burden of musculoskeletal diseases, third edition data to address goals of the global alliance for...
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Burden of Musculoskeletal Diseases, Third EditionData to address goals of the Global Alliance for Musculoskeletal Health
History• 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
Goals• 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 PictureImpact of Musculoskeletal Diseases on
• Individuals• The Health Care System• The US Economy
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
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Musculoskeletal Diseases and Demographic Characteristics
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
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
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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
Cancer
Diabetes
Respiratory
Circulatory
Musculoskeletal
0% 20% 40% 60%
9%
13%
28%
31%
54%
Proportion of United States Population Reporting Chronic Medical Conditions, 2012
Source: National Center for Health Statistics, National Health Interview Survey, 2012
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
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BackPain
Arthritisand
RelatedConditions
Osteoporosisand Low Energy
Fractures [2]
TraumaticInjuries
0
25
50
75
100
125
52.2
106.8
4.2
65.8
Musculoskeletal Disease Health Care Visits,1 2010
Tota
l Hea
lth C
are
Visit
s (in
mill
ions
)
[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.
• 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
Millions more suffer from spinal deformities, congenital conditions, cancers of bone and connective tissue, and rare musculoskeletal diseases
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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
Hospital [2]
Physician Office [3]
Outpatient [4]
Emergency Department
[5]
Total0%
5%
10%
15%
20%
25%
30%
35%
29%
16%14%
29%
18%
Musculoskeletal Diagnoses as a Proportion of All Diagnoses for Care Received, All Care Facilities,
United States 2010/2011
Prop
ortio
n of
Tot
al D
iagn
oses
1
[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 (HCUP). 2010. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.-gov/nedsoverview.jsp
File: G1E.0.1.png
18% of all health care 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
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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
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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
14% ages 65-75 report limitations due to musculoskeletal condition
23% age 75 and older
Twice the rate of circulatory (heart conditions), the second highest cause of limitations
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
Musculoskeketal
Circulatory
Depression/Anxiety/Emotional Problem
Respiratory (Lung/Breathing Problem)
Cancer
Total All Conditions
0 5 10 15 20 25 30 35 40 45 50 5.9
2.9
1.9
1.3
0.5
13.2
Self-Reported Limitations in Activities of Daily Living (ADL) for Persons Due to Select Medical Conditions by Age, United States 2012
0-17 18-44 45-64 65-74 75+ Total PopulationRate per 100 Persons
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
14% age 75 and older have limitations due to arthritis
For all musculoskeletal diseases, the rate of limitations increases sharply as population ages
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health
Back or neck problem
Arthritis or rheumatism
Connective tissue problem
Fracture, bone/joint injury
Total All MusculoskeletalConditions
0 5 10 15 20 25
3.6
3.3
1.8
1.4
5.9
Cause of Self-Reported Limitations in Activities of Daily Living for Persons Due to Musculoskeletal Condition by Age, United States
2012
Total Population 75+ 65-74 45-64 18-44
Rate per 100 PersonsSource: 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 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.
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.
Musculoskeletal
Circulatory
Depression/Anxiety/Emotional Problem
Respiratory (Lung Breathing Problem)
Nervous System/Sensory Organ
Vision Problem
Hearing Problem
Cancer
0 5 10 15 20 25 30
Self-Reported Work Limitations for Persons Age 18 and Over Due to Select Medical Conditions, United States 2012
Limited in Type of Work
Unable to Work
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.
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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
Other Major Health Conditions
Cancer/Tumors
Depression/Fatigue/Nervous Problems
Respiratory
Circulatory
Musculoskeletal Injuries or Conditions
All Causes
0% 5% 10% 15% 20% 25% 30% 35% 40%
3.5%
0.5%
4.4%
1.9%
4.0%
24.5%
33.9%
Proportion of Persons Age 18 and Over Self-Reporting Bed Days Due to Major Health Conditions, United States 2012
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
Other Major Health Conditions
Cancer/Tumors
Depression/Fatigue/Nervous Problems
Respiratory
Circulatory
Musculoskeletal Injuries or Conditions
All Causes
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
1.2%
0.1%
1.7%
0.5%
0.9%
12.0%
16.2%
Proportion of Persons Age 18 and Over Self-Reporting Lost Work Days Due to Major Health Conditions, United States
2012
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 Traumao Back paino Arthritis
Low mortality from musculoskeletal diseases, but high morbidity o Restrict activities of daily livingo Cause lost work dayso 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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$796 Billion = Aggregate total costs, annually for years 2009 to 2011
$213 Billion = Incremental costs, annually for years 2009 to 2011
Direct Cost of Musculoskeletal Diseases
1997 to 1999
1999 to 2001
2001 to 2003
2003 to 2005
2005 to 2007
2007 to 2009
2009 to 2011
$0.0
$100.0
$200.0
$300.0
$400.0
$500.0
$600.0
$700.0
$800.0
$900.0
$378.7$417.2
$531.6
$615.9$654.7
$747.5$796.3
$99.2 $122.0$164.4 $176.9 $182.8
$226.7 $212.7
Aggregate Total and Incremental Direct Costs for Musculoskeletal Diseases in 2011 Dollars,
United States 1996-2011
Aggregate TotalLinear (Aggregate Total)IncrementalLinear (Incremental)
Three-Year Average
Tot
al C
ost i
n 20
11 $
s (in
bill
ions
)
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/
Persons with Musculoskeletal DiseaseN in 1997 = 75.2 millionN in 2011= 102.5 million
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$77.5 Billion = Total indirect costs, annually for years 2009 to 2011
$131 Billion = Incremental costs, annually for years 2009 to 2011*
*Indirect costs attributable to musculoskeletal disease are greater than totalindirect costs because of a 4% gap in the probability of working between persons with and without a musculoskeletalcondition and a lower mean income.
Indirect Cost of Musculoskeletal Diseases
1997-1999* 1999-2001 2001-2003 2003-2005 2005-2007* 2007-2009* 2009-2011*$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
$160.0
$61.4 $65.1 $75.2
$128.6
$106.3
$91.4
$77.5 $66.6 $64.3
$72.6
$103.6
$120.6
$136.1 $130.7
Aggregate Total and Incremental Indirect Costs for Musculoskeletal Diseases in 2011 Dollars,
United States 1996-2011
Aggregate TotalLinear (Aggregate Total)IncrementalLinear (Incremental)
Three-Year Average
Tot
al C
ost i
n 20
11 $
s (in
bill
ions
)
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/
Persons in Work ForceN in 1997 = 47.3 millionN in 2011 = 63.4 million
*Indirect costs attributable to musculoskeletal disease are greater than totalindirect costs because of a 4% gap in the probability of working between persons with and without a musculoskeletal condition and a lower mean income.
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$796.3
$77.5
$14,370.9
Musculoskeletal Disease Aggregate Cost as Equivalent Share of Gross Domestic Product [1],
United States 2009-2011 [2]
Direct costs [3]
Indirect costs [3]
All other expenses
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/
$873.8 Billion = 5.7%
GDP 2009-2011 (average) in 2011 $s = $15,244.7 billion
File: G10E.2.1
Share of US Gross Domestic Product5.7% = Aggregate Total share of US GDP, annually for years 2009 to 2011
3.4% = Aggregate Total share of 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%
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< 18 18-44 45-64 65+0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
5%
23%
31%
42%
3%
17%
42%
37%
Age Distribution of Aggregate Total Costs for Muscu-loskeletal Diseases, United States
1997-1999
2009-2011
Shar
e of
Tot
al C
osts
Future Cost of Musculoskeletal Diseases
Baby Boomer Generation
Since 1997-1999, the burden of cost to treat musculoskeletal diseases is shifting to the aging Boomer generation
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Research Funding to NIAMS*
$43,541
$7,825
$25,993
$8,082
$15,973
$40,295
Funding Dollars (in millions) for National In-stitutes of Health Research
by Disease Areas, United States 2009-2013
Cancers
Musculoskeletal
Heart/Circulatory
Respiratory
HIV/Aids
Other Select Conditions
File: G1A.0.1
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.
$7.8 billion = Total research funding for years 2009 to 2013. Less than 2% of annual National
Institutes of Health (NIH) research budget allocated to NIAMS
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 *National Institute of Arthritis and Musculoskeletal and Skin Diseases
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Research Funding by Type of MSK Disease
50% to trauma/injuries
26% to arthritis/AORC
12% to osteoporosis
11% to all other and rare musculoskeletal diseases
51%
26%
12%
11%
Distribution of $7.8 Billion NIH Research Fund-ing for Years 2009 to 2013 Combined
Trauma/Injuries
Arthritis/AORC
Osteoporosis
Rare /Other MS Diseases
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 FutureMedical 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.
United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health