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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