"Global Developmental Indicators Associated with the Burden of Congenital Limb and Musculoskeletal Anomalies".

Abstract

The burden of congenital limb and musculoskeletal (CLM) anomalies disproportionately affects low- and middle-income countries (LMICs). The objective of this cross-sectional study was to examine the relationship of the global burden of these conditions with other developmental indicators, including financial, geographic, technological, and healthcare workforce metrics. Prevalence and disability-adjusted life year (DALY) rates of pediatric CLM anomalies were extracted from the 2021 Global Burden of Disease database for each country. Multiple economic, geographic, and workforce variables were obtained from the World Bank, International Road Federation, International Telecommunications Union, and World Health Organization. Multivariable analysis with appropriate model selection was used to determine the association of these variables with log-transformed DALYs (logDALYs). After multiple imputation of missing variables, model selection identified three variables: 1) Risk of catastrophic expenditure for surgical care, 2) internet access, and 3) number of doctors for use in regression analysis in addition to prevalence. On multivariable regression, increased prevalence, lower rates of internet access, and fewer doctors were independently associated with logDALYs. Patients with CLM conditions require highly specialized, long-term access to surgical, medical, and rehabilitative services. Bolstering physician workforce, increasing services to patients in rural areas, and expanding internet infrastructure in LMICs will decrease barriers to care for patients with CLM conditions.