Global and high-income regional burden and healthcare costs of musculoskeletal diseases, 1990-2023.

Abstract

This study aimed to clarify the latest epidemiologic trends, economic costs, and key drivers of musculoskeletal disorders (MSDs) in high-income regions, where the disease burden has increased despite high overall healthcare spending. Utilising data from the Global Burden of Disease 2023 database, we analysed the trends in incidence, prevalence, and years lived with disability (YLDs) for MSD across 36 high-income countries from 1990 to 2023. Bayesian meta-regression models were employed to quantify the burden attributable to major risk factors. A cross-national transfer model was used to estimate the direct healthcare economic costs associated with MSD in 2023. Spearman correlation analysis was applied to explore the relationship between the Sociodemographic Index (SDI) and disease burden, and trends in disease burden were forecasted for the period 2024 to 2050. Between 1990 and 2023, the total number of incident cases, prevalent cases, and YLDs for MSD in high-income regions increased by 36.75%, 54.28%, and 49.36%, respectively. Although the age-standardised incidence rate decreased by 4.07%, the standardised prevalence and YLD rates increased by 5.04% and 3.98%, respectively, indicating a continuously growing absolute disease burden. Low back pain and osteoarthritis accounted for the largest proportion of the disease burden. For all MSD subtypes except gout, the burden was higher in females than in males. In 2023, the direct medical costs associated with MSD reached as high as $327.68 billion, with the United States accounting for >45% of this amount. Regarding risk factors, the proportion of YLDs attributable to high body mass index increased from 8.3% in 1990 to 10.7% in 2023. The contribution of occupational ergonomic factors remained stable at approximately 7.7%, whereas the smoking-related burden decreased by 30%. Correlation analysis revealed no significant association between the SDI and the age-standardised burden rates of MSD. The burden of MSD in high-income regions continues to intensify, driven primarily by ageing, obesity, and occupational factors, and has not been alleviated by economic development. Future prevention and control efforts should focus on weight management and occupational ergonomic interventions to curb the growth of the disease and mitigate the substantial economic pressure.