Racial and Ethnic Disparities in the Incidence and Prevalence of Low Back Pain in the United States: A Systematic Review.

Abstract

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). 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. 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. 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.