Prevalence, deaths and disability adjusted life years (DALYs) due to musculoskeletal disorders for 195 countries and territories 1990-2017

Arthritis Rheumatol. 2020 Nov 4. doi: 10.1002/art.41571. Online ahead of print.

Abstract

Objectives: To report level and trends of prevalence, deaths and disability adjusted life years (DALYs) due to musculoskeletal disorders categorized as low back pain, neck pain, osteoarthritis, rheumatoid arthritis, gout and other musculoskeletal disorders, across 195 countries and territories from 1990 to 2017 by age, sex and Socio-Demographic Index (SDI), a composite of socio-demographic factors).

Methods: Data were taken from the Global Burden of Disease (GBD) Study 2017. Fatal and non-fatal burden of musculoskeletal disorders were estimated using the Cause of Death Ensemble model (CODEm) and Bayesian meta-regression tool respectively. Estimates were provided for all musculoskeletal disorders and the corresponding six categories at global, regional, and national levels from 1990 to 2017. Counts and age-standardized rates per 100,000 population along with 95% uncertainty intervals (UIs) were reported for prevalence, deaths and DALYs.

Results: Globally, there were about 1.3 billion (95% UI: 1.2 to 1.4) prevalent cases, 121.3 thousand (95% UI: 105.6 to 126.2) deaths and 138.7 million (95% UI: 101.9 to 182.6) DALYs due to musculoskeletal disorders in 2017. Age-standardized prevalence, death and DALY rates per 100,000 were 16,276.2 (95% UI: 15,495.5 to 17,145.8), 1.6 (95% UI: 1.4 to 1.6) and 1,720 (95% UI: 1,264.4 to 2,259.2) respectively. 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 females than males and increased with age up to the oldest age group. Globally, the proportion of prevalent cases due to categories of musculoskeletal disorders in 2017 was greatest for low back pain (36.8%) followed by other musculoskeletal disorders (21.5%), osteoarthritis (19.3%), neck pain (18.4%), gout (2.6%) and rheumatoid arthritis (1.3%). These proportions did not change appreciably compared with 1990. The burden due to musculoskeletal conditions was higher in developed countries. Switzerland [23,346.0 (95% UI: 22,392.6 to 24,329.8)], Chile [23,007.9 (95% UI: 21,746.5 to 24,165.8)] and Denmark [22,166.1 (95% UI: 20,817.2 to 23,542.1)] were countries with the highest age-standardized prevalence rates of musculoskeletal disorders in 2017. 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)] showed the greatest increase from 1990.

Conclusions: There is a large burden of musculoskeletal disorders globally with some notable inter-country variation. Some countries had twice the burden than other countries. Increasing population awareness regarding risk factors, consequences and evidence-informed treatment strategies of musculoskeletal disorders with a focus on the older female population in developed countries is required, particularly for low back and neck pain and osteoarthritis which contribute a large burden among this cohort.

Keywords: Epidemiology; Gout; Incidence; Low Back Pain; Musculoskeletal Disease; Neck Pain; Osteoarthritis; Prevalence; Rheumatoid Arthritis.