Musculoskeletal health: an ecological study assessing disease burden and research funding

Abstract

Background: Exacerbated by an aging population, musculoskeletal diseases are a chronic and growing problem in the United States that impose significant health and economic burdens. The objective of this study was to analyze the correlation between the burden of diseases and the federal funds assigned to health-related research through the National Institutes of Health (NIH).

Methods: An ecological study design was used to examine the relationship between NIH research funding and disease burden for 60 disease categories. We used the Global Burden of Disease (GBD) Study 2019 to measure disease burden and the NIH Research, Condition, and Disease Categories (RCDC) data to identify 60 disease categories aligned with available GBD data. NIH funding data was obtained from the RCDC system and the NIH Office of Budget. Using linear regression models, we observed that musculoskeletal diseases were among the most underfunded (i.e., negative residuals from the model) with respect to disease burden.

Findings: Musculoskeletal diseases were underfunded, with neck pain being the most underfunded at only 0.83% of expected funding. Low back pain, osteoarthritis, and rheumatoid arthritis were also underfunded at 13.88%, 35.08%, and 66.26%, respectively. Musculoskeletal diseases were the leading cause of years lived with disability and the third leading cause in terms of prevalence and disability-adjusted life years. Despite the increasing burden of these diseases, the allocation of NIH funding to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has remained low compared to other institutes.

Interpretation: Despite the increasing health burden and economic cost of $980 billion annually, the allocation of NIH funding to the NIAMS has remained low compared to other institutes. These findings suggest that the NIH may need to reassess its allocation of research funding to align with the current health challenges of our country. Furthermore, these clinically relevant observations highlight the need to increase research funding for musculoskeletal diseases and improve their prevention, diagnosis, and treatment.

Funding: No funding.

Keywords: Burden of disease; Disability-adjusted life years; Musculoskeletal health; NIH; Research funding; Years lived with disability.

Fig. 1

a) 2021 NIH Funding and 2019 Burden of Disease in Disability-Adjusted Life Years; b) Difference Between Actual and Predicted 2021 NIH Funding of the 20 Most Underfunded Conditions; c) Difference Between Actual and Predicted 2021 NIH Funding Based on 2019 Disease Burden of 20 Disease Categories; and d) Ratio of Actual to Predicted 2021 NIH Funding of Underfunded Diseases. Abbreviations: DALY, disability-adjusted life year; STI, sexually transmitted infection; HIV, human immunodeficiency virus; COPD, chronic obstructive pulmonary disease; ADHD, attention-deficit/hyperactivity disorder.

Fig. 2

a) Proportion of US Burden of Disease vs. NIH Institute Allocated Funding, 2019; b) Prevalence of Major Disease Categories by Age Group, 2019; and c) Proportion of the total DALYs from Musculoskeletal Disease by State, 2019. Abbreviations: DALY, disability-adjusted life year; YLD, years of life lost to disability; NCI, National Cancer Institute; NIAID, National Institute of Allergy and Infectious Diseases; NHLBI, National Heart, Lung, and Blood Institute; NINDS, National Institute on Neurological Disorders and Stroke; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIMH, National Institute of Mental Health; NICHD, National Institute of Child Health and Human Development; NIDA, National Institute on Drug Abuse; NEI, National Eye Institute; NIAMS, National Institute of Arthritis and Musculoskeletal and Skin Diseases; NIAAA, National Institute on Alcohol Abuse and Alcoholism; NIDCD, National Institute on Deafness and Other Communication Disorders.