Assessing the impact of health-care access on the severity of low back pain by country: a case study within the GBD framework

作者：Yifan Wu, Sarah Wulf Hanson, Garland T. Culbreth, Caroline A. Purcell, Peter Brooks, Jacek A. Kopec, Lyn March, Anthony D. Woolf, Maja Pasovic, E. Hamilton, D. Santomauro, Theo Vos · 发表于：The Lancet Rheumatology · 年份：2024 · DOI：10.1016/s2665-9913(24)00151-6 · 被引用次数：18 · 研究领域：Medicine

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is key for policy making. Low back pain is the leading cause of disability in terms of years lived with disability (YLDs). Due to sparse data, a current limitation of GDB is that a uniform severity distribution is presumed based on 12-Item Short Form Health Survey scores derived from US Medical Expenditure Panel Surveys (MEPS). We present a novel approach to estimate the effect of exposure to health interventions on the severity of low back pain by country and over time. Methods We extracted treatment effects for ten low back pain interventions from the Cochrane Database, combining these with coverage data from the MEPS to estimate the hypothetical severity in the absence of treatment in the USA. Severity across countries was then graded using the Health Access and Quality Index, allowing estimates of averted and avoidable burden under various treatment scenarios. Findings We included 210 trials from 36 Cochrane systematic reviews in the network analysis. The pooled effect sizes (measured as a standardised mean difference) for the most effective intervention classes were –0·460 (95% uncertainty interval –0·606 to –0·309) for a combination of psychological and physical interventions and –0·366 (–0·525 to –0·207) for surgery. Globally, access to treatment averted an estimated 17·6% (14·8 to 23·8) of the low back pain burden in 2020. If all countries had provided access to treatment at a lev...