Burden and Risk Factors of Neck Pain in China: A Dual-Database Study of GBD 2021 Population-Level Macro-Trends and CHARLS Individual-Level Prospective Cohort Analyses

Background: We quantified the burden and temporal trends of neck pain (NP) in China using Global Burden of Disease (GBD) 2021 data and identified populations at higher risk of incident NP using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS). Methods: GBD 2021 data were used to estimate NP incidence and prevalence and to assess temporal patterns through joinpoint regression, age–period–cohort modelling, decomposition, and frontier analyses. For the cohort analysis, 6310 CHARLS participants without NP at baseline (2011) and with complete data were followed across five waves through 2020. Incident NP was the outcome. Multivariable Cox regression identified independent predictors. Nonlinear associations, subgroup analyses, trend tests, and mediation analyses were performed, and a nomogram was constructed. Results: GBD analyses showed that the absolute numbers of prevalent and incident NP cases in China increased, with the largest case counts in the 45– 59 age group. Population growth and ageing were the primary drivers of this increase, while age-standardized rates remained stable The 1960– 1965 birth cohort had the highest risk, and the 1997– 2006 period had the lowest period-related risk. In CHARLS, 1849 (29.3%) participants developed NP. After multivariable adjustment, higher NP risk was associated with middle-aged/older adults, women, ethnic minorities, rural residence, greater chronic disease burden, functional impairment, and elevated depressive symptoms. NP risk showed a nonlinear association with depression severity and chronic disease count. Mediation analyses revealed bidirectional partial mediation: depressive symptoms mediated 19.7% of the chronic disease count-NP association, while chronic disease count (17.0%) mediated the depressive symptoms-NP association. Conclusion: China’ s NP burden is rising. Prioritize prevention for: ethnic minorities, middle-aged/older adults, women, rural residence, and individuals with chronic diseases, functional impairment, or depression. Critically, bidirectional mediation between depression and chronic diseases underscores the need for integrated interventions. Keywords: neck pain, depression, chronic diseases, joinpoint regression analysis, mediation analyses