November 30, 2020
3 min read
There were approximately 1.3 billion cases of musculoskeletal disorders worldwide in 2017, leading to 121,300 deaths and 138.7 million disability adjusted life years, according to findings published in Arthritis & Rheumatology.
“This study describes the enormous burden of musculoskeletal conditions in a single paper — previously reported by condition — summarizing the results from the Global Burden of Disease study,” Rachelle Buchbinder, MD, of Monash University, in Melbourne, Australia, told Healio Rheumatology. “These conditions are under-recognized despite their enormous costs to individuals, the economy and the health system.”
To analyze trends of musculoskeletal disorder-related prevalence, disability and death across the world, Buchbinder and colleagues examined data from the 2017 Global Burden of Disease study. According to the researchers, the GBD is the “most comprehensive study measuring the burden of diseases, injuries and risk factors frequently.” In its 2017 round, the study included burden data on 359 diseases and injuries, 282 causes of death and 84 risk factors across 195 countries and territories from 1990 to 2017.
For their own study, Buchbinder and colleagues categorized musculoskeletal disorders into six groups: rheumatoid arthritis, osteoarthritis, lower back pain, neck pain, gout and “other.” This last category included all other musculoskeletal disorders, such as systemic lupus erythematosus, axial spondyloarthropathies and other inflammatory arthritis diseases. The researchers used the Cause of Death Ensemble model (CODEm) and the Bayesian meta‐regression tool to estimate the fatal and non‐fatal burden of musculoskeletal disorders, respectively.
The researchers calculate estimates for all musculoskeletal disorders, as well as the corresponding six categories, at global, regional, and national levels from 1990 to 2017. In addition, counts and age‐standardized rates per 100,000 population, along with 95% uncertainty intervals, were reported for prevalence, deaths and deaths and disability adjusted life years (DALYs).
According to the researchers, there were about 1.3 billion (95% UI, 1.2-1.4) prevalent cases, 121,300 (95% UI, 105,600-126,200) deaths and 138.7 million (95% UI, 101.9-182.6) DALYs due to musculoskeletal disorders around the world in 2017. Age‐standardized prevalence rate was 16,276.2 (95% UI, 15,495.5-17,145.8) per 100,000, while the death and DALY rates were 1.6 (95% UI, 1.4-1.6) and 1,720 (95% UI, 1,264.4-2,259.2), per 100,000, respectively. The age‐standardized prevalence (–1.6%; 95% UI, –2.4 to –0.8) and DALY rates (–3.5%; 95% UI, –4.7 to –2.3) decreased slightly from 1990.
The global point prevalence rate of musculoskeletal disorders in 2017 was higher in women than men and increased with age up to the oldest age group, the researchers wrote. Globally, the proportion of prevalent cases in 2017 was greatest for low back pain, at 36.8%; followed by “other” at 21.5%; osteoarthritis at 19.3%; neck pain at 18.4%; gout at 2.6%; and rheumatoid arthritis at 1.3%. These proportions changed little from 1990.
Musculoskeletal-condition burden was higher in developed countries, according to the researchers. Switzerland (23,346; 95% UI, 22,392.6-24,329.8), Chile (23,007.9; 95% UI, 21,746.5-24,165.8) and Denmark (22,166.1; 95% UI, 20,817.2-23,542.1) demonstrated the highest age‐standardized prevalence rates of musculoskeletal disorders in 2017. Meanwhile, Chile (10.8%; 95% UI, 6.6% to 15.4%), Benin (8.8%; 95% UI, 6.7% to 11.1%) and El Salvador (8.5%; 95% UI, 5.5% to 11.9%) demonstrated the greatest increase from 1990.
“The lack of any significant decline in the burden from these conditions over time means that there is still insufficient emphasis on addressing the problem,” Buchbinder said. “More must be done at international and national levels. Policy makers must be made aware of the size of the problem in all parts of the world and do something to address it. With ageing populations, expect this problem to get worse. We need a global response, and this should be integrated with other strategies that can address some of the modifiable and important risk factors of musculoskeletal disorders, including obesity, poor nutrition, smoking and sedentary lifestyles.”
According to Buchbinder, “one-third of medical care is unnecessary and another 10% is harmful.” Stating this applies to some musculoskeletal conditions as well, particularly low back pain and osteoarthritis, she argued in favor of “concerted efforts to reduce low-value care that is significantly contributing to the problem.”
“The COVID-19 pandemic has created an opportunity due to the general decline in non-COVID-related health care, which has likely reduced low-value care — as well as high-value care,” Buchbinder said. “We should leverage this situation to try to maintain a reduction in low-value care. This will leave opportunity and funds to increase high-value care where it is needed most.”
“There is also a need for standardized methods for collecting data on the health care that is delivered for musculoskeletal conditions and the impact of that care so that we can start measuring whether there is progress in addressing the burden,” she added. “A minimal national dataset could be used to benchmark care and outcomes over time within countries and provide a benchmark that could be used to compare efforts between countries.”