YiFan Wu MPH , Sarah Wulf Hanson PhD , Garland Culbreth PhD , Caroline Purcell MD , Prof Peter Brooks MD , Prof Jacek Kopec PhD , Prof Lyn March PhD , Prof Anthony D Woolf FRCP , Maja Pasovic MEd MA , Erin Hamilton MPH , Damian Santomauro PhD , Prof Theo Vos PhD
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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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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 level estimated for Iceland with the highest Health Access and Quality Index score, an extra 9·1% (6·4 to 11·2) of the burden of low back pain could be avoided. Even with full coverage of optimal treatment, a large proportion (65·9% [56·9 to 70·4]) of the low back pain burden is unavoidable.</p></div><div><h3>Interpretation</h3><p>This methodology fills an important shortcoming in the GBD by accounting for low back pain severity variations over time and between countries. Assumptions of unequal treatment access increased YLD estimates in resource-poor settings, with a modest decrease in countries with higher Health Access and Quality Index scores. Nonetheless, the large proportion of unavoidable burden indicates poor intervention efficacy. This method, applicable to other GBD conditions, provides policy makers with insights into health gains from improved treatment and underscores the importance of investing in research for new interventions.</p></div><div><h3>Funding</h3><p>Bill and Melinda Gates Foundation and Queensland Health.</p></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":null,"pages":null},"PeriodicalIF":15.0000,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2665991324001516/pdfft?md5=8e167b58ec88f1ff73244d66e7292371&pid=1-s2.0-S2665991324001516-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Assessing the impact of health-care access on the severity of low back pain by country: a case study within the GBD framework\",\"authors\":\"YiFan Wu MPH , Sarah Wulf Hanson PhD , Garland Culbreth PhD , Caroline Purcell MD , Prof Peter Brooks MD , Prof Jacek Kopec PhD , Prof Lyn March PhD , Prof Anthony D Woolf FRCP , Maja Pasovic MEd MA , Erin Hamilton MPH , Damian Santomauro PhD , Prof Theo Vos PhD\",\"doi\":\"10.1016/S2665-9913(24)00151-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is key for policy making. 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Assessing the impact of health-care access on the severity of low back pain by country: a case study within the GBD framework
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 level estimated for Iceland with the highest Health Access and Quality Index score, an extra 9·1% (6·4 to 11·2) of the burden of low back pain could be avoided. Even with full coverage of optimal treatment, a large proportion (65·9% [56·9 to 70·4]) of the low back pain burden is unavoidable.
Interpretation
This methodology fills an important shortcoming in the GBD by accounting for low back pain severity variations over time and between countries. Assumptions of unequal treatment access increased YLD estimates in resource-poor settings, with a modest decrease in countries with higher Health Access and Quality Index scores. Nonetheless, the large proportion of unavoidable burden indicates poor intervention efficacy. This method, applicable to other GBD conditions, provides policy makers with insights into health gains from improved treatment and underscores the importance of investing in research for new interventions.
Funding
Bill and Melinda Gates Foundation and Queensland Health.
期刊介绍：
The Lancet Rheumatology, an independent journal, is dedicated to publishing content relevant to rheumatology specialists worldwide. It focuses on studies that advance clinical practice, challenge existing norms, and advocate for changes in health policy. The journal covers clinical research, particularly clinical trials, expert reviews, and thought-provoking commentary on the diagnosis, classification, management, and prevention of rheumatic diseases, including arthritis, musculoskeletal disorders, connective tissue diseases, and immune system disorders. Additionally, it publishes high-quality translational studies supported by robust clinical data, prioritizing those that identify potential new therapeutic targets, advance precision medicine efforts, or directly contribute to future clinical trials.
With its strong clinical orientation, The Lancet Rheumatology serves as an independent voice for the rheumatology community, advocating strongly for the enhancement of patients' lives affected by rheumatic diseases worldwide.
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