Burden of Musculoskeletal Diseases, Third Edition Data to address goals of the Global Alliance for Musculoskeletal Health History 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 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 Health2

3 The Big Picture Impact 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

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 4 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

Prevalence of Musculoskeletal Diseases 1 in 2 (126.6 million) adults are affected, twice the rate of chronic heart and lung conditions Source: National Center for Health Statistics, National Health Interview Survey, United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

[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, 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 6 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

7 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. United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

8 Health Care Visits for Musculoskeletal Diseases 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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

9 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 2 nd most frequent site (8%)  Hip is 3 rd 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

10 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 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

11 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

12 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. United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

13 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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

14 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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

15 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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

16 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. United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

17 $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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

18 $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 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. Indirect Cost of Musculoskeletal Diseases United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

19 $873.8 Billion = 5.7% GDP (average) in 2011 $s = $15,244.7 billion File: G10E.2.1 Share of US Gross Domestic Product 5.7% = Aggregate Total share of US GDP, annually for years 2009 to % = Aggregate Total share of US GDP, annually for years 1996 to % increase in share of GDP over 15 year period Breakdown Aggregate TotalIncremental Direct Costs5.22%1.40% Indirect Costs0.51%0.86% Total All Costs5.73%2.25% United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

20 Future Cost of Musculoskeletal Diseases Baby Boomer Generation Since , the burden of cost to treat musculoskeletal diseases is shifting to the aging Boomer generation United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

21 Research Funding to NIAMS* File: G1A.0.1 Source: National Institutes of Health. Estimates of Funding for Various Research, Condition, and Disease Categories. Accessed December 17, $7.8 billion = Total research funding for years 2009 to  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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

22 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 United States Bone and Joint Initiative, the U.S. National Action Network of the Global Alliance for Musculoskeletal Health

23 Key Challenges to Future  Medical costs rapidly increasing for persons age 45 to 64.  Total medical costs rose 40% between and  Incremental costs attributed to musculoskeletal diseases rose 67% between and  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