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Musculoskeletal Disease Second-highest Global Cause of Years Lived With Disability
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The burden of musculoskeletal diseases increased significantly between 2000 and 2015, and they are now the second most common cause of years lived with disability in the world, according to data published in the Annals of the Rheumatic Diseases.
“This impact is measurable using disability-adjusted life years (DALYs), which combine the years lived with disability (YLDs) and the years of life lost (YLLs) through premature death. Previous studies have suggested a high prevalence and high disability linked to selected [musculoskeletal (MSK)] diseases,” Eden Sebbag, of the Hôpitaux Universitaires Strasbourg in France, and colleagues wrote.
“However, representative data for the impact of MSK diseases as a whole are lacking, considering that osteoarthritis and low back pain are significantly more common than most inflammatory diseases,” they added. “The economic burden of MSK diseases has been well described, but national health care systems tend to underestimate the role of MSK diseases owing to their low death rate.”
To evaluate the worldwide burden of musculoskeletal diseases from 2000 to 2015, Sebbag and colleagues reviewed disability-adjusted life years, years lived with disability and years of life lost from the WHO Global Health Estimates Database, which is publicly available online. The researchers included 183 countries in their analysis, with conditions grouped into 23 categories based on the ICD-10.
They analyzed the median proportion of disability-adjusted life years, years lived with disability and years of life lost for musculoskeletal diseases across the 23 categories, and built mixed models to determine changes over time.
According to Sebbag and colleagues, the total global number of disability-adjusted life years due to musculoskeletal diseases increased significantly from 80,225,634.6 in 2000 to 107,885,832.6 in 2015 (P < .001), while the total number of years lived with disability rose from 77,377,709.4 to 103,817,908.4 (P = .0008) during that same time. This currently makes musculoskeletal diseases the second highest cause of years lived with disability in the world. Years of life lost due to musculoskeletal diseases increased from 2,847,925.2 to 4,067,924.2 (P = .03).
In Europe, 6.66% of disability-adjusted life years were related to musculoskeletal diseases (IQR = 5.3-7.88) in 2015, compared with 4.66% (IQR = 3.98-5.59) in the Americas (P < .0001), 4.17% (3.14-6.25) in Asia (P < .0001), 4.14% (2.6-5.57) in Oceania (P = .0008) and 1.33% (1.03-1.92) in Africa (P < .0001). In addition, for 2015, there was a significant correlation between the proportion of disability-adjusted life years and the gross domestic product per capita (r = 0.85; P < .0001).
“MSK diseases are the ninth cause of DALYs, second cause of YLDs and 19th cause of YLLs over the world,” Sebbag and colleagues wrote. “The increasing burden of MSK diseases mostly affects Europe, partly owing to aging of the population and the global epidemiological transition observed worldwide. We confirmed that the overall burden of MSK disease is essentially due to YLDs rather than YLLs, suggesting a high disability but low lethality of MSK diseases.”
“We observed a strongly significant association between MSK DALYs and the GDP per capita, underlining the role of socioeconomic background as a strong determinant of the MSK disease burden,” they added. “These results are crucial to rheumatologists, and to policy makers and national health care systems to implement future adjustments to health plans.” – by Jason Laday
Disclosures : The researches report no relevant financial disclosures.
Perspective
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Robin K. Dore, MD
The population is aging, some autoimmune diseases are becoming more common and new autoimmune diseases are being diagnosed — yet patients are having to wait longer to see a rheumatologist. From 2017 to 2032, the population under age 18 is expected to grow by only 3.5%, while the population aged 65 years and older is projected to grow by 48.0%. Fifty percent of rheumatologists are expected to retire in the next 10 years and there are not enough training spots to replace them due to changes in funding of medical specialty training.
What can be done to compensate for this reality? The American College of Rheumatology is evaluating alternate methods of funding rheumatology fellowships and the Arthritis Foundation is soliciting request for proposals for rheumatology training spots. A few physician assistant training programs have added additional rheumatology/orthopedic training modules. The ACR has training modules for advanced practice clinicians and other organizations, such as the Association of Women in Rheumatology, have also developed similar programs.
Can telemedicine provide care to rheumatology patients by interviewing them via a video link when they don’t have access to local rheumatology consultation? This method is being used at the Geisel School of Medicine at Dartmouth College. Can group visits for patients with the same diagnoses provide care to a larger group at one time as is being done at Kaiser Permanente? These are some possible solutions, which hopefully will have an impact in the short term so that access to rheumatologic care is maintained.
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