Pattern and trend of five major musculoskeletal disorders in China from 1990 to 2017: findings from the Global Burden of Disease Study 2017

Abstract

Background: With increasing life expectancy in China, no large population-based studies have been done on the trend for musculoskeletal disorders in China. We have investigated the pattern and trend of five major musculoskeletal disorders in China from the Global Burden of Disease Study 2017 and its association with sociodemographic index (SDI).

Methods: The main outcome measures were incidence, prevalence, and disability-adjusted life years (DALYs) for rheumatoid arthritis, osteoarthritis, low back pain, neck pain, and gout. Average annual percent change (AAPC) and annual percent change (APC) between 1990 and 2017 were analyzed with Joinpoint regression.

Results: The age-standardized rate of incidence, prevalence, and DALYs for the five major musculoskeletal disorders increased with age. For SDI, the age-standardized rate of DALYs was zigzagged increasing for rheumatoid arthritis and curvilinear increasing for gout, curvilinear decreasing for low back pain, and reaching to the highest point for osteoarthritis and neck pain with an SDI value of 0.61. The AAPC in age-standardized rate of DALYs indicated an increasing trend for rheumatoid arthritis (0.20, 95% CI 0.07, 0.34), osteoarthritis (0.26, 95% CI 0.20, 0.31), neck pain (0.09, 95% CI 0.07, 0.12), and gout (0.25, 95% CI 0.23, 0.27), but a decreasing trend for low back pain (- 0.96, 95% CI - 0.98, - 0.93). The AAPC of risk factors indicated a decreasing trend in smoking (- 0.14, 95% CI - 0.24, - 0.04) for rheumatoid arthritis, smoking (- 0.22, 95% CI - 0.24, - 0.19) and occupational ergonomic factors (- 1.25, 95% CI - 1.29, - 1.21) for low back pain, and impaired kidney function (- 0.95, 95% CI - 1.00, - 0.90) for gout, but an increasing trend in high body-mass index for osteoarthritis (3.10, 95% CI 3.03, 3.17), low back pain (3.07, 95% CI 2.99, 3.14), and gout (3.12, 95% CI 3.04, 3.20). Comparing the burden of five musculoskeletal diseases in China with the 19 countries of G20, China ranked first to second in the number of DALYs, and 12th to 16th in age-standardized rate of DALYs.

Conclusion: There are remarkably complex temporal patterns in disease burden and risk factors for five major musculoskeletal disorders across past three decades. Population-wide initiatives targeting high body-mass index may mitigate the burden of musculoskeletal disorders.

Keywords: Disease burden; Gout; Low back pain; Osteoarthritis; Rheumatoid arthritis; Temporal trend.

Fig. 1

Rate of DALYs for 5 major musculoskeletal disorders at all ages. The age-stratified breakdown in rate of the DALYs for rheumatoid arthritis (a), osteoarthritis (b), low back pain (c), neck pain (d), and gout (e). Twenty age groups from 1 to 100 years old. All data are expressed as the rate of DALYs per 100,000 persons

Fig. 2

Correlation of age-standardized rate of DALYs with SDI for five major musculoskeletal disorders between 1990 and 2017. Correlation of age-standardized rate of DALYs with SDI for rheumatoid arthritis (a), osteoarthritis(b), low back pain(c), neck pain (d), and gout (e). SDI sociodemographic index

Fig. 3

Temporal trends of the population attributable fraction of age-standardized rate DALYs for rheumatoid arthritis, osteoarthritis, low back pain, and gout between 1990 and 2017. Smoking for rheumatoid arthritis (a); high body-mass index for osteoarthritis (b); smoking, high body-mass index, occupational ergonomic factors for low back pain (c); high body-mass index, impaired kidney function for gout (d). All data are expressed as the percentage of age-standardized rate of DALYs per 100,000 persons

Fig. 4

Cumulative ranking of incidence, prevalence, DALYs for 5 major musculoskeletal disorder in 19 of Group 20 countries except European Union. Cumulative ranking of number (left) and age standardized rate (right) of incidence for 5 major musculoskeletal disorder in 19 of Group 20 countries except European Union (a) ; Cumulative ranking of number (left) and age standardized rate (right) of prevalence for 5 major musculoskeletal disorder in 19 of Group 20 countries except European Union (b) ; Cumulative ranking of number (left) and age standardized rate (right) of DALYs for 5 major musculoskeletal disorder in 19 of Group 20 countries except European Union (c). The cumulative ranking (5-95) was sum of rank of incidence, prevalence, DALYs for each country according to either the number or age standardized rate