Evaluation of the Prevalence, Trends, and Correlates of Low Back Pain in India: A Retrospective Cross-Sectional Study.

BACKGROUND

Low back pain (LBP) is a leading cause of disability worldwide, including a significant portion of the Indian population; however, comprehensive epidemiological data are lacking. This study aimed to explore the prevalence, risk factors, and prescribing patterns for LBP in the Indian population.

METHODS

This cross-sectional, retrospective study (CTRI/2025/01/079359 (registered on: January 24, 2025)) analyzed anonymized electronic medical record (EMR) data of 16866 patients from 76 private centers in 18 states across India, diagnosed with LBP between 2019 and 2023. The primary outcomes include the assessment of the prevalence of LBP across demographic and clinical subgroups, the distribution of treatment practices among various medical specialties, and the utilization of medication classes such as nonsteroidal anti-inflammatory drugs (NSAIDs) and calcium supplements. Secondary outcomes include the assessment of the prevalence of LBP categorized by sex, BMI, age group, and comorbidities, as well as the proportion of patients with LBP treated by physicians of different medical specialties. Anthropometric parameters, including weight, height, and body mass index (BMI), were assessed. The prevalence of LBP, associated symptoms, comorbidities, and prescribing trends were examined using statistical analyses.

RESULTS

Among 16866 patients diagnosed with LBP, the prevalence of LBP fluctuated across the five-year study period (2019-2023). From 3767 cases (22.33%) in 2019, prevalence declined sharply to 2762 cases (16.38%) in 2020 (χ² = 154.7, p < 0.001), followed by a significant increase to 3272 cases (19.40%) in 2021 (χ² = 43.11, p < 0.001 compared to 2020). Prevalence remained statistically stable in 2022 at 3248 cases (19.26%; χ² = 0.09, p = 0.766 compared to 2021), before rising significantly to 3817 cases (22.63%) in 2023 (χ² = 45.83, p < 0.001 compared to 2022). Notably, while the 2023 prevalence represented the highest point in the study period, it was not statistically different from the 2019 baseline (χ² = 0.33, p = 0.566). Females exhibited a significantly higher prevalence of LBP compared to males (11420 (67.71%) vs. 5546 (32.29%), p < 0.001). Additionally, 10328 (61.24%) patients were classified as overweight or obese. Among patients with comorbidities, 3870 (22.95%) patients presented with gastrointestinal disorders, 2763 (16.38%) had orthopedic conditions, and 2226 (13.20%) were diagnosed with hypertension. These conditions were identified as significant predictors of LBP. Calcium supplements were utilized by 4479 (26.56%) patients, NSAIDs by 4350 (25.79%), and NSAID-muscle relaxant combinations by 1342 (7.96%) patients, with a limited use of opioids in 633 (3.75%) patients.

CONCLUSION

This pan-Indian cross-sectional study highlighted LBP as a major health burden affecting anthropometric parameters. Key risk factors included female gender, young adulthood, and high BMI, emphasizing the need for targeted management strategies.