,358 (237,076—540,256) | 275 (185—396) | 695,489 (468,529—998,102) | 275 (184—397) | -0.17% (-0.27—-0.07) |
| Western Europe | 1,409,943 (954,254 – 1,974,984) | 309 (210—437) | 1,682,062 (1,128,399 – 2,364,048) | 297 (197—425) | -0.24% (-0.34—-0.13) |
| Western Sub-Saharan Africa | 409,191 (270,841—592,368) | 309 (206—435) | 1,091,636 (716,859 – 1,578,425) | 319 (212—448) | 0.14% (0.12—0.15) |
Data in parentheses are 95% uncertainty interval unless specifically noted
ASIR Age Standardized Incidence Rate, YLDs Years Lived with Disability, ASYLDsR Age Standardized Years Lived with Disability rate, EAPC Estimated Annual Percentage Change, CI Confidence interval, SDI Sociodemographic Index
The ASIR of neck pain between 1990 and 2021 showed an increasing trend globally, AAPC = 0.04 (95% CI, 0.01 to 0.07, P = 0.02). By dividing the age interval, the largest increase occurred in 2005—2009, APC = 0.87 (95% CI, 0.76 to 0.98, P < 0.001) (Fig. 1A). In terms of the ASYLDsR of neck pain, an increasing trend was noted during 1990—2021, AAPC = 0.003 (95% CI, − 0.03 to 0.03, P = 0.87). The largest increase in ASYLDsR occurred during 2005—2010, APC = 0.72 (95% CI, 0.66 to 0.79, P < 0.001) (Fig. 1B). Notably, ASYLDs showed a decreasing trend globally from 2018 to 2021, APC = -0.04 (95% CI, -0.15 to 0.07, P = 0.42).
Fig. 1.
The Joinpoint regression model for the age-standardized incidence rate (A) and age-standardized YLDs rate (B) for neck pain
Both the ASIR and ASYLDsR of neck pain were higher in women than in men from 1990—2021 (Fig. 2). Incident cases and YLDs caused by neck pain were more common in women than in men at different ages (Fig. 3). Incident cases were largest in both sexes in the 40—44 years group. ASIR of neck pain in men and women also peaked between 40 and 44 years of age but continued to fluctuate thereafter before increasing again after 85—89 years of age. Men and women between 45 and 49 years of age had the largest YLDs, and ASYLDs in both genders reached their highest at 55—59 years of age.
Fig. 2.
Trends in the number and age-standardized rates for neck pain worldwide from 1990—2021. A Incidence, B YLDs. Error bars represent the 95% uncertainty interval (UI), and shading indicates 95% UI for the rates. YLDs, years lived with disability
Fig. 3.
Characterization of global neck pain in 2021 by sex. Age-specific numbers and rates of (A) incidence, B YLDs. Error bars indicate the 95% uncertainty interval (UI), and shading indicates 95% UI for the rates. YLDs, years lived with disability
In 2021, among the 21 regions included in the GBD, North Africa and the Middle East had the highest ASIR and ASYLDsR of Neck pain; Australasia had the lowest ASIR and ASYLDsR (Table 1). At the national level, countries with low levels of development had high ASIR and ASYLDsR. Countries with high levels of development have low ASIR and high ASYLDsR. Specifically, the Islamic Republic of Iran had the highest ASIR and ASYLDsR of neck pain among all countries, whereas New Zealand had the lowest ASIR and ASYLDsR (Fig. 4A and Supplementary material online, Table S2, S3). The largest decrease in ASIR and ASYLDsR between 1990 and 2021 was observed in the Kingdom of Spain with an EAPC of [-1.36 (-1.96—-0.76) %], and [-2.13% (-3.01—-1.24) %], respectively. On the other hand, the largest increase was noted in the State of Kuwait with an EAPC of [0.34 (0.18—0.39) %] and [0.34 (0.18—0.49) %], respectively (Supplementary material online, Table S2 and Table S3).
Fig. 4.
Age-standardized rates for neck pain globally in 2021. Shown are the neck pain-related rates of (A) incidence, B YLDs in both sexes from 204 countries and territory. Each point shows the observed age-standardized incidence or YLDs rate for a specified country or territory in 2021. The black line indicates the expected values based on the sociodemographic index and disease rates in all locations. YLDs, years lived with disability
A correlation analysis was performed to investigate the relationship between EAPC, ASR, SDI. EAPC presented a negative correlation with ASIR in 1990 (R = -0.037, p = 0.308), and ASYLDsR in 1990 (R = -0.11, p = 0.121) (Fig. 5A and B). SDI in 2021 showed a negative correlation with both EAPC of ASIR (R = -0.037, p = 0.308), and EAPC of ASYLDsR (R = -0.11 p = 0.121) (Fig. 5C and D). Figure 6 presents the predicted trends for ASIR and ASYLDsR up until 2050. Future projections suggest that ASIR and ASYLDR of neck pain will display a weak downward trend.
Fig. 5.
Correlation of the EAPC with ASR and SDI for neck pain. Correlation of the EAPC with the (A) ASIR of neck pain in 1990, B ASYLDsR of neck pain in 1990. Correlation between EAPC with C ASIR, D ASYLDsR and 2021 SDI. EAPC, estimated annual percent change. ASIR, age-standardized incidence rate. ASYLDsR, age-standardized years lived with disability rate. SDI, socio-demographic index. * P < 0.05 was statistically significant. Each circle represents a country, and the size of the circle indicates the number of cases of neck pain
Fig. 6.
The predicted trends until 2050 Using BAPC model, trends in age-standardized (A) incidence, B YLDs rates associated with neck pain have been predicted for up—2050
Discussion
This research provides a comprehensive assessment of the global burden of neck pain, covering incidence and YLDs across 204 countries and territories between 1990 and 2021. The study uses the latest publicly available data and methods from the GBD study of 2021 [11]. In 2021, neck pain accounted for approximately 206 million cases, with 42 million new incident cases, and 20 million YLDs globally. Joinpoint regression revealed that the overall ASIR and ASYLDsR of neck pain displayed an increasing trend between 1990 and 2021; on the other hand, ASYLDsR showed a decreasing trend between 2018 and 2021. Predictive analysis suggested that both ASIR and ASYLDsR of neck pain will display a weak downward trend until 2050. Nonetheless, the absolute burden of neck pain, including the number of cases and YLDs is expected to rise. Neck pain is a major contributor to YLDs, ranking 15th among all causes globally [11]. We observed the highest ASIR and ASYLDsR for neck pain in North Africa and the Middle East, with the Islamic Republic of Iran having the highest ASIR and ASYLDsR among 204 countries. On the other hand, China has the largest affected population, with 48 million individuals suffering from neck pain.
Our analysis further showed that women consistently bear a higher burden of neck pain than men from 1990 to 2021, corroborating with previous GBD 2010 [16], GBD 2017 [1], and GBD 2019 [17, 18] reports. Multiple studies have shown that estrogen and its receptors may affect pain perception, with biomedical mechanisms indicating that it may exacerbate inflammatory pain responses [19]. Women clinically tend to exhibit greater susceptibility to inflammation than men [20]. Psychological factors, among them prolonged stress, lack of social support, anxiety, and depression are important contributors to neck pain [9]. A Chinese study [21] revealed that individuals with chronic neck pain often report comorbid conditions, specifically mood disorders, which have a stronger relationship with neck pain than anxiety or substance use disorders. The differences in pain perception between men and women may also be caused by genetic and environmental factors [22]. Women are more likely to show emotional vulnerability, suffer more from mental stress (anxiety, depression), and may require greater resources to manage these challenges [4]. Furthermore, sedentary behavior is a key risk factor contributing to neck pain [23], with women participating in more sedentary jobs than men, which similarly results in an increased incidence of neck pain. We also noted gender differences in the effects of different behaviors on neck pain, with men more likely to experience neck pain due to reading, whereas women were more likely to experience neck pain due to driving [24]. Furthermore, Finite Element Analysis showed that the linear and areal dimensions of the cervical spine were larger in men, suggesting that the spine is more stable and may be more resistant to inertial load imposed during posterior automobile impacts [25]. Therefore, women are more likely to experience whiplash injuries caused by traffic accidents than men. In this regard, relevant institutions should strengthen social and emotional support for women to minimize their burden of neck pain.
Among all the 21 GBD regions, ASIR and ASYLDsR initially increased with increasing SDI levels, followed by a decline. National-level data revealed that ASIR was higher in low-SDI countries and lower in high-SDI countries, whereas ASYLDsR increased in both low- and high-SDI nations, with medium-SDI countries, showing the lowest levels. This is unlike trends reported in 2017 [1] and 2019 [17] GBD studies. This suggests evolving patterns in neck pain across regions. This also implies that neck pain remains somewhat unequal between regions. In high-income countries, the high ASYLDsR of neck pain may be due to increased use of electronic devices such as mobile phones and computers. The incidence and YLDs of neck pain may be higher in regions where individuals rely more on the neck to carry heavy objects [10]. Higher ASIR in countries with middle SDI may be linked to work-related injuries and economic development-related stress. Thus, policymakers should consider these factors when developing approaches to minimize the burden of neck pain.
Overall, neck pain has a high incidence and significantly promotes YLDs among females. Gender inequality, i.e., disparities in opportunities and rights between men and women [26], is a recognized risk factor for non-communicable diseases in low- and middle-income countries [27]. As such, a comprehensive study of gender inequality in related diseases is important to inform healthcare policy formulation. For instance, giving more customized healthcare policies to female groups would alleviate this phenomenon. At the national development level, countries with a high SDI show a lower incidence of neck pain but report higher ASYLDRs. Research suggests that certain nutritional and behavioral practices common in developed countries and regions, including increased consumption of fast food, alcohol, and tobacco have rapidly increased the burden of non-communicable diseases including diabetes [28]. In countries with low SDI, inadequate working environments and limited medical infrastructure have inevitably resulted in a high burden of neck pain. Thus, advocating complementary cooperation between regions and promoting the transfer of production technologies and medical assistance from developed to developing countries will help reverse this trend. Additionally, the COVID-19 pandemic is also linked to neck pain. Although the clinical presentation of COVID-19 ranges from mild symptoms to severe pneumonia and severe organ damage, research has shown higher pain during COVID-19 than during pre- and post-infectious states [29]. Neck pain intensities of teachers have significantly increased since the introduction of distance learning. Therefore, there is a relationship between the occurrence of neck pain and changes like teacher work associated with the COVID-19 epidemic [30]. Furthermore, increased neck pain during the COVID-19 pandemic may be explained by physical inactivity, psychosocial stress, and lack of access to health care [31]. This reminds policymakers that the potential effect of mass isolation on other chronic diseases should be considered when carrying out epidemic prevention and control.
This study has compelling limitations. First, the diagnosis of neck pain in GBD 2021 was derived from self-reports which could harbor some bias. Although we discuss the relationship between COVID-19 and neck pain, the 2021 data GBD 2021 does not consider the effect of COVID-19 on neck pain morbidity and burden in data analysis and prediction. The pandemic may have reduced treatment opportunities, affecting the overall neck pain burden. Moreover, the 2021 data on GBD does not include data on risk factors for neck pain, restricting the capacity to fully inform disease control policies. In addition, limited studies are available on socio-economic impact, and living habits on neck pain between regions. Therefore, it is not yet possible to comprehensively explain the reasons for disease burden differences in various regions, hence warranting additional studies.
Conclusion
The global burden of neck pain showed an increasing trend between 1990 and 2021. Forecasts show a decreasing trend in future disease burden. Women are more likely to suffer from neck pain than men. Less developed areas have a higher incidence and YLDs of neck pain. Thus, effective preventive and intervention measures are necessary to further reduce neck pain burden and address the differences in neck pain between genders and regions.
Supplementary Information
Acknowledgements
The authors would like to thank all collaborators involved in GBD 2021 study.
Patient and public involvement
Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Abbreviations
- GHDx
Global Health Data Exchange
- UIs
Uncertainty Intervals
- GBD
Global Burden of Disease, Injury, and Risk Factor Study
- ASIR
Age-standardized incidence rate
- ASYLDsR
Age Standardized Years Lived with Disability rate
- YLDs
Years lived with disability
- ASR
Age-standardized rates
- SDI
Sociodemographic index
- EAPC
Estimated Annual Percentage Chang
Authors’ contributions
(I) Conception and design: Haifeng Wu, Yue Li, Congying Zou. (II) Administrative support: Lin Sun. (III) Data processing and plotting: Haifeng Wu, Weidong Guo, Guoshun Huang. (IV) Data analysis and interpretation: Yue Li, Feng Han. (V) Manuscript writing: All authors. (VI) Final approval of manuscript: All authors.
Funding
Not applicable.
Data availability
The data underlying this article were derived from sources in the public domain: Institute for Health Metrics and Evaluation, at http://ghdx.healthdata.org/gbd-results-tool, accessed on 20 August 2024. The data used and analyzed in this study is included in the article or are available from the corresponding and first authors on reasonable request.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Haifeng Wu, Yue Li and Congying Zou are co-first authors; and they contributed equally to this work.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data underlying this article were derived from sources in the public domain: Institute for Health Metrics and Evaluation, at http://ghdx.healthdata.org/gbd-results-tool, accessed on 20 August 2024. The data used and analyzed in this study is included in the article or are available from the corresponding and first authors on reasonable request.