Low Back Pain


Lead Author(s): 

Kern Singh, MD
Gunnar Andersson, MD, PhD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

For each of the years 2013 to 2015, an annual average of nearly 29% of the US population age 18 years and older self-reported having had low back pain during the past three months. Among persons reporting low back pain, one in three (35.7%) suffered from back pain radiating into the leg. Approximately one-third of persons reporting low back pain also reported experiencing neck pain. Lower back pain is reported in higher rates by females (30.5%) than males (26.4%). The highest rates for lower back pain reported for both genders occurred in the 45-64 years age group (33.3%); there is a slight decrease in low back and neck pain complaints in ages 65 years and older (32.8%). Low back pain is most prevalently reported in the non-Hispanic white ethnic group. The Midwest region of the United States is responsible for recording the highest prevalence of low back pain. With the exception of persons 18 to 44 years, the prevalence of lower back pain with or without radiating leg pain did not vary considerably across all measured demographic categories. (Reference Table 2A.1 PDF CSV)

As discussed previously, healthcare utilization by people with low back pain, which represents 82% of back pain healthcare visits, is only understood in part due to the lack of information about visits to chiropractors, physical therapists, and others involved in the care of back pain. Even so, the reported numbers in the databases are very high. In 2013, nearly 62 million visits to hospitals, emergency departments, outpatient clinics, and physician offices included a diagnosis of low back pain. Three in four visits were to physician offices, but more than 2.3 million patients were hospitalized and almost 10 million patients were treated for low back pain at an emergency department. (Reference Table 2A.2.1 PDF CSV and Table 2A.4.1 PDF CSV)


Demographics of Low Back Pain

The prevalence of low back pain healthcare visits is greatest in the 45-64 years age group, closely followed by the 18-44 years age group. Together, the 18-64 years age group represents 72% of all low back pain healthcare visits. However, adjusting for the 2013 US Census population estimates, healthcare visits for low back pain per 100 persons is highest in the 65 years and older age group, where it is 36.1%. In reviewing the three low back diagnostic categories, the category labeled "back disorders" dominates in all age groups. Disc disorders are uncommon in the younger than 18 years age group, but increase in frequency as the population ages, and are most prevalent in the 45-64 years age group. Back injuries are more common in patients younger than age 45 years (48%), declining to 14% in those 65 years and older. (Reference Table 2A.2.2 PDF CSV)

The average age of persons hospitalized in 2013 for low back pain was 61.8 years. This compared to an average age of 47.2 years for persons visiting an emergency department, 49.4 years for visits to outpatient departments, and 54.5 years for visits to a physician. These numbers are essentially unchanged since 2010, with the exception of the average age of persons visiting an emergency department, which increased by 4.5 years. (Reference Table 2A.2.2 PDF CSV)

Low back pain is found more frequently among females than males, with females representing 55% of healthcare resource visits. Back disorders, in particular, are more common in females, while disc disorders and back injuries are recorded similarly between sexes. Over 8 in 10 (84.4%) female healthcare visits in 2013 for low back pain were classified as back disorders, compared to 80.4% for males. This is probably a reflection of the prevalence of spinal stenosis and degenerative spondylolisthesis in both sexes. (Reference Table 2A.2.1 PDF CSV)

Ethnic groups show preferences in where they might go to receive healthcare for low back pain, as exemplified by the rate of visits per 100 persons per race/ethnicity in the population. Overall, three out of four (74%) patients seen at a hospital were non-Hispanic whites, totaling approximately 1.8 million visits. This is in comparison to a combined total of 380,000 inpatient visits for non-Hispanic black (10%) and Hispanic (6%) visits. In contrast, for outpatient healthcare visits, non-Hispanic black (15%) and Hispanic (13%) ethnic groups reported an increase in percentage of visits compared to the hospital setting, a total of 1.2 million visits. Non-Hispanic white (66%) patients reported 2.8 million outpatient low back pain visits. Race/ethnicity is not reported in the NEDS database on emergency department visits. (Reference Table 2A.2.3 PDF CSV)

Total healthcare visits for low back pain reflected differences between regions regarding back injuries (7.2 million) and back and disk disorders (50.9 million; 10 million). The southern United States recorded the highest percentage of total visits for back and disc disorders (31%; 40%), while the western United States recorded the highest percentage of total visits for back injuries (31%). (Reference Table 2A.2.4 PDF CSV)



Length of Stay

Persons hospitalized for low back pain in 2013 spent, on average, nearly 5 days in the hospital. Persons hospitalized for low back injuries were hospitalized for the longest period, an average of 6.8 days. When comparing the total days of hospitalization for all causes with those for low back pain are similar. As a proportion of hospitalizations for all causes, back pain constitutes 7% of both discharges and of total hospital days. The length of hospital stays has remained relatively stable since 2004. (Reference Table 2A.8 PDF CSV and Table 2A.9 PDF CSV)

The mean length of stay for all low back pain discharges was similar between sexes. Regarding back injuries, length of stay of males is 1.5 days longer than for females (7.6 vs 6.1 days). (Reference Table 2A.10.1 PDF CSV)

Age is an important factor influencing length of stay. Although they constitute a small proportion of back pain hospitalizations, persons younger than 18 years have longer stays for back pain, a ratio of 1.56 days longer, when compared to the average length of stay for all causes for this age group. After the age of 18 years, the length of hospital stays for back pain tend to increase as the population ages, however, similar patterns are seen with other diagnoses. (Reference Table 2A.10.2 PDF CSV)

When comparing length of stay for all causes with those for low back pain, non-Hispanic white patient back pain visits compose 8% of both discharges and of total hospital days, approximately twice the proportion of discharges and of total hospital days reported by all other ethnic groups. However, the average length of stay tended to be slightly longer for non-Hispanic black (5.2 days) and Hispanic (5.1) patients than for non-Hispanic white patients (4.7 days). No considerable difference is observed in length of stay among geographic regions. (Reference Table 2A.10.3 PDF CSV and Table 2A.10.4 PDF CSV)

Hospital Charges

Average hospital charges are provided along with length of stay in the HCUP NIS database. On average, hospital charges for a low back pain inpatient visit were 129% that of the average inpatient visit for any cause. In 2013, an estimated $120 million in charges were assessed against the 2.3 million inpatient stays for low back pain, 9% of the estimated total $1.2 billion in hospital charges for that year. Mean charges at $80,800 are highest for lumbar back injuries and, at $46,100, lowest for lumbar back disorders. When comparing male and female differences in the proportion of low back pain inpatient visit to total inpatient visit charges, no significant differences were found. Patients age 45-64 years and 65 years and older represent 83.7% of the total expenditure for low back pain hospital charges among the population. These age groups also demonstrate the highest proportion of total charges for all causes to those for low back pain, 10% on average. (Reference Table 2A.9 PDF CSV; Table 2A.10.1 PDF CSV; and Table 2A.10.2 PDF CSV)

Variations in hospital charges by US geographic location are observed. The South region, whhich has the largest population, records the highest total hospital charges as well as total discharges among the geographic locations. Across ethnic groups, non-Hispanic white patients account for 76.7% of total charges for hospitalized persons with a diagnosis of back pain while comprising 65.5% of the population. However, the highest mean charges are found among thoses of Hispanic ethnicity. (Reference Table 2A.10.3 PDF CSV and Table 2A.10.4 PDF CSV)


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