Epidemiology of musculoskeleteal disorders

Prof.Dr.Selma KARABEY

• Condition: A state of health,a state of readiness or physical fitness, a disease or physical ailment.

• Disorder: An ailment that affects the function of mind or body.

• Disease: The failure of an organism to adequately or appropriately counteract stresses or stimuli, which can be biological, behavioral, or environmental,resulting in sickness or disability.

• 1 M00–M99 – Diseases of the musculoskeletal system and connective tissue

• 1.1 (M00–M25) Arthropathies • 1.1.1 (M00–M03) Infectious arthropathies• 1.1.2 (M05–M14) Inflammatory polyarthropathies• 1.1.3 (M15–M19) Arthrosis• 1.1.4 (M20–M25) Other joint disorders• 1.2 (M30–M36) Systemic connective tissue disorders• 1.3 (M40–M54) Dorsopathies • 1.3.1 (M40–M43) Deforming dorsopathies• 1.3.2 (M45–M49) Spondylopathies• 1.3.3 (M50–M54) Other dorsopathies• 1.4 (M60–M79) Soft tissue disorders • 1.4.1 (M60–M63) Disorders of muscles• 1.4.2 (M65–M68) Disorders of synovium and tendon• 1.4.3 (M70–M79) Other soft tissue disorders• 1.5 (M80–M90) Osteopathies• 1.6 (M91–M94) Chondropathies• 1.7 (M95–M99) Other disorders of the musculoskeletal system and connective

tissue

Prevalence of SelectMedical Conditions in the U.S. Population

• Musculoskeletal conditions (MSC) are the most common cause of severe long term pain and disability,

• lead to significant healthcare and social support costs,• as a major cause of work absence and incapacity• they have a significant economic cost through lost productivity.

Prevalence of SelectMedical Conditions in the U.S. Population

• The prevalence of many MSC and their associated disability increases with

• ageing, • obesity and • lack of physical activity.

Prevalence of SelectMedical Conditions in the U.S. Population

• MSCs were reported by 110.34 million adults in the U.S. in 2008 in the National Health Interview Survey (NHIS)

• (½ of persons aged 18 and over of the estimated 2008 population)

• The rate of chronic MSCs found in the adult population is 60% greater than that of chronic circulatory conditions,

• more than twice that of all chronic respiratory conditions.

Prevalence of SelectMedical Conditions in the U.S. Population

• Among females, 53 in every 100 in the population report musculoskeletal conditions;

• among males the rate is 45 per 100, a slight increase in recent years.

Prevalence of SelectMedical Conditions in the EU Population

• In a 2007 EU survey, 22% of the population currently had, or had experienced long-term muscle, bone and joint problems such as rheumatism and arthritis.

• The most common musculoskeletal pain experienced is back pain;

• pain is the most prominent symptom in most people with arthritis

• and is the most important determinant of disability in patients with osteoarthritis.

Turkey health statistics

• The distribution of disease or health problems in individuals aged 15 years and over, in Turkey:

1) Hypertension; 8.7% in males, 17.6% in females, 13.2% in both total2) Lumbar region of musculoskeletal problems(low back pain, herniated disc):9.6% in males, 15.9% in females,12.8% in both total3) Rheumatoid disease(RA):5.3% in males, 12.7% in females, 9.1% in both total6) Arthritis(OA, arthrosis, degenerative joint disease): 3.6% in males, 9.4% in females, 6.5% in both total7) Neck region of musculoskeletal problems( neck pain, herniated disc):3.1% in males, 8.8% in females, 6% in both total

Turkey health statistics yearbook 2012

Turkey health statistics

• The distribution of the disease or health problems that are determined by the physician in individuals aged 15 years and over, in Turkey:

1) Lumbar region of musculoskeletal problems(low back pain, herniated disc): 8% inmales, 13.8% in females, 10.9% in both total 3) Rheumatoid disease(RA): 4.25% in males,11.4% in females,7.9% in both total 5) Arthritis(OA, arthrosis, degenerative joint disease): 3.1% in males, 8.8% in females, 6% in both total 8) Neck region of musculoskeletal problems( neck pain, herniated disc): 4.2% in males, 5.4% in females, 4.8% in both total

Turkey health statistics yearbook 2012

TÜİK Ölüm Nedeni İstatistikleri, 2013

The Eurobarometer Report on Health in the EU

• Activity restricting musculoskeletal pain:• 32% of all respondents • 44% of those 55 years and over said that in the preceding week they experienced • Muscle, • joint, • neck • back pain which affected their daily activities.

The Eurobarometer Report on Health in the EU

• Women were more likely than men to experience this pain (37% vs. 27%).

• Countries reporting particularly high levels of reduced activities due to pain wereFinland (44%) and Lithuania (42%).

• The lowest proportions reporting activity reducing pain were

Ireland (18%) and Portugal (21%).

MSC related mortality

• Osteoarthritis and rheumatoid arthritis are associated with increased mortality due to an increased risk of co-morbidities and the adverse effects of medication.

• Mortality rates are up to 20-24% in the first year after a hip fracture and the greater risk of dying may persist for at least 5 years afterwards

DETERMİNANTS OF MUSCULOSKELETAL HEALTH

Turk and Okifuji 1997, Statistisches Bundesamt 1998, Schneider et al. 2005

Factors Impact on to the chronicity

Factors about the work place

Decreased workplace satisfaction Strong progresser

Low-income Progresser

Hard work Progresser

Stress Progresser

Sitting at work Moderate progresser

Turk and Okifuji 1997, Statistisches Bundesamt 1998, Schneider et al. 2005

Factors Impact on to the chronicity

Sociodemografic factorsOld age ProgresserWoman patient Progresser

To be married ProgresserSocial support Irregular

Privately insured Preventative

Low-educated Progresser

Low social status Progresser

Low-income Progresser

Turk and Okifuji 1997, Statistisches Bundesamt 1998, Schneider et al. 2005

Factors Impact on to the chronicity

Psychological / behavioral factors

Unsuitable processing of the events Strong progresser

Reaction to the social stress Strong progresser

Major obsession with physical damage Strong progresser

Expectation of being completely undamaged

Strong progresser

Fear related avoidance Strong progresser

Depressed mood Strong progresser

Active behaviors during leisure time Preventative

Good Condition Preventative

Tobacco use Progresser

Alcohol and substance abuse Strong progresser

High body mass index Progresser

Age

• Eurostat projections indicate that while the total population of the EU-25 will fall only slightly by 2050, the age structure will change dramatically.

• By 2050, the EU will have 48 million less people of aged 15- to 64-year-olds and 58 million more people aged 65 and over.

Obesity

• Obesity is associated with a range of disabling conditions in adults

• there is evidence that childhood obesity can have a significant effect on a child’s musculoskeletal system (Anandacoomarasamy et al 2008, Shiri et al 2010, Tsiros et al 2011).

• Obesity rates vary substantially across the EU with the lowest adult rate in Romania,the highest in the UK.

• Across all EU countries the prevalence of obesity is higher in women than men (OECD 2010).

Physical activity and exercise

• Physical activity is essential for good musculoskeletal health.• It can increase bone density in adolescents, • maintain it in adults and slow its decline in old age.

• The average proportion of people in the EU 27 who say they never do any exercise or do so very rarely is 24%.

• However this varies widely from 51% in Lithuania to 14% in Germany.

Diet and nutrition

An adequate intake of calcium and Vitamin D is essential for bone formation and the maintenance of musculoskeletal health.

Inadequate vitamin D can cause rickets, osteoporosis in adults, osteomalacia. The European Male Ageing study (McBeth 2010) indicated that musculoskeletal pain is associated with very low levels of Vitamin D in men. Vitamin D inadequacy is particularly common among patients with osteoporosis.

Alcohol

• Consumption of alcohol is related to over 60 medical conditions, including the increased risk of some skeletal conditions, such as fractures and muscle diseases (Anderson & Baumberg, 2006)

• There is some evidence that women with low levels of alcohol intake have higher bone density than women with higher levels of alcohol intake (Lu et al 2010)

• Moderate alcohol consumption may decrease the risk for RA and RA progression (Lu et al 2010).

Smoking

• Smoking is a well-established environmental risk factor for the development of rheumatoid arthritis (RA).

• There is evidence of an overall negative association between smoking and osteoarthritis.

• Europe smoking prevalence is higher among men than women.• The overall prevalence of smoking is higher among younger people

than older generations. • Deprivation, including poverty and lower educational levels are

related to higher rates of smoking in the population. (ASPECT, 2004).

Work type

• MSDs are the single largest category of work-related illness, representing a third or more of all registered occupational diseases in the United States, the Nordic countries, and Japan.

• Numerous surveys of working populations have reported upper extremity symptom prevalences of 20 to 30% or even higher.

Changing lifestyles and the prevention of musculoskeletal conditions

• Lifestyles to optimise musculoskeletal health include:

• Physical activity to maintain physical fitness • Maintaining an ideal weight • A balanced diet that meets the recommended daily allowance for calcium and vitamin D • The avoidance of smoking • The balanced use of alcohol and avoidance of alcohol abuse

• Put Pain in Its Place• How to Get Osteoarthritis Pain Under

Control• Put Pain in Its Place gives you the tools to

manage your Osteoarthritis (OA) pain and live better. Developed by the experts you trust at the Arthritis Foundation in conjunction with the National Council on Aging and sponsored by Ferring Pharmaceuticals, Inc., this program will help you:

• Understand OA, its causes and how to treat it

• Learn self-management strategies to prevent and relieve pain

• Get inspired to take action and get your pain under control

• Find out about effective and safe exercises from the Arthritis Foundation Exercise Program

• About the Program• Move More, Feel Great! • Life With Arthritis empowers people

with both arthritis and diabetes to incorporate physical activity and healthy eating into their daily routine. Developed in partnership with the American Diabetes Association, this informative two-hour class will help people:

• Understand the relationship between arthritis and diabetes and what that means for their health

• Learn how to incorporate exercise and good eating habits into their everday life

• Find out about safe, effective physical activity programs that can be done individually or in a group setting

Secondary Fracture Prevention Programs

• In the U.S., Kaiser Permanente’s Healthy Bones program has reduced the expected hip fracture rate by 38 percent since 1998 Geisinger Health System achieved $7.8 million in cost savings over five years.

• The FLS (Fracture Liaison Service) model of care is a tested, effective way to improve patient outcomes, decrease health care costs and improve provider quality measure compliance.

• FLS programs coordinate post-fracture care through a FLS coordinator (a nurse practitioner, physician’s assistant, nurse or other health professional) who ensures that individuals who suffer a fracture receive appropriate diagnosis, treatment and support

‘School Milk’ Programs in the World

• In more than 80 countries around the world the School Milk project was implemented, in different periods.

• Netherlands, Denmark, Czech Republic, China, Portugal and Sweden are the most successful of them.

‘School Milk’ Programs in Turkey

• 7 million 200 thousand 144 million cans of milk were distributed to students 32 thousand 500 schools in Turkey ,in 2011-2012 Academic Year.

• 296 million cans of milk were distributed to 6 million 172 thousand 692 master classes and elementary school students in Turkey, in 2012-2013 Acedemic Year.

• From 10 February 2014, 303 million boxes,in reliable, 200 mL healthy packaging, fat, plain UHT milk will be distributed to

6 million 330 thousand 215 students, 3 days a week (Monday, Wednesday, Friday)

References and Web Sources

• The Burden of Musculoskeletal Diseases in the United States,• http://www.boneandjointburden.org/• Musculoskeletal Health in Europe Report v5.0• http://www.eumusc.net/mwginternal/de5fs23hu73ds/progress?id=qzA6pLxK

YU• TURKEY BURDEN OF DISEASE STUDY 2004• http://ekutuphane.tusak.gov.tr/kitaplar/turkey_burden_of_disease_study.pdf• T.C Sağlık Bakanlığı, Sağlık İstatistikleri Yıllığı 2012• Oxford Textbook of Public Health, Musculoskeletal Diseases, Roger Detels,

Robert Beaglehole, Mary Ann Lansang, Martin Gulliford, 2009• Dictionary of public health promotion and education,Terms and

Concepts,Naomı N . Modeste, Teri S .Tamayose,2004• Musculoskeletal Disorders and Workplace Factors A Critical Review of

Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck,Upper Extremity, and Low Back, Edited by: Bruce P. Bernard,1997

References and Web Sources

• Impact of musculoskeletal disorders and social determinants on health in construction workers, Sameer Valsangkar, K. Surendranath Sai, Int J Biol Med Res. 2012; 3(2):1727-1730

• Work-related musculoskeletal disorders: the epidemiologic evidence and the debate Laura Punnett , David H. Wegman,Journal of Electromyography and Kinesiology 14 (2004) 13–23,

• Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-studyH.S.J. Picavet, J.S.A.G. Schouten, Pain 102 (2003) 167–178

• http://www.sciencedirect.com/science/article/pii/S030439590200372X#• Arthritis Foundation• http://www.arthritis.org/resources/community-programs/educational-program

s• Centers for Diseases Control and Prevention• http://www.cdc.gov/injury/stateprograms/index.html