The spatio-temporal distribution of musculoskeletal disorders: results of the Global Burden of Disease in 204 countries and 21 subregions between 1990 and 2019

Abstract

BackgroundMusculoskeletal disorders (MSD) represent the main contributor to disability worldwide. However, a global view of the geographic and temporal trends in the occurrence of MSD remains lacking. This study aimed to assess the spatio-temporal distribution of MSD from 1990 to 2019.MethodsWe used data from the 2019 Global Burden of Diseases (GBD) to analyse the prevalence of 6 work-related MSD defined medically or self-reported pain, over the 1990-2019 period. We mapped raw and age-standardized prevalence in over 204 countries. We also described the 2019 MSD prevalence by sub-regions, age, and sex. We assessed temporal trends in prevalence using Cochran-Armitage trend tests (CA). We also explored the correlation between national income level and medical density for each country with the MSD prevalence using multivariate regression.FindingsIn 2019, global raw prevalences of work-related MSD ranged from 0·56% [95% CI: 0·43-0·70] for hip osteoarthritis to 8·62% [95% CI: 7·62-9·74] for low back pain, with large variations across countries. The prevalence of MSD increased monotonically with age, except for neck pain which increase then remain stable or decreases after 45-50 years old. Globally, MSD prevalences increased with age in both men and women. Although the shapes of the age distributions were similar between men and women in all sub-regions, MSD prevalences were higher in women compared to men. Prevalences were higher in high vs. middle income countries for the 6 MSD. Over time, in most sub-regions, trends in raw prevalences of low back and neck pain increased significantly, whereas after controlling for age, a majority were no longer significant. Osteoarthritis raw prevalence increased in more than half of the sub-regions; however, after taking age into account, almost half of the trends remained significant or close to significance. Finally, on multivariate linear regressions, the World Bank income level and medical density for each country were positively correlated with the prevalences of MSD.InterpretationThe ageing of the population presumably drives the growing burden of MSD on a global scale, although other factors also play a role in the occurrence of these pathologies over time. Longitudinal data on a larger panel of MSD, considering occupational exposures over time, would allow better prevention of these pathologies.FundingsThe French National Institute for Science, Technology, and Management (Cnam) grant and the Health and Enterprises Chair (Cnam, Malakoff Humanis).Research in contextEvidence before this studyMusculoskeletal disorders (MSD) represent a major public health problem and the burden of morbidity is expected to increase considerably due to the overall ageing of the population. Several studies from the Global Burden of Disease (GBD) have shown that MSD are among the most disabling chronic non-communicable pathologies in the world. There are established links between many risk factors and MSD such as biomechanical and psychosocial factors, but very few studies have focused on the temporal trends of MSD and their geographical distribution. We searched PubMed and Google Scholar for articles of any language focusing on temporal trends in MSD, up to July 15, 2022. The search terms were: (“Musculoskeletal disorder*” OR “Musculoskeletal disease*”) AND (“temporal trends” OR “time trends” OR “over time”) AND (“incidence” OR “prevalence”)). Several articles described the global burden of specific MSD based on data from the GBD. However, these studies focused on a unique MSD, and did not describe global patterns of diseases. Additionally, a recent systematic review explored the role of aging and other risk factors in the time trends of MSD. This review highlighted the scarcity of evidence regarding time trends in the burden of MSD, especially beyond western countries. The surveys set up by the GBD allowed to quantify the prevalence of several pathologies, including MSD standardized by age, in the world, to be able to compare diseases and study their trends over time.Added value of this studyTo our knowledge, this study is the first to analyze the spatio-temporal distribution of global and regional MSD. It has been shown that the burden of MSD has tended to increase over the past 30 years. Regardless of the years and geographical locations studied, the prevalence of low back pain is by far the most widespread in the world. There is also a great diversity of prevalence between MSD and regions. Most MSD increased significantly over time but were explained by age. However, age was not sufficient to explain all the trends we report here. Especially, we observe a marked difference in the prevalence of MSD between countries in the global North vs. global South, which was not totally explained by differences in age structures. The prevalence of MSD is higher in high-income countries and with countries with high medical density.Implications of all the available evidenceIn a context of expected ageing of the active population, a better understand these pathologies, it is becoming urgent to better understand these pathologies to better prevent them. This study has therefore highlighted the relevance of broader surveillance of these pathologies, considering occupational exposure over time, with a view to developing effective policies for the management and prevention. Furthermore, the cause of the difference in MSD prevalence between the Global North and the Global South deserve further research.

Magnitude and possible risk factors of musculoskeletal disorders among street cleaners and solid waste workers: a cross-sectional study

“…As conceptualized in our literature review [8,9,11,24,33], it is not surprising that we observed that the bodily pain increased monotonically with age, except for the upper back, hip/thigh pain, elbow pain, and neck pain, which plateaus after 46-50 years old. Given that the [9] has estimated that 37% of all global back pain reporting is attributed to occupational exposure or hazards.…”

“…An estimated 1.71 billion people were affected by musculoskeletal disorders globally, DALYs were 150.1 million based on GBD 2019 and the utmost bodily region (67%) reported was LBP. MSDs are ranked first in years lost due to disability (YLDs) and it is one of the most common reasons for seeking rehabilitation services among adolescents and adults [8][9][10][11]. Though the prevalence of MSDs is higher in developed countries, the DALYs have shown a downtrend due to improved informed policy and implementations.…”

“…Reporting the burden of disease, among varied occupations, regions, SDI and constant examining of risk factors can immensely improve the understanding of the burden and potential factors associated which will surely help to better characterize, and prevent MSDs related to work [8]. A study of spatialtemporal distribution [11] of MSD (based on GBD 2019) across 204 countries and 21 sub-region reported that the overall average prevalence per sub-regions ranged between 0.09% (for OA hand) and 15.8% (LBP), in Southeast Asia and in high-income North America respectively. Sub-Saharan Africa (SSA), sub-region observed the lowest overall prevalence for all years combined at 3.9% (LBP), 1.4% (knee OA), and 0.7 (neck pain) in Eastern and Central SSA.…”