Back in college, when I was in that ripe age between high school and “oh hey, now I have to figure out what to do with the rest of my life” (cue stress memories), what first interested me in medical device (or biomedical textiles in this case) was thinking that as the baby boomers (my parent’s generation) aged, there would be greater opportunity for the medical field to grow and take care of them. So, when I see trends saying that “lower back pain” is increasing, I think, it’s got to be because of the aging population, right?
The Baby Boomers, born between 1946 and 1964, are a massive demographic group estimated at 73 million. As of 2020, the oldest Baby Boomers were turning 74. The number of people over 65 has grown rapidly, from 3.1 million in 1900 to 52 million in 2018. Their proportion of the population has also risen from 12.4% to 16%. [3] And if you look at the numbers, nearly 59% of adults (18 and over) experienced pain of any kind, with back pain being the most common at 39% (while in 2013, nearly 29% of US adults reported experiencing low back pain in the past 3 months). [1,5]. Back pain was also more likely to affect older adults, with rates climbing steadily from young adults (28.4%) to those over 65 (45.6%). [1] Without jumping to conclusions too hard, if correlation leads to causation, my hypothesis seemed to be holding strong. However, digging more into the numbers, the correlation started wavering.
Nearly 65 million Americans experience recent back pain, with 16 million having persistent pain impacting daily activities. Back pain ranks as the sixth most expensive condition, costing over $12 billion annually in healthcare and lost productivity. Back pain is a major cause of missed work, leading to an estimated 83 million lost workdays per year. Adults with back pain are significantly more likely to miss workdays due to illness or injury compared to those without back pain (64% vs 45%). They’re also more likely to miss extended work periods. The number of back pain injuries causing missed workdays has seen an increase between 1998 and 2000, following a prior decrease. [2] So far, this is aligning with “yes, our population is getting older, so there’s more back pain.”
However, in 2013, most healthcare visits came from the 45-64 age group (highest prevalence) and 18-44 age group (combined 72%). “Back disorders” were the most common diagnosis across all age groups. Disc disorders increased with age, peaking in the 45-64 age group, while back injuries are more frequent in younger people (under 45) and decrease with age. The average hospitalization age for low back pain is 61.8 years. [5] In 2019, adults with back pain are more likely to be between 18 and 44 years old (41% vs. 54% for all adults). [2] Another study showed low back pain occurs more frequently in young adults (25-29 years old) and older adults (95-99 years old). [4] Women were also more prone to back pain compared to men. [2] In 2013, Women account for 55% of healthcare visits for low back pain. [5] Men are more likely to experience low back pain between 10-49 years old, while women are more prone to it between 65-94 years old. [4] Racial and ethnic disparities have been observed, with non-Hispanic whites experiencing the highest prevalence and non-Hispanic Asians the lowest.[2] In 2013, Non-Hispanic whites had the highest hospitalization rates (74%), followed by blacks (10%) and Hispanics (6%). This pattern flips for outpatient visits, where blacks (15%) and Hispanics (13%) have higher rates compared to whites (66%).[5] Black and white individuals have a higher incidence of low back pain compared to Asians.[4] Finally, lower socioeconomic status correlated with a higher chance of back pain. [1] For working-age adults (18-64), back pain is the leading cause of work limitations, affecting one in five adults in this age group. While less impactful than for younger adults, back pain still ranks as the fourth leading cause of work limitations for those over 65.[2]
Overall, I have rejected my initial hypothesis. While the prevalence of back pain has increased from 29% in 2013 to 39% in 2019, the statistics point to reasons are not entirely dependent on the aging population of baby boomers, it is dependent on many demographic factors:
- Work Impact: Back pain is a leading cause of work limitations, especially for working-age adults (18-64).
- Age: Prevalence patterns differ across studies. Some show peaks in young adults (25-29) and older adults (65+), while others show a high prevalence among working-age adults (18-64).
- Diagnosis: Back disorders are the most common diagnosis regardless of age. Disc disorders become more frequent with age, while back injuries are more common in younger people.
- Hospitalization: Adults are typically hospitalized for low back pain in their early 60s.
- Gender: Women visit healthcare providers more often for low back pain than men. Back disorders are more prevalent in females, though disc disorders and injuries occur similarly between genders. There may be age-specific variations too, with men experiencing more pain between 10-49 years old and women between 65-94 years old.
- Race/Ethnicity: Non-Hispanic whites have the highest hospitalization rates, followed by blacks and Hispanics. This pattern flips for outpatient visits, with blacks and Hispanics having higher rates than whites.
- Socioeconomic Status: Lower socioeconomic status is linked to a higher chance of low back pain.
References:
[1] Lucas, J. W., Connor, E. M., & Bose, J. (2021). Back, lower limb, and upper limb pain among U.S. adults, 2019. https://doi.org/10.15620/cdc:107894
[2] Chronic Back Pain – Health Policy Institute. (2019b, February 13). Health Policy Institute. https://hpi.georgetown.edu/backpain/
[3] U.S. Census Bureau. (2022, February 25). 2020 census will help policymakers prepare for the incoming wave of aging boomers. Census.gov. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html
[4] Waterman, B. R., Belmont, P. J., & Schoenfeld, A. J. (2012). Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. The Spine Journal, 12(1), 63–70. https://doi.org/10.1016/j.spinee.2011.09.002
[5] Singh, Kern, MD, Andersson, Gunnar, MD, PhD, Watkins-Castillo, S. L., PhD. Low Back Pain. BMUS: The Burden of Musculoskeletal Diseases in the United States. (2014) https://www.boneandjointburden.org/fourth-edition/iiaa0/low-back-pain
Image – Photo by Kindel Media: https://www.pexels.com/photo/a-woman-having-a-back-pain-7298408/
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