THE GLOBAL BURDEN OF LOW BACK PAIN: ESTIMATES FROM THE GLOBAL BURDEN OF DISEASE 2010 STUDY
 
   

The Global Burden of Neck Pain:
Estimates From the Global Burden of Disease 2010 Study

This section is compiled by Frank M. Painter, D.C.
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   Frankp@chiro.org
 
   

FROM:   Ann Rheum Dis. 2014 (Jul); 73 (7): 1309–1315 ~ FULL TEXT

   OPEN ACCESS   


Damian Hoy, Lyn March, Anthony Woolf, Fiona Blyth, Peter Brooks, Emma Smith, Theo Vos, Jan Barendregt, Jed Blore, Chris Murray, Roy Burstein, Rachelle Buchbinder

University of Queensland,
Herston, Queensland, Australia.



OBJECTIVE:   To estimate the global burden of neck pain.

METHODS:   Neck pain was defined as pain in the neck with or without pain referred into one or both upper limbs that lasts for at least 1 day. Systematic reviews were performed of the prevalence, incidence, remission, duration and mortality risk of neck pain. Four levels of severity were identified for neck pain with and without arm pain, each with their own disability weights. A Bayesian meta-regression method was used to pool prevalence and derive missing age/sex/region/year values. The disability weights were applied to prevalence values to derive the overall disability of neck pain expressed as years lived with disability (YLDs). YLDs have the same value as disability-adjusted life years as there is no evidence of mortality associated with neck pain.

RESULTS:   The global point prevalence of neck pain was 4.9% (95% CI 4.6 to 5.3). Disability-adjusted life years increased from 23.9 million (95% CI 16.5 to 33.1) in 1990 to 33.6 million (95% CI 23.5 to 46.5) in 2010. Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability as measured by YLDs, and 21st in terms of overall burden.

CONCLUSIONS:   Neck pain is a common condition that causes substantial disability. With aging global populations, further research is urgently needed to better understand the predictors and clinical course of neck pain, as well as the ways in which neck pain can be prevented and better managed.

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KEYWORDS:   Epidemiology; Health services research; Outcomes research



From the FULL TEXT Article:

INTRODUCTION

Neck pain occurs commonly throughout the world and causes substantial disability and economic cost. [1] The pain and disability associated with neck pain have a large impact on individuals and their families, communities, healthcare systems and businesses. [2–4] Economic consequences include the cost of healthcare, reduced work productivity, work absenteeism and insurance. As part of the Global Burden of Disease 2010 Study (GBD 2010), the global burden of musculoskeletal (MSK) conditions was estimated. Burden was expressed in disability-adjusted life years (DALYs).

This paper details the methods and results for estimating the global burden of neck pain for GBD 2010. It is part of a series of articles. The main overall articles for GBD 2010 were published in the Lancet, [5–9] and the MSK-specific papers are published in this issue of Annals of Rheumatic Diseases. [10–18] One of these papers give an in-depth description of the methods used for estimating the global burden of the MSK conditions [15] and this should be read in conjunction with the current paper.



DISCUSSION

      Estimates of the global burden of neck pain

This is the first time the global burden of neck pain has been estimated. The methods were complex and the process took almost 6 years. The results show that the prevalence and burden from neck pain is high around the world. Out of the 291 conditions studied in GBD 2010, neck pain was found to rank 21st in terms of overall burden and 4th in terms of overall disability. In addition, the study has identified that neck pain prevalence peaks in the middle age groups. With improved child survival and aging populations throughout the world, especially in lowincome and middle-income countries, the number of people experiencing neck pain will increase substantially over the coming decades.

      Strengths and limitations

The greatest strength of the neck pain burden estimates in GBD 2010 is the extensive series of systematic reviews that were undertaken to obtain data for making the estimates and the large number of captured studies. Risk of bias was also considered and studies considered to be at high risk of bias were excluded from the analysis.

Further strengths included:

(1)   the development of a new case definition and set of functional health states for neck pain;

(2)   the development of a set of disability weights for these health states, which were derived through community-based
and health professional surveys in a number of countries; and

(3)   use of a new, more advanced version of DisMod that can

(A)   pool all data rather than rely on a ‘pick and choose’ method,

(B)   perform meta-regression to make data points from different studies more comparable,

(C)   use data to fill in missing information, and

(D)   carry forward uncertainty throughout the analysis.

Despite these strengths, there were some limitations. The functional domains in GBD 2010 refer to body functions and structures (eg, vision) as well as more complex human operations (eg, mobility), but they are not as inclusive as the WHO International Classification of Functioning, Disability and Health. They do not refer to broader aspects of life such as participation, well-being, carer burden, economic impact and burden of disease from the individual’s perspective. It is important that burden of disease estimates are supplemented with this information to consider the full impact of a condition in a population.

Health state valuations are complex and can lead to very different answers. GBD 2010 endeavoured to respond to previous criticism that existing DWs were derived by a small group of international public health experts. Consequently, GBD 2010 undertook large-scale population and internet surveys to ask the general public to provide the health state valuations. That meant each health state had to be described in lay terms. Pilot testing revealed that descriptions of more than 30–40 words could not be absorbed. There will be ongoing work on DWs to explore what difference small changes in the wording of health state descriptions can make to the ultimate health state valuation.

Prevalence data for many countries and a number of regions were unable to be found. In GBD, no individual data point is adopted as reflecting the truth. Instead, statistical models are employed to all available data sources with corrections built in for risk of data bias in order to best predict true values of any epidemiological entity of interest. In regions with lots of data, estimates reflect the available data or at least find reasonable middle ground between what often are rather heterogeneous data sources. For regions with little or no data, the estimates will borrow strength from all other data and any available predictors of disease outcome. The level of uncertainty around each estimate reflects the strength of the underlying data to make a particular region’s estimate.

It is a guiding principle in GBD to make estimates even if data are sparse. The alternative of not including some conditions that are known to be important contributors elsewhere is that it would give policy makers the impression that the condition is not important in their country. Also, in the studies that were captured, there was considerable methodological variation, especially relating to the prevalence period and case definition used making pooling of the data difficult. While ‘neck or shoulder’ pain was assumed to be a proxy for ‘neck’ pain, future GBD efforts may benefit from adjusting ‘neck or shoulder’ to ‘neck’ pain using the same Bayesian meta-regression method as for the other anatomical definition variations. In GBD 2010, the burden of neck pain may be overestimated due to the inclusion of shoulder pain.

Researchers are encouraged to adopt recent recommendations on defining neck pain in epidemiological studies to assist future reviews, enable comparisons between countries and improve our understanding of neck pain. [3]

While using the MEPS study had the advantage of estimating the distribution of severity while taking comorbidity into account, it also had limitations. There is likely to have been some level of recall bias despite there being five follow-up points over 2 years. Also, MEPS may not be representative of the health state experience for neck pain across the globe. In low-income and middle-income countries, where services for the prevention and management of neck pain are not as extensive as the USA, the health state experience could be different.

      Suggested further research

There is clearly a need for further research on the natural history of neck pain. Long-term longitudinal population-based studies would provide important information on the natural history, average duration and disability associated with an episode of neck pain. Incorporating this research with pain diaries to track the daily patterns of pain and disability would add greater depth to this research. With expanding and aging populations in many low-income and middle-income countries, the burden from neck pain in these areas will grow significantly over coming decades. There is an urgent need to increase our understanding and attempt to mitigate the growing burden of neck pain in low/middle-income countries.



CONCLUSION

Neck pain is one of the main causes of disability throughout the world and requires greater attention from governments, health service providers and researchers. Further research is urgently needed to better understand the predictors and clinical course of neck pain across different settings, particularly in low-income and middle-income countries, and the ways in which neck pain can be prevented and better managed.



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