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Epidemiology - PowerPoint PPT Presentation

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Overview. Epidemiology. In this lecture on epidemiology the following issues are reviewed:. • The prevalence of musculoskeletal (MSK) • disorders in Canada. • The effect of MSK disorders on the individual.

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In this lecture on epidemiology the following issues are reviewed:

• The prevalence of musculoskeletal (MSK) • disorders in Canada

• The effect of MSK disorders on the individual

• The economic impact of MSK disorders on both the • individual and society.

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Prevalence of Musculoskeletal Disorders in Canada


• 29% of adult population

• 22% have chronic MSK problems

• 5% have long-term disability

• 18% of adults affected by arthritis and rheumatism

More than half of those patients with a musculoskeletal (MSK) disorder has either arthritis or rheumatism. (1)

1. Badley EM, Webster GK, Rasooly. The impact of musculoskeletal disorders in the population: Are they just aches and pains? Findings in the 1990 Ontario Health Survey. J Rheumatol 1995;22:733-739.

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Prevalence of Specific MSK Disorders (1)


• Degenerative arthritis

• Rheumatoid arthritis

• Ankylosing spondylitis

The prevalence of degenerative arthritis varies depending on whether radiological surveys or symptomatic disease is considered. Degenerative arthritis rises steeply with age. Less than 1% have it between the ages of 25 and 34, >30% after the age of 70. As with many other forms of arthritis, women are disproportionately affected, especially with hand and knee osteoarthritis (OA).

Approximately 1% of Caucasian adults is affected by rheumatoid arthritis (RA). It is two to three times more frequent among women and its prevalence also increases with age.

Ankylosing spondylitis affects between 0.5-1% of the population and has a male predominance.

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Prevalence of Specific MSK Disorders (2)


• Systemic lupus erythematosus

• Seronegative arthritis

• Gout

• Calcium pyrophosphate dihydrate (CPPD) deposition disease

Lupus (1 in 2,000 individuals) is less common than rheumatoid arthritis and ankylosing spondylitis. It has a female predominance (90%), especially in the 14-64 age group.

Seronegative inflammatory arthritis (inflammatory arthritis with a negative test for latex titre/rheumatoid factor [RF] and antinuclear factor [ANF]) is as common as rheumatoid arthritis. For example, 20 to 30% of patients with psoriasis have an arthritic condition.

The prevalence of gout is difficult to estimate given its intermittent nature. It is more common among males (5-28/1,000) vs females (1-6/1,000). Peak age of onset for males is 40-50 years and females >60.

The incidence of calcium pyrophosphate dihydrate (CPPD) deposition disease is unknown. Chondrocalcinosis is more common (8-100/100,000) with a female predominance (2-7:1). Peak age of onset is between 60 and 70. Symptomatic disease is approximately half that of gout.

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Impact of MSK Disorders


• Chronic health problems

• Long-term disability

• Consultation with health professional

• Restricted activity days

• Drug usage

Lecture Note

The impact of musculoskeletal disorders is enormous. They are the most common cause of chronic health problems, long-term disability and consultation with a health professional (9-11% of primary care visits (1)). Musculoskeletal disorders are the second leading cause of restricted activity days and prescription and non-prescription drug use.

1. Rosenblatt RA, Cherkin DC, Schnweeweiss R et al. The structure and content of family practice: Current status and future trends. J Fam Pract 1982;15:681-722.

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MSK or Only Aches and Pains?


• 79% of MSK disorders last >6 months

• 68% of those with arthritis consult a health professional

• Projected 32% increase in arthritic disability by 2020

Musculoskeletal disorders reported by patients are more than aches and pains. (1)(2) The majority of complaints have a median duration of five years and the prevalence of musculoskeletal disorders is increasing.

1. Badley EM, Webster GK, Rasooly. The impact of musculoskeletal disorders in the population: Are they just aches and pains? Findings in the 1990 Ontario Health Survey. J Rheumatol 1995;22:733-739.

2. Badley EM, Crotty M. Quantitative estimates of the impact of the aging population on the need for rheumatological services: An international comparison. Arthritis Rheum 1994;35:S177.

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Economic Impact


• Job loss

• Early retirement

• Reduced working hours

• Stop working

• Reduced family income

People with RA are three times more likely than the general population to lose their job, work fewer hours or stop working. This results in a reduced family income.

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Economic Impact on Society


• ± 1% of GNP

• $5 billion in Canada per year

• $55 billion in USA per year

The costs of MSK disorders are huge.

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Direct Costs


• RA $2,162 per patient per year

• Rx 62%, ambulatory care 21%, hospital 16%

• OA $543 per patient per year

• Rx 32%, ambulatory care 22%, hospital 46%

The predominant direct cost in the management of RA is medication. (1)

In OA, while the individual cost is less, the total community costs are six to seven times higher than for RA. (1)

1. Lanes SF, Lanza LL, Radensky PW et al. Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting. Arthritis Rheum 1997;40:1475-1481.

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Indirect Costs


• 13-56% of total costs

• non-wage losses:

• RA = $889 per person per year

• OA = $726 per person per year

• non-arthritis = $335* per person

*Figures in US dollars.

There is no way to determine indirect costs given different methodologies used for tracking.

The indirect and non-medical costs for OA are substantial and approach those for RA. (1)

In addition to the possibility of job loss or reduced hours, there are also out-of-pocket expenses amounting to $889 for those with RA and $726 for OA.

1. Gabriel SE, Crowson CS, Campion ME et al. Nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol 1997;24:43-48.

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• Common

• Serious

• Treatable

Musculoskeletal disorders are as common or more common than the common cold in family doctors' offices. They are serious and chronic, can cause disability and pain, and can result in financial loss.While there is no cure, many patients can obtain good control of their symptoms.

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