ARTHRITIS & RHEUMATISM Vol. 64, No. 6, June 2012, pp 2028–2037 DOI 10.1002/art.34347 © 2012, American College of Rheumatology A Systematic Review of the Global Prevalence of Low Back Pain Damian Hoy, 1 Christopher Bain, 1 Gail Williams, 1 Lyn March, 2 Peter Brooks, 3 Fiona Blyth, 4 Anthony Woolf, 5 Theo Vos, 1 and Rachelle Buchbinder 6 Objective. To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence. Methods. We conduced a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review. Results. Low back pain was shown to be a major problem throughout the world, with the highest preva- lence among female individuals and those aged 40–80 years. After adjusting for methodologic variation, the mean  SEM point prevalence was estimated to be 11.9  2.0%, and the 1-month prevalence was estimated to be 23.2  2.9%. Conclusion. As the population ages, the global number of individuals with low back pain is likely to increase substantially over the coming decades. Investi- gators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies. Low back pain is one of the most common health problems and creates a substantial personal, community, and financial burden globally (1–4). As part of estimat- ing the global burden of low back pain, with low back pain defined as “activity-limiting low back pain (+/- pain referred into 1 or both lower limbs) that lasts for at least 1 day” (5), country-specific prevalence data were required. The most recent global review of the prevalence of low back pain in the adult general population was published in 2000 and showed point prevalence of 12–33% and 1-year prevalence of 22–65% (6). Since then, 2 additional global reviews have been conducted, one of which focused on the elderly (2) and the other on adolescents (7). A key finding from these reviews was the extent of methodologic variation between studies, especially regarding the case definition and prevalence period used, and the nature and extent of measures taken to minimize bias (2,6–10). Although these previous reviews made a major contribution to our understanding of low back pain, a large number of prevalence studies have been published subsequently. The specific aim of the current study was to perform an up-to-date systematic review of the global prevalence of low back pain for informing the Global Burden of Disease (GBD) study, and in doing so, to examine the influence that case definition, prevalence period, and other variables have on prevalence. METHODS The methods used conformed to the Meta-analysis of Observational Studies in Epidemiology (11) and the Cochrane Collaboration (12) recommendations. Selection criteria. All population-based studies pub- lished from 1980 to 2009 in which the prevalence of low back Supported by the Bill and Melinda Gates Foundation (to Dr. Hoy and Prof. Vos), the Australian Commonwealth Department of Health and Ageing (to Prof. March), and the Australian National Health and Medical Research Council (Postgraduate Scholarship 569772 to Dr. Hoy and Practitioner Fellowships 334010 [2005–2009] and 606429 [2010–2014] to Prof. Buchbinder). 1 Damian Hoy, BAppSc, MPH, PhD, Christopher Bain, MBBS, MPH, Gail Williams, PhD, MSc, Theo Vos, PhD, MSc: Uni- versity of Queensland, Herston, Queensland, Australia; 2 Lyn March, MBBS, PhD, MSc: Royal North Shore Hospital, North Sydney Public Health Unit, Institute of Bone and Joint Research, and University of Sydney, Sydney, New South Wales, Australia; 3 Peter Brooks, MD, FRACP: University of Melbourne, Melbourne, Victoria, Australia; 4 Fiona Blyth, MBBS, PhD, MPH, FAFPHM: University of Sydney, Sydney, New South Wales, Australia; 5 Anthony Woolf, MBBS, FRCP: Peninsula College of Medicine and Dentistry, Plymouth, UK; 6 Ra- chelle Buchbinder, MBBS, PhD, MSc, FRACP: Cabrini Medical Centre, Malvern, Victoria, Australia, and Monash University, Melbourne, Victoria, Australia. Address correspondence to Damian Hoy, PhD, MPH, Uni- versity of Queensland, School of Population Health, Herston Road, Herston, Queensland 4006, Australia. E-mail: d.hoy@uq.edu.au. Submitted for publication May 10, 2011; accepted in revised form December 15, 2011. 2028