It’s our greatest disability burden, yet it attracts the lowest funding of all national health priorities. Why is this?
It gets little attention because it rarely kills, but musculoskeletal disease is a growing problem globally and causes a greater share of disability in Australia than in any other country.
In a study published in the Annals of the Rheumatic Diseases last month, French researchers used data from the World Health Organisation Global Health Estimates Database to show that the proportion of disability-adjusted life years (DALYs) due to musculoskeletal disease grew by about 40% between 2000 and 2015. The absolute number of DALYs grew from just over 80 million to just under 108 million.
As a cause of years lived with disability (YLD) – a more relevant measure for conditions that cause disability rather than death – musculoskeletal diseases came second globally in 2015, but has since reached first place.
Australia had the highest proportion of DALYs (8.8%) due to musculoskeletal diseases of any country in 2015, and the second-highest YLD (19.9%), equal with Canada, behind The Netherlands.
African countries filled out the bottom 10 of 183 nations, with Somalia the lowest.
The researchers also mapped each country’s musculoskeletal burden on to its GDP per capita and found a strong positive correlation. They attributed this to higher life expectancy, ageing populations and a reduction in life-shortening communicable diseases.
Professor Lyn March AM, who holds the Liggins chair of rheumatology and musculoskeletal epidemiology at the University of Sydney, said Australia’s top ranking was interesting if not unexpected.
As well as our increased longevity, she said other possible contributors were our high levels of obesity, a risk factor for osteoarthritis, lower back pain and other conditions; and our high participation in sport at all ages, leading to higher rates of injury.
“Musculoskeletal conditions are totally underrated and it is not entirely clear why,” Professor March told The Medical Republic.
“It is frustrating to note that the Australian Health Minister [Greg Hunt], in response to the National Strategic Action Plan for Arthritis presented earlier this year, only pledged $4 million – that’s less than $1 per person affected by arthritis and MSK conditions in Australia. Hopefully more will follow for musculoskeletal research and treatment programs.”
She said that while these highly prevalent conditions accounted for the greatest disability burden, they attracted among the lowest funding of all national health priorities.
“That’s in part due to the fact that mortality is low,” she said. “But it’s not zero – there is increased mortality associated with most of the musculoskeletal conditions, particularly with rheumatoid arthritis and osteoporotic fractures.
“By and large people living with these conditions in Australia tend to be very resilient and suffer in silence. And given that we have not been able to cure these chronic conditions, we as rheumatologists have also had the tendency towards a positive outlook, to maintain hope and encourage patients to be active rather than creating the vision of progressive disability and chronic pain.
“Perhaps we have done musculoskeletal conditions a disservice to undersell their impact.”
Professor March co-wrote a paper published in January in the American Journal of Public Health on the global burden of musculoskeletal pain. Pain which reduces mobility and physical activity, leading to frailty, sarcopenia and cognitive decline.
“Physical activity is important for all aspects of health – heart disease, diabetes, lung disease, recovery from cancer, warding off dementia – yet you can’t do it if you have a significant musculoskeletal problem and you have musculoskeletal pain,” Professor March said.
“The importance of including musculoskeletal health interventions in all general health models of care for chronic disease cannot be stressed enough.”
To deal with a burden that is only expected to grow, she said more investment was needed in rheumatology, specialised nurses, chronic care programs and research.
Dr Damien Nevin from the Australian Association of Musculoskeletal Medicine, which offers a post-graduate certificate and workshops for GPs on these disorders, said they accounted for about 20% of GP consultations.
“The burden of disease is growing and insidious, leading to high-cost ongoing disability, but not death,” he told The Medical Republic.
“Undergraduate training in musculoskeletal disease is minimal and dominated by an orthopaedic/operative intervention syllabus. Very few GPs have post-graduate training in it.
“Orthopaedic surgery works for many conditions but it is high-cost and treats end-stage disease. Most other therapy treats symptoms only.”
Dr Nevin said GPs were well placed to educate patients in how to prevent conditions such as osteoarthritis – by losing weight, keeping active, avoiding injury and minimising inflammation – but that this took time, and the Medical Benefits Schedule did not encourage longer GP consultations.
