Measuring the Burden of Musculoskeletal Disease

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 Groups’ Previous, Current and Proposed Efforts  Other Breakout Groups  Measures of  Data Burden of Disease Sources Plan  National Action  Support for Bone & Joint Monitor Project Previous Efforts in Measuring Burden of Disease  AAOS: collect and analyze data to estimate incidence & impact of musculoskeletal diseases and injuries in the US—1978, 1984, 1992, 1999 analysis of measures of burden of musculoskeletal diseases & injuries ―White Paper‖ 1999 Atlas of Musculoskeletal Care, 2001  AAOS:  Dartmouth University: History: Documenting the Problem 1978 Kelsey et al. Musculoskeletal Disorders: Their Frequency of Occurrence and their Impact on the Population of the United States, Prodist Publishing History: Documenting the Problem 1984 Kelsey et al. The Frequency of Occurrence, Impact, and Cost of Musculoskeletal Conditions in the United States, AAOS History: Documenting the Problem 1992 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 Problem 1999 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 Other Musculoskeletal Conditions 2.7% Musculoskeletal and Connective Tissue 49.2% Complication or Reaction* 3.7% Neoplasms 3.5% Congenital Anomalies 0.9% Dislocation and Sprains Other Injury 4.6% 5.6% Fractures 29.8% Ambulatory Care Visits for Musculoskeletal Conditions United States, 1995 98.7 100 Patient Visits (millions) 80 60 40 20 0 . 23.9 8.2 Physician Office Hospital Outpatient Department Hospital Emergency Department The Impact of Musculoskeletal Impairments by Site United States 1995 Upper Extremity or Shoulder Bed Days (millions) 10.8 48.7 93.4 152.8 Lower Extremity or Hip Back or Spine All MS Impairments Restricted Activity Days (millions) 0 57.9 190.7 240.0 488.6 100 200 300 400 500 Total Cost of All Musculoskeletal Conditions by Type of Cost, 1995. 7% 37% Mortality costs Morbidity costs Direct costs 56% $215 Billion 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 22% 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 20.0% 18.5% Percent of U.S. population 16.5% 14.7% 12.8% 12.6% 2.4% 2.1% 5.8% 6.8% 12.6% 13.2% 2.0% 2.0% 4.8% 4.2% 1.4% 4.3% 1.5% 4.5% 1.7% 4.5% 1.9% 4.3% 7.1% 6.6% 6.4% 7.0% 8.5% 9.7% 10.6% 10.8% Age Groups 1996 2000 2005 2010 2015 2020 2025 2030 65 to 74 75 to 84 85 and Over Annual Total Knee Replacements: U.S. Female Population Projections through 2030* 300,000 250,000 Effect of 274,000 population aging Effect of population increase 204,000 200,000 150,000 100,000 50,000 0 1996 2000 2005 2010 2015 2020 2025 2030 ----- based on constant (1996) age and gender distribution based on Census Bureau age and gender projections Annual Total Hip Replacements: U.S. Female Population Projections through 2030* 160,000 143,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 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 population aging Effect of population increase 105,000 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  Combined Measures   Prevalence Mortality  DALY, QUALY, HEALY Cost  Disability  The Dartmouth Atlas of Health Care, 1999 The Quality of Medical Care in the United States: A Report on the Medicare Program Bone and Joint Decade Monitor Project 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  International effort 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  Data of data sources gleaned from each source measuring progress  Health indicators for 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