Racial and Ethnic Disparities in the Incidence and Prevalence of Low Back Pain in the United States: A Systematic Review.
Date
2025-10
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Abstract
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This systematic review synthesizes existing evidence to quantify racial and ethnic disparities in low back pain (LBP) incidence and prevalence in the United States across stages of chronicity (acute, subacute, and chronic LBP).Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science (through January 7, 2025) for studies reporting LBP incidence or prevalence by race and ethnicity in US adults. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies - of Exposure (ROBINS-E) tool.Results
Of 8,145 citations, 23 studies met inclusion criteria (10 on incidence, 13 on prevalence). Some incidence studies found higher risk of chronic LBP among Black adults compared to White adults, whereas data on Hispanic and Latino adults remain limited. Prevalence studies showed higher rates in White and American Indian and Alaska Native adults, with lower prevalence in Black, Hispanic and Latino, and Asian adults. Military studies consistently reported that Black service members experienced higher LBP incidence compared to other races. No studies examined the subacute state.Conclusion
This review highlights persistent race-based differences in LBP, with critical gaps in research on acute LBP incidence and community-based prevalence. Future studies should prioritize population-based research to better capture racial differences in LBP burden and inform targeted interventions.Type
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Publication Info
Burke, Colleen A, Rebecca Fillipo, Meira Epplein, M Alan Brookhart, Hayden B Bosworth and Adam P Goode (2025). Racial and Ethnic Disparities in the Incidence and Prevalence of Low Back Pain in the United States: A Systematic Review. Arthritis care & research. 10.1002/acr.25665 Retrieved from https://hdl.handle.net/10161/33903.
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Scholars@Duke
Rebecca Fillipo
Rebecca Fillipo is a PhD student in Population Health Sciences interested in advancing methods to study the impact of climate change on health outcomes.
Meira Epplein
Meira Epplein is a cancer epidemiologist interested in modifiable risk factors in under-served populations. She is a Professor in Population Health Sciences and in Medicine, and currently serves as Co-Leader of the Cancer Risk, Detection, and Interception research program of the Duke Cancer Institute. Previously, she was a tenured faculty member at Vanderbilt University Medical Center, after two years as a post-doctoral fellow with the Multiethnic Cohort Study at the University of Hawaii. Prior to earning her PhD in epidemiology from the University of Washington, she completed an MA in international studies, and spent five years as a program officer for the Asian research think tank, the National Bureau of Asian Research.
Dr. Epplein’s research program is focused on the prevention of infection-associated cancers, and has specifically centered around the bacteria Helicobacter pylori, a spiral, gram-negative bacterium that infects approximately 50% of the world’s population, and is the leading carcinogenic infectious agent according to the International Agency for Research on Cancer. Her research seeks to determine the most toxigenic forms of the bacteria so to identify the highest risk populations which can then be targeted for antibiotic therapy, which has been shown to be effective for risk reduction. At the same time, she is committed to furthering our understanding of the co-factors involved in both H. pylori-associated disease risk and benefit, as the bacteria has inhabited the stomachs of humans for over 100,000 years, and so very likely also confers certain biological advantages to its hosts.
She has been PI of four grants from the NIH focusing on a greater understanding of the diversity of Helicobacter pylori and host response to infection and the association with gastrointestinal cancers. Through this work she has established the importance of the understanding of H. pylori as a heterogeneous exposure, identifying bacteria-specific blood biomarkers of increased cancer risk, and finding that these biomarkers interact with other potentially modifiable factors such as diet and aspirin use, in their association with the development of gastric cancer. She has also found significant differences in H. pylori prevalence and antibody response by self-reported race within the US, and have begun local initiatives to understand the prevalence of H. pylori in the community and clinic and to move towards eradication trials for high-risk individuals.
Area of expertise: Epidemiology
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Adam Payne Goode
Dr. Goode is an Associate Professor in the Department of Orthopedic Surgery. He is a physical therapist by clinical training and epidemiologist by scientific training. His focus is on understanding the etiology of low back pain and other chronic musculoskeletal conditions and improving the delivery of care for patients with acute and chronic musculoskeletal conditions. In his research he has published in the areas of the relationship between individual radiographic features in the lumbar spine and clinical symptoms, biomarkers and peripheral joint osteoarthritis.
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