Burden of Musculoskeletal Conditions

Economic stratum

Number of injury deaths (000)

Population (000)

Rates (deaths/100,000/year)

Low

850

826,417

103

Lower middle

2903

3,834,641

Upper middle

816

999,625

High

561

1,076,797

Total

5130

6,737,480

Source of data: 2008 Global Burden of Disease Study [1]

These high rates of death are in part due to the rising rates of injuries from increased use of motorized transport combined with less developed trauma care systems [2]. Rates of injury have been decreasing in high-income countries due to injury prevention schemes and improved trauma care. At the same time, rates of injury-related death and disability have been steadily rising in most LMICs and account for 90% of the global injury deaths. As most of the world’s people live in these countries, these trends have led to increasing rates of injury globally [2, 3].

For every person who dies from injury, many more suffer from nonfatal injury, leading to temporary or permanent disability. The global data for nonfatal injuries is not as comprehensive as those we have for deaths; however, the existing data show a significant burden of disability from musculoskeletal injuries affecting all economic strata, but it is especially heavy for LMICs [3].

Data on the burden of musculoskeletal injury come from several sources including hospital records and household surveys. Data from the National Health Interview Survey in the United States showed a rate for all extremity injuries of 68/1000 persons/year. This included many minor cases that received outpatient treatment only but excluded strains, sprains, and contusions, which did not receive medical treatment or which did not cause more than a half day of disability [4].

Data on more serious musculoskeletal injuries were obtained from the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS) . This showed an incidence of hospitalization (for at least 24 h) for musculoskeletal injuries of 3.5/1000/year (2.7/1000/year for lower extremity injuries and 0.8/1000/year for upper extremity injuries). Fifty percent of these injuries were due to falls and 20% to road traffic injuries. Similar data have been reported from other high-income countries [4].

Data from LMICs is limited to a few studies from a few countries; however, even these data are instructive. A survey from Ghana showed a rate of serious musculoskeletal injury (disability time of ≥30 days) of 17/1000/year. It is difficult to draw comparisons due to different methodology, and it is likely that many of these serious injuries would have been treated as inpatients in high-income countries , but injury rates in Ghana are far higher than in the United States [4, 5].

Due to difficulties accessing medical care in LMICs , many of the musculoskeletal injuries go on to poor outcomes (see Chap. 5). The Ghana survey showed that 0.83% of Ghanaians had an injury-related disability that had lasted longer than 1 year and was likely to be permanent. Seventy-eight percent of these disabilities were due to extremity injuries. Such disabilities should be readily amenable to low-cost improvements in orthopedic care and rehabilitation, in contrast to the more difficult to treat neurological injuries that are relatively more frequent causes of disability in high-income countries [6].

Using the available data from high-income countries and LMICs, the Global Burden of Disease (GBD) study [1] has provided some global estimates for musculoskeletal injuries. The GBD study evaluated rates of hospital admission for various nonfatal injuries from road traffic crashes. Table 2.2 shows that the majority of these are musculoskeletal injuries. As with fatal injuries, nonfatal musculoskeletal injuries primarily affect those in LMICs. The GBD estimated that the combined rates of extremity injury from falls and road traffic crashes range from 1000 to 2600/100,000/year in LMICs compared with 500/100,000/year in high-income countries [3, 4].

Table 2.2

The 20 leading nonfatal injuries sustained^a as a result of road traffic collisions, world, 2002

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