Burden of Musculoskeletal Diseases,
Third Edition
Data to address goals of the Global Alliance for Musculoskeletal Health
History
Goals
• 2002-2011 declared United
States Bone and Joint Decade
• 2007 BMUS1 published (print)
• 2011 BMUS2 published (web)
• 2012 United States Bone and
Joint Initiative formed
• 2014 BMUS3 launched @
www.boneandjointburden.org
• Improve quality of life for
people with musculoskeletal
conditions
• Advance understanding and
treatment through research,
prevention, and education
• Support for increased
research funding
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
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The Big Picture
Impact of Musculoskeletal Diseases on
• Individuals
• The Health Care System
• The US Economy
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Musculoskeletal Diseases
and Demographic Characteristics
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
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Low Back and Neck Pain
Spinal Deformity
Arthritis and Related Conditions
Osteoporosis and Bone Health
Injuries – Traumatic, Workplace, Sports, Military
Children and Adolescents
Tumors of Bones and Joints, Muscles and Tissues
Rare Bone Diseases
Neuromuscular Disorders
Diseases of the Muscles
Aging
Sex and Gender
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Prevalence of Musculoskeletal Diseases
•1 in 2 (126.6 million) adults are affected, twice the
rate of chronic heart and lung conditions
Proportion of United States Population Reporting
Chronic Medical Conditions, 2012
Musculoskeletal
54%
Circulatory
31%
Respiratory
28%
Diabetes
13%
Cancer
9%
0%
20%
40%
60%
Source: National Center for Health Statistics, National Health Interview Survey, 2012
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• 51.8 million adults report they have arthritis
• 75.7 million adults suffer from neck or low back pain
• 4.5 million sports musculoskeletal injuries require medical attention each year,
64% of all sports injuries
• 1 in 2 women and 1 in 4 men over age 50 will have an osteoporosis-related fracture,
with 20% mortality rate within 12 months of a hip fracture
Musculoskeletal Disease Health Care Visits,1 2010
125
Total Health Care Visits
(in millions)
Millions more suffer from
spinal deformities, congenital
conditions, cancers of bone and
connective tissue, and rare
musculoskeletal diseases
100
106.8
75
50
65.8
52.2
25
4.2
0
Back
Pain
Arthritis
and
Related
Conditions
Osteoporosis
and Low
Energy
Fractures [2]
Traumatic
Injuries
[1] Includes hospital discharges, ED, outpatient, and physician visits.
[2] Includes only hospital discharges and ED visits.
Source: National Center for Health Statistics, NHDS, NAMCS, 2010.
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• Disproportionately affect older persons, accounting for >50% of
all chronic conditions in people older than 50 years
• Age 65 and older population to nearly double in next 25 years
In 2040, persons age 65 and
older will constitute 21% of
US population, equal to the
share who are 18 and under.
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Health Care Visits for Musculoskeletal Diseases
visits in 2010/2011 had a
musculoskeletal condition
diagnosis listed
 29% of hospital discharges
 16% of physician visits
 14% of outpatient visits
 29% of emergency
department visits
Proportion of Total Diagnoses1
18% of all health care
35%
Musculoskeletal Diagnoses as a Proportion of All
Diagnoses for Care Received, All Care Facilities,
United States 2010/2011
30%
25%
29%
29%
20%
15%
16%
10%
18%
14%
5%
0%
Hospital
[2]
Physician
Office [3]
Outpatient
[4]
Emergency
Department [5]
Total
[1] Includes all possible diagnoses. The number of diagnosis variables varies in the databases (NIS up to 25;
NAMCS up to 15; NHAMCS_OP up to 3, NEDS up to 15).
[2] Source: HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2011. Agency
for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp
[3] Source: National Ambulatory Medical Care Survey (NAMCS), 2010.
www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm April 23, 2013.
[4] Source: National Hospital Ambulatory Medical Care Survey_Outpatient Department (NHAMCS_OP), 2010.
www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm April 23, 2013.
[5] Source: HCUP Nationwide Emergency Department Sample (NEDS). Healthcare Cost and Utilization Project
File:Rockville,
G1E.0.1.png
(HCUP). 2010. Agency for Healthcare Research and Quality,
MD. www.hcupus.ahrq.gov/nedsoverview.jsp
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Chronic Pain of Musculoskeletal Diseases
1 in 4 persons over age of 18
report chronic joint pain in at
least one joint
 Knee is the most frequent site (17%)
 Shoulder is 2nd most frequent site (8%)
 Hip is 3rd most frequent site (6%)
40% = percentage of persons over
age 65 with chronic joint pain
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
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Limitations due to Musculoskeletal Diseases
6% of population reports
limitations carrying out
common activities of daily
living (eating, dressing,
bathing) due to
musculoskeletal diseases
Self-Reported Limitations in Activities of Daily Living (ADL) for Persons
Due to Select Medical Conditions by Age, United States 2012
Total All Conditions
13.2
Cancer
0.5
Respiratory (Lung/Breathing Problem)
 14% ages 65-75 report
limitations due to
musculoskeletal condition
1.3
Depression/Anxiety/
Emotional Problem
1.9
Circulatory
2.9
 23% age 75 and older
Musculoskeketal
5.9
Twice the rate of
circulatory (heart
conditions), the second
highest cause of limitations
0
0-17
18-44
10
45-64
20
30
Rate per 100 Persons
65-74
75+
40
50
Total Population
Source: National Health Interview Survey (NHIS), Person Sample.
http://www.cdc.gov/nchs/nhis/nhis_2012_data_release.htm July 2, 2013.
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Limitations due to Specific MSK Diseases
5%-6% of population
over age 18 report
limitations carrying out
common activities of daily
living are due to back or
neck problems
Cause of Self-Reported Limitations in Activities of Daily Living for
Persons Due to Musculoskeletal Condition by Age, United States 2012
5.9
Total All Musculoskeletal
Conditions
1.4
Fracture, bone/joint injury
1.8
14% age 75 and older
have limitations due to
arthritis
Connective tissue problem
3.3
Arthritis or rheumatism
3.6
 For all musculoskeletal
diseases, the rate of
limitations increases
sharply as population ages
Back or neck problem
0
Source: National Health Interview
Survey (NHIS), Person Sample.
http://www.cdc.gov/nchs/nhis/nhis_
2012_data_release.htm July 2, 2013.
5
10
15
20
25
Rate per 100 Persons
Total Population
75+
65-74
45-64
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
18-44
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Limitations due to All Diseases
Rate of persons in the
work force unable to work
or limited in type of work
due to musculoskeletal
diseases is twice that of
any other medical
condition.
Self-Reported Work Limitations for Persons Age 18 and Over Due
to Select Medical Conditions, United States 2012
Cancer
Limited in Type of Work
Hearing Problem
Unable to Work
Vision Problem
Nervous System/Sensory Organ
28 in 1000 persons in
work force unable to work
due to musculoskeletal
condition
 17 in 1000 limited in type
of work they can do.
Respiratory (Lung Breathing Problem)
Depression/Anxiety/Emotional Problem
Circulatory
Musculoskeletal
0
5
10
15
20
25
Rate per 1000 Persons
Source: National Health Interview Survey (NHIS), Person Sample.
http://www.cdc.gov/nchs/nhis/nhis_2012_data_release.htm July 2, 2013.
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
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30
Bed Days due to Musculoskeletal Diseases
A bed day is ½ or more
days in bed due to injury or
illness in a 12 month
period, excluding
hospitalization
 1 in 3 persons age 18
and over report at least
one bed day for medical
reasons
72% of them had a bed
day due to musculoskeletal
condition – 1 in 4 adults
Proportion of Persons Age 18 and Over Self-Reporting
Bed Days Due to Major Health Conditions, United States 2012
All Causes
33.9%
Musculoskeletal Injuries or Conditions
24.5%
Circulatory
4.0%
Respiratory
1.9%
Depression/Fatigue/Nervous Problems
4.4%
Cancer/Tumors
0.5%
Other Major Health Conditions
3.5%
0%
10%
20%
30%
40%
Proportion of Adult Population Reporting
Source: National Health Interview Survey (NHIS), Adult Sample.
www.cdc.gov/nchs/nhis/nhis_2012_data_release.htm July 2, 2013.
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Lost Work Days from Musculoskeletal Diseases
A lost work day is
absence from work due to
illness or injury in 12 month
period, excluding maternity
or family leave
 1 in 6 persons age 18
and over report at least
one lost work day for
medical reasons
74% of them cite a lost
work day due to a
musculoskeletal condition –
1 in 8 persons in the work
force
Proportion of Persons Age 18 and Over Self-Reporting
Lost Work Days Due to Major Health Conditions, United States
2012
All Causes
16.2%
Musculoskeletal Injuries or Conditions
12.0%
Circulatory
0.9%
Respiratory
0.5%
Depression/Fatigue/Nervous Problems
1.7%
Cancer/Tumors
0.1%
Other Major Health Conditions
1.2%
0%
5%
10%
15%
20%
Proportion of Adult Population Reporting
Source: National Health Interview Survey (NHIS), Adult Sample.
www.cdc.gov/nchs/nhis/nhis_2012_data_release.htm July 2, 2013.
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Burden of Musculoskeletal Diseases
Widespread prevalence
Three of the most costly healthcare conditions
o Trauma
o Back pain
o Arthritis
Low mortality from musculoskeletal diseases,
but high morbidity
o Restrict activities of daily living
o Cause lost work days
o Source of lifelong pain
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Definitions of Cost
Direct Costs = Health care costs for treatment of disease.
Indirect Costs = Impact of disease in terms of lost wages
due to disability or death.
Aggregate Total Costs = Total medical costs for
musculoskeletal diseases and other comorbid conditions
of persons with musculoskeletal conditions.
Incremental Costs = Share of costs directly attributable
to musculoskeletal disease.
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Direct Cost of Musculoskeletal Diseases
Aggregate Total and Incremental Direct Costs for
Musculoskeletal Diseases in 2011 Dollars,
United States 1996-2011
$796 Billion
$213 Billion
= Incremental
costs, annually
for years 2009 to
2011
$900.0
$800.0
Total Cost in 2011 $s (in billions)
= Aggregate total
costs, annually
for years 2009 to
2011
$700.0
Persons with Musculoskeletal Disease
N in 1997 = 75.2 million
N in 2011= 102.5 million
$615.9
$600.0
$654.7
$531.6
$500.0
$400.0
$796.3
$747.5
$417.2
$378.7
$300.0
$200.0
$99.2
$122.0
$164.4
$176.9
$182.8
$226.7
$212.7
$100.0
$0.0
1997 to 1999 1999 to 2001 2001 to 2003 2003 to 2005 2005 to 2007 2007 to 2009 2009 to 2011
Three-Year Average
Source: Medical Expenditures Panel Survey (MEPS), Agency for Healthcare Research
and Quality, U.S. Department of Health and Human Services, 1996-2011.
http://meps.ahrq.gov/mepsweb/
Aggregate Total
Incremental
Linear (Aggregate Total)
Linear (Incremental)
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Indirect Cost of Musculoskeletal Diseases
Aggregate Total and Incremental Indirect Costs for
Musculoskeletal Diseases in 2011 Dollars,
United States 1996-2011
$77.5 Billion
$131 Billion
= Incremental
costs, annually
for years 2009 to
2011*
$160.0
Total Cost in 2011 $s (in billions)
= Total indirect
costs, annually
for years 2009 to
2011
$140.0
Persons in Work Force
N in 1997 = 47.3 million
N in 2011 = 63.4 million
$120.0
$128.6
$100.0
$130.7
$120.6
$103.6 $106.3
$91.4
$80.0
$60.0
$136.1
$61.4
$66.6
$65.1 $64.3
$77.5
$75.2 $72.6
$40.0
$20.0
$0.0
1997-1999* 1999-2001
2001-2003
2003-2005 2005-2007* 2007-2009* 2009-2011*
Three-Year Average
*Indirect costs attributable to
musculoskeletal disease are
greater than total
indirect costs because of a 4% gap
in the probability of working
between persons with and without
a musculoskeletal
condition and a lower mean
income.
Source: Medical Expenditures Panel Survey (MEPS), Agency for Healthcare Research
and Quality, U.S. Department of Health and Human Services, 1996-2011.
http://meps.ahrq.gov/mepsweb/
*Indirect costs attributable to musculoskeletal disease are greater than total
indirect costs because of a 4% gap in the probability of working between persons with
and without a musculoskeletal condition and a lower mean income.
Aggregate Total
Incremental
Linear (Aggregate Total)
Linear (Incremental)
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Share of US Gross Domestic Product
5.7% = Aggregate Total share of
US GDP, annually for years 2009 to
2011
3.4% = Aggregate Total share of
Musculoskeletal Disease Aggregate Cost as
Equivalent Share of Gross Domestic Product [1],
United States 2009-2011 [2]
$14,370.9
US GDP, annually for years 1996 to
1998
68% increase in share of GDP over
15 year period
2009-2011 Breakdown
Aggregate
Total Incremental
Direct Costs
5.22%
1.40%
Indirect Costs
0.51%
0.86%
Total All Costs
5.73%
2.25%
GDP 2009-2011
(average) in 2011 $s
= $15,244.7 billion
$77.5
$796.3
$873.8 Billion = 5.7%
Sources:
[1] Current GDP multiplied by inflation factors calculated per
http://meps.ahrq.gov/mepsweb/about_meps/Price_Index.shtml,
accessed 2/4/14.
[2] Average across three years 2009 to 2011.
[3] Medical Expenditures Panel Survey (MEPS), Agency for
Healthcare Research and Quality, U.S. Department of Health and
Human Services, 1996-2011. http://meps.ahrq.gov/mepsweb/
Direct costs [3]
Indirect costs [3]
All other expenses
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File: G10E.2.1
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Future Cost of Musculoskeletal Diseases
Age Distribution of Aggregate Total Costs for Musculoskeletal
Diseases, United States
Baby Boomer
Generation
50%
Since 1997-1999,
the burden of cost
to treat
musculoskeletal
diseases is shifting
to the aging
Boomer generation
Share of Total Costs
45%
40%
42%
42%
35%
37%
30%
31%
25%
20%
23%
15%
17%
10%
5%
5%
3%
0%
< 18
18-44
45-64
65+
1997-1999
2009-2011
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Research Funding to NIAMS*
$7.8 billion = Total research
funding for years 2009 to
2013.
Funding Dollars (in millions) for National Institutes of
Health Research
by Disease Areas,
United States 2009-2013
$43,541
$40,295
 Less than 2% of annual National
Institutes of Health (NIH) research
budget allocated to NIAMS
$25,993
$15,973
$8,082
$7,825
 Annual average share of funding
declining since 2000
 In spite of prevalence and high
morbidity, musculoskeletal
diseases research dollars a fraction
of allocations for other common
conditions
Musculoskeletal
Cancers
Respiratory
Heart/
Circulatory
HIV/Aids
Other Select
Conditions
Source: National Institutes of Health. Estimates of Funding for Various
Research, Condition, and Disease Categories.
http://report/nih.gov/categorical_spending.aspx
Accessed December 17, 2013.
File: G1A.0.1
*National Institute of Arthritis and Musculoskeletal and Skin Diseases
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Research Funding by Type of MSK Disease
Distribution of $7.8 Billion NIH Research
Funding for Years 2009 to 2013 Combined
 50% to trauma/injuries
 26% to arthritis/AORC
11%
Trauma/Injuries
 12% to osteoporosis
12%
Arthritis/AORC
Osteoporosis
 11% to all other and rare
musculoskeletal diseases
51%
Rare /Other MS Diseases
26%
Source: National Institutes of Health. Estimates of Funding for Various Research,
Condition, and Disease Categories.
http://report/nih.gov/categorical_spending.aspx
Accessed December 17, 2013.
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Key Challenges to Future
Medical costs rapidly increasing for persons age 45 to 64.
 Total medical costs rose 40% between 1996-1998 and 2009-2011.
 Incremental costs attributed to musculoskeletal diseases rose 67% between
1996-1999 and 2009-2011.
Persistence of chronic musculoskeletal diseases that begin in
middle years 45 to 64 throughout lifetime.
Aging population.
Lack of research funding for treatment and prevention of
painful and debilitating musculoskeletal diseases.
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