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. 2024 Aug 9;5(8):943-962.e6.
doi: 10.1016/j.medj.2024.04.009. Epub 2024 Jun 3.

Global pattern, trend, and cross-country inequality of early musculoskeletal disorders from 1990 to 2019, with projection from 2020 to 2050

Collaborators

Global pattern, trend, and cross-country inequality of early musculoskeletal disorders from 1990 to 2019, with projection from 2020 to 2050

GBD 2019 MSK in Adolescents Collaborators. Med. .

Abstract

Background: This study aims to estimate the burden, trends, forecasts, and disparities of early musculoskeletal (MSK) disorders among individuals ages 15 to 39 years.

Methods: The global prevalence, years lived with disabilities (YLDs), disability-adjusted life years (DALYs), projection, and inequality were estimated for early MSK diseases, including rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP), neck pain (NP), gout, and other MSK diseases (OMSKDs).

Findings: More adolescents and young adults were expected to develop MSK disorders by 2050. Across five age groups, the rates of prevalence, YLDs, and DALYs for RA, NP, LBP, gout, and OMSKDs sharply increased from ages 15-19 to 35-39; however, these were negligible for OA before age 30 but increased notably at ages 30-34, rising at least 6-fold by 35-39. The disease burden of gout, LBP, and OA attributable to high BMI and gout attributable to kidney dysfunction increased, while the contribution of smoking to LBP and RA and occupational ergonomic factors to LBP decreased. Between 1990 and 2019, the slope index of inequality increased for six MSK disorders, and the relative concentration index increased for gout, NP, OA, and OMSKDs but decreased for LBP and RA.

Conclusions: Multilevel interventions should be initiated to prevent disease burden related to RA, NP, LBP, gout, and OMSKDs among individuals ages 15-19 and to OA among individuals ages 30-34 to tightly control high BMI and kidney dysfunction.

Funding: The Global Burden of Disease study is funded by the Bill and Melinda Gates Foundation. The project is funded by the Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Keywords: Global Burden of Disease study; Translation to population health; gout; inequality; low back pain; musculoskeletal disorders; neck pain; osteoarthritis; pattern; rheumatoid arthritis; trend.

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Conflict of interest statement

Declaration of interests J.H.A. reports support for the present article from the Health Research Council of New Zealand as payment to their institution; grants or contracts from Otago Medical Research Foundation as payments to their institution; and leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, with the Osteoarthritis Research Society International and Osteoarthritis Aotearoa New Zealand outside the submitted work. B.A. reports an investigator-initiated trial grant with the Rebecca Cooper Foundation, investigator-initiated trial biomarkers assessment support from a Nat Rem Ltd grant, a speaker fee for a pharma-related presentation from Nat Rem Ltd; and travel support from IRACON, all outside the submitted work. T.W.B. reports support for the present article from the IDAlert project, part of the Europe Horizon Framework; grants from the European Union (Horizon 2020 and EIT Health), German Research Foundation (DFG), US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kröner-Fresenius-Foundation, Wellcome Trust, Bill & Melinda Gates Foundation, KfW, UNAIDS, and the WHO; consulting fees from KfW on the OSCAR initiative in Vietnam; participation on a data safety monitoring board or advisory board with the NIH-funded study “Healthy Options” (PIs: Smith Fawzi, Kaaya) as chair; membership on the Data Safety and Monitoring Board (DSMB), German National Committee on the “Future of Public Health Research and Education”; a role as chair of the scientific advisory board to the EDCTP Evaluation; membership on the UNAIDS Evaluation Expert Advisory Committee; National Institutes of Health Study Section Member on Population and Public Health Approaches to HIV/AIDS (PPAH); US National Academies of Sciences, Engineering, and Medicine’s committee for the “Evaluation of Human Resources for Health in the Republic of Rwanda under the President’s Emergency Plan for AIDS Relief (PEPFAR)”; University of Pennsylvania (UPenn) Population Aging Research Center (PARC) external advisory board member; and leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as co-chair of the Global Health Hub Germany (which was initiated by the German Ministry of Health), all outside the submitted work. R. Buchbinder reports grants or contracts from the Australian National Health and Medical Research Council (NHMRC), Australian Government, HCF Foundation, Cabrini Foundation, and Arthritis Australia as payments to their institution and royalties from UpToDate for a book chapter on plantar fasciitis, all outside the submitted work. X.D. reports support for the present article from IHME through salary as their employee. S. Das reports leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, as American Association of Clinical Chemistry Division Leader and India section program chair and member of Women in Global Health India, all outside the submitted work. R.C.F. reports grants or contracts from Heatwaves in Queensland – Queensland government, Arc Flash – Human Factors – Queensland government, and Mobile Plant Safety – Agrifutures; honoraria for the World Safety Conference 2022 as conference convener; support for attending meetings and/or travel for ACTM – Tropical Medicine and Travel Medicine Conferences 2022 and 2023 and ISTM – Travel Medicine Conference, Basel 2023; and leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as director of Kidsafe, director of Auschem, ISASH governance committee, director of Farmsafe, and PHAA Injury Prevention SIG convenor, all outside the submitted work. V.B. Gupta and V.K. Gupta report grants or contracts from the National Health and Medical Research Council (NHMRC), Australia, outside the submitted work. J.J.H. reports grants or contracts from ResearchNB and the Canadian Chiropractic Research Foundation, outside the submitted work. A.H.H. reports leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as a board member of the Iranian Orthopedic Association Research Committee, editorial board member of Bone Reports, editorial board member of BMC Research Notes, and editorial board member of PlosOne, all outside the submitted work. I.M.I. reports support for the present article from the Ministry of Education, Science and Technological Development, Republic of Serbia (project no. 175042, 2011–2023). M.D.I. reports support for the present article from the Ministry of Science, Technological Development, and Innovation of the Republic of Serbia (no. 451-03-47/2023-01/200111). S.M.S.I. reports an investigator grant from NHMRC and a Vanguard grant from the Heart Foundation, all outside the submitted work. N.E.I. reports leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, as bursar and council member of the Malaysian Academy of Pharmacy, Malaysia, outside the submitted work. T.J. reports support for the present article from the National Research, Development, and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security) and National Research, Development, and Innovation Fund (TKP2021-NVA). I.M.K. reports support for attending meetings and/or travel from Hofstra University for the APHA Conference 2022, outside the submitted work. K. Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. T. Lallukka reports support for the present article from the Social Insurance Institution of Finland (grant 29/26/2020) as payment to their institution. L.G.M. reports institutional grants from Roche and Biogen and speakers fees from UCB, Seqirus, and Jansen, all outside the submitted work. L.M. reports support for the present article from the Italian Ministry of Health (Ricerca Corrente 34/2017) through payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. S. Muthu reports support for attending meetings and/or travel from the ON Foundation for ICRS 2022 and 2023 and leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with Research Grants Committee SICOT International and NextGEN Committee ICRS, all outside the submitted work. F.P. reports grants or contracts from the National Health and Medical Research Council (NHMRC) through an Australia Early Career Fellowship, outside the submitted work. M.P. reports grants from the Belgian Kids Fund for Pediatric Research outside the submitted work. Y.L.S. reports a doctoral scholarship from Taipei Medical University; contracts from FK Unpar, Indonesia, as contract-based academic staff; and leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as co-founder of Benang Merah Research Center; all outside the submitted work. S. Sawyer reports leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as president and past president of the International Association for Adolescent Health, outside the submitted work.

Figures

None
Graphical abstract
Figure 1
Figure 1
Contribution of prevalence and disability-adjusted life years from six individual to overall musculoskeletal (MSK) diseases, both sexes, globally and by region, 1990 and 2019 (A) Contribution of prevalence from six individual to overall MSK diseases, both sexes, globally and by region, 1990. (B) Contribution of disability-adjusted life years from six individual to overall MSK diseases, both sexes, globally and by region, 1990. (C) Contribution of prevalence from six individual to overall MSK diseases, both sexes, globally and by region, 2019. (D) Contribution of disability-adjusted life years from six individual to overall MSK diseases, both sexes, globally and by region, 2019.
Figure 2
Figure 2
Projection of disease-adjusted life years by age from 2020 to 2050 (A) Projection of number of disease-adjusted life years by age from 2020 to 2050. (B) Projection of rate of disease-adjusted life years by age from 2020 to 2050.
Figure 3
Figure 3
Average annual percentage change in rates of prevalence and disability-adjusted life years on musculoskeletal disorders among adolescents and young adults from 1990 to 2019, globally and regionally (A) Average annual percentage change in rate of prevalence of musculoskeletal disorders among adolescents and young adults from 1990 to 2019, globally and regionally. (B) Average annual percentage change in rate of disability-adjusted life years due to musculoskeletal disorders among adolescents and young adults from 1990 to 2019, globally and regionally. MSK, musculoskeletal disorders; LBP, low back pain; NP, neck pain; OA, osteoarthritis; OMSK, other musculoskeletal disorders; RA, rheumatoid arthritis.
Figure 4
Figure 4
The association between age-specific rate of disease-adjusted life years and sociodemographic index for overall musculoskeletal disorders across GBD regions and countries and territories in 2019 (A) The association between age-specific rate of disease-adjusted life years and sociodemographic index for overall musculoskeletal disorders across 21 GBD regions in 2019. Black line represents expected values based on sociodemographic index and disease rates across 21 Global Burden of Disease regions; each point shows the observed age-specific rate of disease-adjusted life years for the specified Global Burden of Disease region in 2019. (B) The association between age-specific rate of disease-adjusted life years and sociodemographic index for overall musculoskeletal disorders across 204 countries and territories in 2019. Black line represents expected values based on sociodemographic index and disease across 204 countries and territories; each point shows the observed age-standardized rate of incidence for the specified country in 2019. (C) The correlation between average annual percentage change and age-specific rate of disease-adjusted life years attributable to overall musculoskeletal disorders in 1990 across 204 countries and territories. The size of the circle increases with the number of disease-adjusted life years. The ρ indices and p values were derived from Pearson correlation analysis. (D) The correlation between average annual percentage change and sociodemographic index attributable to overall musculoskeletal disorders in 2019 across 204 countries and territories. The size of the circle increases with the number of disease-adjusted life years. The ρ indices and p values were derived from Pearson correlation analysis.
Figure 5
Figure 5
Health inequality regression curves and concentration curves for overall musculoskeletal disorders in terms of prevalence, disease-adjusted life years, and years lived with disability (A) Health inequality regression curves of prevalence for overall musculoskeletal disorders. (B) Concentration curves of prevalence for overall musculoskeletal disorders. (C) Health inequality regression curves of disease-adjusted life years for overall musculoskeletal disorders. (D) Concentration curves of disease-adjusted life years for overall musculoskeletal disorders. (E) Health inequality regression curves of years lived with disability for overall musculoskeletal disorders. (F) Concentration curves of years lived with disability for overall musculoskeletal disorders.

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