{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:25:53Z","timestamp":1791512753992,"version":"4.3.4"},"reference-count":78,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Smoking has a major influence on the development and worsening of low back pain (LBP). However, the effect of smoking on the burden of LBP has not been thoroughly examined at the global, regional, and national levels. This study aims to analyze the trends in smoking-related LBP from 1990 to 2021. It uses data from the 2021 Global Burden of Disease (GBD), providing scientific evidence for policy-making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This observational study, based on population data, used epidemiological information on LBP due to smoking from the GBD 2021 study. The study categorized the disability-adjusted life years (DALYs) from smoking-related LBP by year, age, country, and socio-demographic index (SDI). Trends in smoking-related LBP from 1990 to 2021 were assessed using the estimated annual percentage change (EAPC). The GBD frontier analysis was used to monitor and assess progress toward global health goals. Furthermore, the Bayesian age-period-cohort (BAPC) model was applied to predict trends in smoking-related LBP from 2022 to 2036.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 2021, smoking-related LBP was responsible for 8823.84\u202f\u00d7\u202f10<jats:sup>3<\/jats:sup> DALYs, a 30.05% increase since 1990. From 1990 to 2021, the age-standardized DALYs rate (ASDR) for smoking-related LBP declined with an EAPC of \u22121.26%. ASDR dropped in all five SDI regions. Montenegro had the highest DALYs due to smoking-related LBP, while Madagascar saw the greatest decline from 1990 to 2021. Regionally, Central Europe and high-income North America had higher-than-expected LBP burdens, while Western Sub-Saharan Africa, Andean Latin America, Southeast Asia, and Central Latin America had lower-than-expected burdens. Frontier analysis identified countries and regions that need urgent action to lessen smoking-related LBP burden. Finally, it is forecasted that the smoking-related LBP burden will decrease from 2022 to 2036.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>From 1990 to 2021, the global ASDR of LBP attributable to smoking decreased, and this downward trend is expected to persist. However, regions with high smoking rates and low socio-economic status still face a significant burden from smoking-related LBP. The data from these regions highlight the need for targeted health policies and interventions to further reduce the burden of smoking-related LBP.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1584659","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:31:29Z","timestamp":1752125489000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Global burden of low back pain attributable to smoking in 204 countries and territories in 1990\u20132021"],"prefix":"10.3389","volume":"13","author":[{"given":"Baodong","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Ke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/S0140-6736(21)00733-9","article-title":"Low 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