Neck pain (NP), whether caused by traumatic or nontraumatic factors, is a prevalent and disabling condition leading to considerable self-reports of pain, disability, and ongoing personal and health care burdens worldwide (1). Peripheral neuropathic pain in the neck is defined as mechanical or chemical irritation primarily from a peripheral nervous system injury or disease, usually involving the nerve roots. The most common examples are radicular symptoms and spinal stenosis due to a herniated or bony disc, whereas central neuropathic pain is a painful condition that may be caused by spinal cord pathology (2). In 2016, low back and NP accounted for the highest health care expenditures of 154 conditions in the U.S., estimated at $134.5 billion (3). In 2012, NP caused 25.5 million people in the U.S. to be absent from work, with an average of 11.4 days of absence per person (4). NP causes considerable personal and socioeconomic burdens, and it is one of the top five chronic pains in terms of prevalence and years of disability. Although most acute episodes resolve spontaneously, more than one-third of patients continue to experience mild symptoms or recurrences for more than 1 year, with genetic and psychosocial factors being persistent risk factors (5). According to the GBD 2021 (6), NP is one of the most common musculoskeletal disorders. In the GBD 2021 study, we found that, among musculoskeletal diseases, the burden of disease for NP in terms of incidence rate, prevalence rate, and DALY rate is relatively high worldwide, whereas it is more pronounced in China and G20 countries. In addition, the impact on the daily life of patients with NP increases with the age of the patients (7). In consideration of the currently accelerating global ageing population, we expect the probability of a reduced quality of life and burden of disability on patients caused by NP to be much greater. However, NP differs from fatal disease because it is nonfatal and primarily affects quality of life through symptoms such as pain and discomfort. Thus, the damage caused by NP, compared with fatal disease, is perceived to be less important (4).

In today’s world, with the rapid improvement in medical care, the life expectancy of human beings will be longer than ever before. China is one of the world’s most populous countries; therefore, it is also one of the countries with the largest and fastest ageing populations in the world. According to key indicators from China’s seventh national census in 2021, China’s population has grown to more than 1.4 billion, and owing to the changing demographic structure, the proportion of older adult people will be greater than ever (8); this means that some age-related diseases, such as NP, are placing an increasing disease burden on the health system. In China, neck pain is one of the most common diseases among people, especially middle-aged and older adults (9). Nearly half of older adults in China suffer from chronic pain (10). In 1990, NP was the 21st leading cause of DALY in China. A cross-sectional study analysing the prevalence and risk factors for musculoskeletal disorders associated with workers in the electronics manufacturing industry in China revealed that the prevalence of musculoskeletal pain is high in the Chinese electronics manufacturing industry and that the impact on work productivity remains significant (11). Currently, if we want to realize the aspiration of “Healthy China 2030,” we must face the difficulties and setbacks encountered during the building a beautiful blueprint for a healthy China and do our best to overcome them (8). Therefore, it is urgent to study the long-term trend of the NP disease burden in recent decades to determine the gap between the current situation and the goal of “Healthy China 2030.” Some previous studies have reported global prevalence rates, years lived with disability (YLD), and projected prevalence rates in China by 2050 from 1990 to 2020 using data from GBD 2021 but not the prevalence rate, DALY rate, and projected incidence rate in China by 2051 for NP (6). In addition, this study did not apply joinpoint regression analysis to analyse the temporal trend of NP for each period or the overall time trend, which is a method that can help policy-makers formulate policies and set future goals.

Table 1 presents the number of cases, incidence rate, prevalence rate, ASIR, ASPR, ASDR, and AAPC from 1990 to 2021 for China and the G20 countries in 1990 and 2021. The data in parentheses are 95% UIs.

Over the past 31 years, we have observed significant increases in the incidence rate, prevalence rate, and DALY rate of NP in China. In 2021, the number of NP patients in China reached 48,377,404, and the number of patients in G20 countries reached 137,669,360. This finding reflects the severity of the disease burden of NP in China and even in G20 countries. Compared with the NP burden in the G20 countries, the incidence rate, prevalence rate, and DALY rate of NP in China are significantly higher than those estimated for the G20 countries. In addition, we observed that the ASIR, ASPR, and ASDR AAPCs of both man and woman NP patients increased in China between 1990 and 2021. In contrast, the G20 countries presented increases in the ASIR and ASDR AAPCs but decreases in the G20 ASPR AAPCs. We believe that several reasons explain these phenomena. First, before 1995, the degree of mechanization in China and the world was relatively low, and production was mainly achieved with manual labour and manual operation, especially in some less developed countries and regions; thus, a large number of NP patients performed manual labour (19). However, as the degree of mechanization and automation around the world has increased significantly, the income level and health awareness of people in China and the G20 countries have generally increased, and people are more likely to choose occupations with light labour, which may explain the decline in the APCs for the ASIR, ASPR, and ASDR of NPs in China and the G20 countries after 1995 (5). Second, after 2000, given the rapid development of China’s economy at that time, the number of people with jobs requiring light labour with high incomes increased. These individuals spent most of their time in front of computers in constant postures. Combined with the severe situation of an ageing population (19), these factors may also be the main factors explaining the increasing trends in NP ASIR, ASPR, and ASDR in the APCs. Therefore, we must continue increasing investment in the prevention and treatment of NP.

Moreover, we found that the age-standardized NP ASIRs and ASDRs in China have also increased over the past 31 years. These findings suggest that NP changes and increases in severity at older ages. The odds that psychological risk factors contribute to NP increase with age, e.g., chronic stress, lack of social support, anxiety, and depression are important risk factors for NP (20). Certainly, degenerative cervical instability in older adults is first associated with NP but has not received sufficient attention (21). With the advancement of current medical technology, more NP patients can improve their quality of life by reducing the risk of NP through a combination of Chinese and Western medicine. However, in China, many NP patients do not have access to combined Chinese and Western medicine treatments, especially in areas with more limited medical resources, where NP is not categorized into neuropathic or nonneuropathic pain, and this information needs to be used to guide NP examinations (necessity of imaging) and treatment decisions (5). We found that the incidence rate, prevalence rate, and DALY rate of NP were higher in women than in men in China and the G20 countries. We consider the possibility that women in China and G20 countries may be responsible for more domestic activities or exhibit physiological and structural differences (22). Ostergren et al. (23) noted that the influence of psychosocial factors was more prominent in women, which may be due to the synergistic effect of psychosocial and biological factors leading to an increased risk of shoulder and NP in women. In addition, Hey et al. (24) reported that being a woman was the only identifiable potential risk factor for the prevalence of NP in Singaporeans that may have contributed to the higher incidence rate, prevalence rate, and DALY rate of NP in women.

Monitoring disease prevalence and predicting trends is an important part of disease prevention and control, and the ARIMA model predicts a decreasing trend in the incidence rate of NP in Chinese women over the next 30 years. However, the trend of the NP incidence rate in man subjects was estimated to be insignificant based on the predicted values. This prediction suggests that the risk of NP in women may be declining, possibly due to the current critical situation of an ageing population and the declining birth rate in China (19). Despite clear evidence that NP is a long-term problem characterized by recurrent episodes, little attention has been given to studying effective strategies to prevent NP (25); this is where the large discrepancy between the NP incidence rate, prevalence rate, and DALY rate and low awareness and treatment may partly explain the extent of the increase in the NP disease burden that has continued to occur in recent years. Most studies have investigated interventions for the treatment of NP, and in one review, it was reported that exercise programs also appear to have the potential to prevent NP episodes (26). NP, whether acute or chronic, was also mentioned in another paper as typically being treated through physical or manipulative therapies. These include ultrasound; ice or heat packs; electrical stimulation; avoidance of pain-producing activities; traction; and passive activities. These “conventional” interventions may have some short-term effects in reducing pain and improving neck range of motion; however, there are no long-term effects. On the other hand, exercise has been associated with long-term positive effects (27). This type of literature provides good methods for diagnosing NP and preventing chronic disability (28). There is also another study in the literature that mentions the role of using Eastern and Western manipulation for NP (1). Gonzalez-Alvarez et al. (29) examined lifestyle interventions (e.g., exercise, diet, probiotics, and electroacupuncture) and their effects on the regulation of the gut flora in patients with widespread chronic pain. Another study conducted by Cuenca-Zaldívar et al. (30) explored the effects of climatic variables (e.g., barometric pressure and air temperature) on the frequency of visits for chronic musculoskeletal pain in Spanish primary care. In addition, Pereira et al. (31) reported that workplace interventions combining ergonomics and neck-specific exercises may provide potential long-term benefits for sick leave rates and health-related productivity losses among general office workers, as well as for office workers with NP. Furthermore, a multicentre randomized clinical trial of Italian surgeons demonstrated the effectiveness of a global program based on ergonomic applications in the operating room and specific lower back exercises (32). In conclusion, a better understanding of the factors influencing NP and effective strategies to prevent NP could provide public health workers with a focus on NP research.

This study has several advantages. To the best of our knowledge, this study investigated temporal trends in the NP incidence rate, incidence rate, and DALY rate by sex in China and G20 countries. Second, GBD 2021 uses a uniform and standardized methodology in its data analysis techniques, making these estimates comparable across time. Moreover, not only the change over the entire period (as assessed by the AAPC) but also that over each segmented period (as assessed by the APC) is determined using a joinpoint regression model. Finally, the use of the ARIMA model to predict the incidence rate of NP in China over the next 30 years is important for further prevention of NP. Moreover, Fernández-Carnero et al. (33) explored the predictors of patient satisfaction following the use of Mulligan activity therapy for chronic NP, demonstrating how clinical predictors can be statistically modelled to improve treatment accuracy and outcome prediction in musculoskeletal pain syndrome patients, and the combination of these two factors is also important for furthering the prevention of NP in the future.

However, this study has several limitations. First, the data source in this study was GBD 2021; these values were obtained mainly from modelling data using the process in DisMod-MR 2.1 rather than direct measurements, leading to unavoidable bias, as previously described (7). However, in GBD 2021, several adjustments were used to minimize bias, and the reliability of this source has been confirmed by the previous literature and IHME annual reports. In addition, the interpretation of the results focuses on the population level rather than the individual level, which may lead to ecological fallacies. For example, certain occupations, such as office and computer workers, manual labourers, and health care workers, have been found to have a high incidence rate of NP in some studies, but the main workplace factors associated with this condition are low job satisfaction and a perceived poor workplace environment (34). There is also uncertainty in predicting the future incidence rate of NP in China. In addition, with the further development of artificial intelligence, people, such as working for long hours in front of computers and maintaining static postures for long periods, may lead to the development of NP (35). A recent study on the burden of NP in the general population of China revealed that NP is a serious public health problem in the general population of China, especially in the central and western regions, with an overall increasing trend over the past three decades (36), which is generally consistent with the results of the present study and reinforces the top priority of the disease burden of NP in China. Subsequent studies predicting the future disease burden of NP in China can be further examined and confirmed when the GBD database is updated.

Therefore, the results of this study can only provide policy-makers with a general direction to address the disease burden of NP. To develop policies specific to a particular country or region, more targeted fieldwork and survey-based research are required. A recent Lancet report emphasized the need for legislation to incorporate a balance between local needs and global frameworks (37).

In conclusion, NP is a serious public health challenge for people in China and G20 countries. In the past, the ASIR, ASPR, and ASDR increased. Given the current serious situation of population ageing and the demographic indices of China and the top G20 countries in the world, the burden of NP may be even more serious in the future. Therefore, improving the precise clinical diagnosis and targeted treatment of NP has the potential to not only reduce the unnecessary waste of medical resources but also reduce the recurrence of NP. Therefore, to reduce the NP disease burden in the future, policy-makers can formulate policies that consider factors such as the different ages and occupations of local individuals and the climate of the local environment. In particular, some high-risk occupations and harsh climatic environments should be given more legislative protection, such as personalizing the implementation of ergonomic exercises, improving the working environment and reducing working hours as much as possible, to address the root causes of the burden of NP on people. The burden brought by NP to the people.