The Urgency of Addressing the Burden of Musculoskeletal Conditions

1. The Urgency of Addressing the Burden of Musculoskeletal Conditions The Bone and Joint Decade2000 - 2010 Professor Anthony D Woolf International Steering Committee, Bone and Joint Decade Co-ordinator, Bone and Joint Monitor Project Co-leader GBD 2005 Musculoskeletal Expert Group Peninsula College of medicine and Dentistry, Universities of Exeter and Plymouth, UK

2. The Burden of Musculoskeletal Conditions “Musculoskeletal diseases are the major cause of morbidity throughout the world. These diseases have a substantial influence on health and quality of life and they inflict an enormous cost on health systems” Dr Gro Harlem Brundtland Past Director General, WHO, January 2000 Scientific Group Meeting organised by WHO and Bone and Joint Decade, Geneva

3. Musculoskeletal Conditions • Joint diseases • Osteoarthritis • Rheumatoid arthritis • Gout • Infections • Systemic connective tissue disorders • Back pain • Musculoskeletal pain • Osteoporosis and low trauma fractures • Bone infections • Trauma • Injuries and more……… ARTHRITIS BACK PAIN OSTEOPOROSIS INJURIES & TRAUMA

4. Musculoskeletal Conditions Mostly characterised by pain and loss of function • limit every day activities • usually chronic and impact is under-rated

5. Bone and Joint Monitor ProjectHealth Needs Assessment of Musculoskeletal Conditions Gaining priority and resources through advocacy with evidence IMPACT OF DISEASE UNAVOIDABLEBURDEN “STATE OF THE ART” EFFECTS OF INTERVENTION EFFECTS IN CLINICALPRACTICE AVOIDABLE BURDENOF DISEASE Co-ordinators:Anthony Woolf, Kristina Åkesson, Mieke Hazes

6. Impact of Musculoskeletal Conditions World Health Report Global Burden of Disease 2005 In preparation WHO Seattle, Harvard, Queensland Gates Foundation

7. How musculoskeletal conditions can affect the healthy lifespan of an individual Knee pain Vertebral fracture Road traffic accident

8. Global Burden of DiseaseSummary Measures of Population Health (SMPH) “Measures that combine information on mortality and non-fatal health outcomes to represent the health of a particular population as a single number” 100 90 C B 80 70 60 %surviving (thousands) 50 A 40 30 20 10 0 0 20 40 60 80 100 Age Disability-adjusted life-year (DALY) C = Years of Life Lost (YLLs) B = Years of Life lived with Disability (YLDs) DALY = YLL + YLD

9. What is the burden? • Incidence • Prevalence • Mortality • Morbidity • Natural history • health states / sequelae • disability weights • Treatment • response & numbers being treated Global Burden of Diseases in 2005 In preparation

10. Prevalence of musculoskeletal pain: DMC3 study, The NetherlandsPicavet et al Pain 2003; 102: 167-78 74.5% any musculoskeletal pain during the past 12 months 53.9% musculoskeletal pain during survey (point prevalence) 44.4% musculoskeletal pain lasting longer than 3 months Majority reported pain at multiple sites

11. Prevalence of musculoskeletal pain in developing countries: COPCORD surveys Rural populations 14.4 – 33% at any site Urban populations 11.9 – 48% at any site Chopra & Abdel-Nasser 2008

12. Prevalence of self-reported primary medical conditions in adults, USA 2005

13. Prevalence of self reported musculoskeletal diseases 40.8% men and 48.0% women have had a physician diagnosis of a musculoskeletal disease Age dependent diseases &non-age dependent diseases Age related diseases Picavet, H S J et al. Ann Rheum Dis 2003;62:644-650

14. Chronic diseases ranked in terms of impact on quality of life: higher scores imply poorer quality of life MAG Spranger et al. Journal of Clinical Epidemiology 2000 53: 895-907 Summed rank scores for disease clusters

15. Prevalence of self-reported impairment in activities of daily living, USA 2005

16. Knee OA prevalence rates for WHO regions, GBD 2000

17. RA prevalence rates for WHO regions, GBD 2000

18. Low Back Pain prevalence rates for WHO regions, GBD 2000

19. Osteoporotic fractures increase with age

20. Musculoskeletal Occupational Injuries • Major cause of work loss • Back pain • Shoulder pain • Capsulitis • Bursitis • Elbow pain • Medial epicondylitis • Lateral epicondylitis • Hand pain • Tenosynovitis

21. Musculoskeletal Injuries and Trauma

22. What effect do musculoskeletal conditions have? • Pain • Deformity • Physical disability • Quality of life • Mortality

23. OA: Years Lived with Disability rates by region, GBD 2000 Differences in impact largely related to differences in life expectancy and access to joint replacement surgery

24. High-income countries Low- and middle-income countries  Cause YLD (millions of years) % of total YLD Cause YLD (millions of years) % of total YLD 1 Unipolar depressive disorders 43.22 9.1 Unipolar depressive disorders 8.39 11.8 2 Cataracts 28.15 5.9 Alzheimer’s and other dementias 6.33 8.9 3 Hearing loss, adult onset 24.61 5.2 Hearing loss, adult onset 5.39 7.6 4 Vision disorders, age-related 15.36 3.2 Alcohol use disorders 3.77 5.3 5 Osteoarthritis 13.65 2.9 Osteoarthritis 3.77 5.3 6 Perinatal conditions 13.52 2.8 Cerebrovascular disease 3.46 4.9 7 Cerebrovascular disease 11.10 2.3 Chronic obstructive pulmonary disease 2.86 4.0 8 Schizophrenia 10.15 2.1 Diabetes mellitus 2.25 3.2 9 Alcohol use disorders 9.81 2.1 Endocrine disorders 1.68 2.4 10 Protein-energy malnutrition 9.34 2.0 Vision disorders, age-related 1.53 2.1 Global Burden of Disease: the 10 Leading Causes of YLD, 2001 Global Burden of Disease and Risk Factors Lopez et al DCPP World Bank 2006

25. The 20 Leading Causes of Global Burden of Disease (DALYs), 2001 Global Burden of Disease and Risk Factors Lopez et al DCPP World Bank 2006

26. What is the burden? – need to identify all impacts Mortality and lower quality of life Caregiver time National economy Health care system Caregivers Person Health care costs Work disability Human and financial consequences

27. Total bed days for adults: proportion by major medical conditions, USA 2005 BUT most people treated in ambulatory care

28. Total lost work days by adults: proportion by major medical conditions, USA 2005

29. GBD 2005 – regions Differences across the globe but why?

30. Life expectancy Genetics Aetiological agents Infections Trauma Access to treatment Risk factors Obesity Physical activity Environmental factors Attitudes / expectations of individuals and society etc ……. Global differences in the impact of musculoskeletal conditions relate to

32. Global Prevalence of Obesity in Adult Males

33. Global Prevalence of Obesity in Adult Females

34. The burden is increasing Why? • Ageing of the population • People are living longer in all populations

35. Ageing of the population

36. Total number of hip fractures in 1990 = 1.6 millions in 2050 = 6.3 millions Estimated Number of Hip Fractures: Forecast 2050 3,250,000 1990 1000 2050 800 600 Population (x 1000) 400 200 0 North Europe Latin Asia America America Cooper C, et al. Osteoporos Int. 1992;2:285-9.

37. The burden is increasing Why? • Ageing of the population • Changes in lifestyle

38. The way we live today – Consequences tomorrow ? • Physical fitness decreasing • Obesity increasing • Alcohol - consumption still excessive in many • Smoking - increasing • Musculoskeletal injuries common - sport, occupational, RTAs, falls A 25-yr old woman today spends 4 times as much time watching TV as exercising !

39. Trends of overweight among school children in Europe

40. Changes in Transportation

41. The Burden of Musculoskeletal Conditions ”…. With the increasing number of older people and changes in lifestyle occuring throughout the world, this trend will increase dramatically over the next decade and beyond. …we must act on them now ” Kofi Annan, 1999 Past Secretary General, UN

42. Need implementation of strategies for prevention and treatment of musculoskeletal conditions Gaining Health The European Strategy for the Prevention and control of Noncommunicable Diseases