Definitions:

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

2. 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.

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. 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

9. Breakout Groups • Measures of Burden of Disease • Data Sources • National Action Plan • Support for Bone & Joint Monitor Project

10. 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

11. 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

12. History: Documenting the Problem 1984 Kelsey et al. The Frequency of Occurrence, Impact, and Cost of Musculoskeletal Conditions in the United States, AAOS

13. History: Documenting the Problem 1992 Praemer et al. Musculoskeletal Conditions in the United States, AAOS

14. 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

15. History: Documenting the Problem 1999 Praemer et al. Musculoskeletal Conditions in the United States, (2nd edition), AAOS Bone and Joint Decade publication

16. Musculoskeletal Conditions in the United States Large Scale Problem • Chronic impairments • Injuries

18. Impact: • Hospitalizations for musculoskeletal conditions in 1995: 3,008,000

19. Distribution of Hospitalizations Resulting from Musculoskeletal Conditions: United States, 1995 by Aggregate Category

20. Ambulatory Care Visits for Musculoskeletal ConditionsUnited States, 1995 .

21. The Impact of Musculoskeletal Impairments by Site United States 1995

22. Total Cost of All Musculoskeletal Conditions by Type of Cost, 1995. $215 Billion

23. 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

24. 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

25. ----- 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

26. ----- 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

27. Dissonance: • Large burden of musculoskeletal conditions • Modest research funding

28. Meeting With NIH Director OUTGROWTH: White paper on measures of Burden of Disease

29. Incidence Prevalence Mortality Disability Combined Measures DALY, QUALY, HEALY Cost White Paper:Measures Identified

30. The Dartmouth Atlasof Health Care, 1999 The Quality of Medical Care in the United States: A Report on the Medicare Program

31. 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

32. 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

33. 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

34. BJD - WHO Meeting US Role: data collection • Inventory of data sources • Data gleaned from each source • Health indicators for measuring progress

35. US Data Collection Efforts • Literature search • National surveys • National Health Interview Survey • National Health and Nutrition Examination Survey • National Nursing Home Survey

36. 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

37. 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

38. 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

39. Recent Publications • National Osteoporosis Foundation: • America’s Bone Health, The State of Osteoporosis and Low Bone Mass in our Nation, 2002