measuring the burden of musculoskeletal disease musculoskeletal conditions and injuries: status and...

Measuring the Burden of

Musculoskeletal Disease

Musculoskeletal Conditions and Injuries: Status and Goals

United States Bone and Joint Decade

Definitions: Burden of disease: refers to the combination of

the incidence/prevalence, impact (in terms of quality of life and disability), and cost of musculoskeletal conditions.

Bone and Joint Decade: a worldwide coalition to document the burden of musculoskeletal conditions and to improve care through patient empowerment, communication and research.

Background

In 1999 and 2000 two conferences, hosted by the American Academy of Orthopaedic Surgeons, were organized to determine the burden of disease of musculoskeletal conditions in the United States on American society. For many, this was the first activity of the U.S. Bone and Joint Decade, and its most important initial charge. A good knowledge of the prevalence of musculoskeletal conditions provides the foundation to support education, research and advocacy activities of the Decade.

Background

This slide set provides a summary of the findings of the two conferences. After viewing the slide set, refer to the section “Resources” for more comprehensive data, and to obtain materials mentioned in the slide set.

Reasons for the Conference Mutual interest in burden of disease Lack of comprehensive data and agreement

concerning measures of this burden Importance relative to research funding (US

Congress, National Institutes of Health) Emergence of Bone and Joint Decade Improved prevention and treatment

Conference Goals

Identify and discuss burden of disease measures for musculoskeletal conditions

Describe international efforts Produce a preliminary plan to improve

measurement of the burden of musculoskeletal disorders

Identify ways to support the Bone and Joint Monitor Project

Presentations and Discussions

The Bone and Joint Decade - Stuart Weinstein, MD, chairman, US National Action Network

Measuring the Burden of Disease – Dorothy Rice, PhD

Bone and Joint Decade Health Needs Assessment – Prof. Anthony Woolf, member, International Steering Committee for the Bone and Joint Decade

Presentations and Discussions

Previous, Current & Proposed Efforts to Measure the Burden – Joseph A. Buckwalter, MD, chair, Council on Research, American Academy of Orthopaedic Surgeons

Other Groups’ Previous, Current and Proposed Efforts

Breakout Groups

Measures of Burden of Disease

Data Sources

National Action Plan

Support for Bone & Joint Monitor Project

Previous Efforts inMeasuring Burden of Disease

AAOS: collect and analyze data to estimate incidence & impact of musculoskeletal diseases and injuries in the US—1978, 1984, 1992, 1999

AAOS: analysis of measures of burden of musculoskeletal diseases & injuries “White Paper” 1999

Dartmouth University: Atlas of Musculoskeletal Care, 2001

History: Documenting the Problem1978 Kelsey et al.Musculoskeletal Disorders:Their Frequency of Occurrence and their Impact on the Population of the United States, Prodist Publishing

History: Documenting the Problem1984 Kelsey et al.

The Frequency of Occurrence, Impact, and Cost of Musculoskeletal Conditions in the United States, AAOS

History: Documenting the Problem1992 Praemer et al.

Musculoskeletal Conditions in the United States, AAOS

History: Documenting the Problem Lawrence, et al. “Estimates of the

Prevalence of Arthritis and Selected Musculoskeletal Disorders in the United States,” Arthritis and Rheumatism, May 1998

History: Documenting the Problem1999 Praemer et al.

Musculoskeletal Conditions in the United States, (2nd edition), AAOS

Bone and Joint Decade publication

Musculoskeletal Conditions in the United States

Large Scale Problem

Chronic impairments

Injuries

Impact:

Hospitalizations for musculoskeletal conditions in 1995: 3,008,000

Distribution of Hospitalizations Resulting from Musculoskeletal Conditions: United States, 1995 by Aggregate Category

Neoplasms3.5%

Dislocation and Sprains

4.6%

Congenital Anomalies

0.9%

Other Injury5.6%

Complication or Reaction*

3.7%

Other Musculoskeletal

Conditions2.7%

Fractures29.8%

Musculoskeletal and Connective

Tissue49.2%

Ambulatory Care Visits for Musculoskeletal ConditionsUnited States, 1995

98.7

8.2

23.9

0

20

40

60

80

100

Patie

nt V

isits

(mill

ions

)

Physician Office Hospital OutpatientDepartment

Hospital EmergencyDepartment

.

The Impact of Musculoskeletal Impairments by Site United States 1995

488.6

152.8

240.0

93.4

190.7

48.7

57.9

10.8

0 100 200 300 400 500

RestrictedActivityDays

(millions)

Bed Days(millions)

Upper Extremity or Shoulder

Lower Extremity or Hip

Back or Spine

All MS Impairments

56%

37%

7%

Mortality costsMorbidity costsDirect costs

$215 Billion

Total Cost of All Musculoskeletal Conditions by Type of Cost, 1995.

Impact of an Aging Population:

Predicted growth in the next 30 years: 1 in 5 Americans will be 65 or older by 2030 [up from 1 in 8 in the year 2000]

About 65 million people in 2030 Incidence of musculoskeletal conditions will

grow proportionally

U.S. Population, Age 65 and Over(as a percent of total population)

1996 - 2030

10.6% 10.8%9.7%

8.5%7.0%6.4%6.6%7.1%

6.8%5.8%4.8%

4.2%4.3%

4.5%4.5%4.3%

2.4%2.1%

2.0%

2.0%1.9%1.7%1.5%1.4%

0%

2%4%

6%

8%

10%12%

14%

16%

18%20%

22%

1996 2000 2005 2010 2015 2020 2025 2030

65 to 74 75 to 84 85 and Over

Age Groups

12.8% 12.6% 12.6%13.2%

14.7%

16.5%

18.5%20.0%

Per

cen

t o

f U

.S.

po

pu

lati

on

Annual Total Knee Replacements: U.S. Female PopulationProjections through 2030*

204,000

274,000

0

50,000

100,000

150,000

200,000

250,000

300,000

1996 2000 2005 2010 2015 2020 2025 2030

----- based on constant (1996) age and gender distribution

based on Census Bureau age and gender projections

Effect of populationaging

Effect of populationincrease

Annual Total Hip Replacements: U.S. Female PopulationProjections through 2030*

105,000

143,000

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

1996 2000 2005 2010 2015 2020 2025 2030

Effect of populationaging

Effect of populationincrease

----- based on constant (1996) age and gender distribution

based on Census Bureau age and gender projections

Dissonance:

Large burden of musculoskeletal conditions

Modest research funding

Meeting With NIH Director

OUTGROWTH:

White paper on measures of Burden of Disease

White Paper:Measures Identified

Incidence

Prevalence

Mortality

Disability

Combined Measures

DALY, QUALY, HEALY

Cost

The Dartmouth Atlasof Health Care, 1999

The Quality of Medical Care in the United States: A Report on the Medicare Program

Bone and Joint DecadeMonitor Project

International effort to document the burden of musculoskeletal disease at the beginning of the Bone and Joint Decade

Zurich, Switzerland 1999—to collect and collate existing data and determine areas where data are weak or non-existent

Preparation for Geneva 2000 meeting

Bone and Joint Decade/World Health Organization Meeting

Geneva, 2000 Measure global MS Burden of Disease Conjunction with launch of the Bone

and Joint Decade Welcome by WHO director general

BJD - WHO Meeting

US Role: participants and data sources

Expertise in OA, RA, osteoporosis, trauma, spinal disorders, children’s MS conditions

Expertise in outcomes, economics

BJD - WHO Meeting

US Role: data collection

Inventory of data sources

Data gleaned from each source

Health indicators for measuring progress

US Data Collection Efforts

Literature search

National surveys National Health Interview Survey National Health and Nutrition

Examination Survey National Nursing Home Survey

US Data Collection Efforts

• National Ambulatory Medical Care Survey

• National Hospital Ambulatory Medical Care Survey

• National Hospital Discharge Survey

• National Medical Expenditure Survey

• National Survey of Ambulatory Surgery

Most Important Conditions

Hip Fracture Osteoarthritis Hip Dysplasia Post-traumatic

Arthritis MS Complications of

Diabetes Spinal Cord Injury

Back Pain Osteoporosis Sports Injuries MS Deformities in

Children Inflammatory

Arthritis Overuse Syndromes MS Malignancy

US Proposed BJD Activities Improve methods of collecting and analyzing data Develop collaborations with other interested

organizations Participate in international BJD activities National Conference on Measures of Burden of

Disease (co-sponsored with other organizations and agencies)

Funding to support studies of burden of MS disorders

Recent Publications

National Osteoporosis Foundation:

America’s Bone Health, The State of Osteoporosis and Low Bone Mass in our Nation, 2002