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Measuring the Burden of Musculoskeletal DiseaseMusculoskeletal Conditions and Injuries: Status and GoalsUnited States Bone and Joint Decade

slide2
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
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.
background4
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
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
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
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 discussions8
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
Breakout Groups
  • Measures of Burden of Disease
  • Data Sources
  • National Action Plan
  • 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

AAOS: analysis of measures of burden of musculoskeletal diseases & injuries “White Paper” 1999

Dartmouth University: Atlas of Musculoskeletal Care, 2001

Previous Efforts inMeasuring Burden of Disease
history documenting the problem
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 problem12
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 problem13
History: Documenting the Problem

1992 Praemer et al.

Musculoskeletal Conditions in the United States, AAOS

history documenting the problem14
History: Documenting the Problem
  • Lawrence, et al.
  • “Estimates of the Prevalence of Arthritis and Selected Musculoskeletal Disorders in the United States,” Arthritis and Rheumatism, May1998
history documenting the problem15
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
Musculoskeletal Conditions in the United States

Large Scale Problem

  • Chronic impairments
  • Injuries
impact
Impact:
  • Hospitalizations for musculoskeletal conditions in 1995: 3,008,000
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Distribution of Hospitalizations Resulting from Musculoskeletal Conditions: United States, 1995 by Aggregate Category

impact of an aging population
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
slide24

U.S. Population, Age 65 and Over(as a percent of total population)1996 - 2030

20.0%

18.5%

16.5%

14.7%

13.2%

12.8%

12.6%

12.6%

Percent of U.S. population

Age Groups

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----- based on constant (1996) age and gender distribution

based on Census Bureau age and gender projections

Annual Total Knee Replacements: U.S. Female PopulationProjections through 2030*

Effect of

population

aging

Effect of

population

increase

slide26

----- based on constant (1996) age and gender distribution

based on Census Bureau age and gender projections

Annual Total Hip Replacements: U.S. Female PopulationProjections through 2030*

Effect of

population

aging

Effect of

population

increase

dissonance
Dissonance:
  • Large burden of musculoskeletal conditions
  • Modest research funding
meeting with nih director
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

White Paper:Measures Identified
the dartmouth atlas of health care 1999
The Dartmouth Atlasof Health Care, 1999

The Quality of Medical Care in the United States: A Report on the Medicare Program

bone and joint decade monitor project
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
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
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 meeting34
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
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 efforts36
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

Most Important Conditions
us proposed bjd activities
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
Recent Publications
  • National Osteoporosis Foundation:
  • America’s Bone Health, The State of Osteoporosis and Low Bone Mass in our Nation, 2002