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