Time to Address the Global Impact of Pain

More people may be living longer, but they're not enjoying it, particularly when it comes to musculoskeletal health, according to the latest Global Burden of Disease (GBD) study.¹ The largest analysis of global disability data to date, GBD 2013 reveals that "the burden of musculoskeletal disorders [is] much larger than previously appreciated," accounting for nearly 21 percent of global years lived with disability as of 2013. Back pain remains the No. 1 cause of years lived with disability worldwide; neck pain is also a common contributor to years lived with disability.

Led by the Institute for Health Metrics and Evaluation and funded by the Bill and Melinda Gates Foundation, GBD 2013 represents a massive analysis of global disability data, with 35,000 data sources spanning 188 countries.2 Here are a few of the key findings from the latest analysis, published in Lancet in June, highlighting the global musculoskeletal disability burden:

The Musculoskeletal Burden

• "In this analysis, we show that musculoskeletal disorders ranged from 9.6% of YLDs [years living with disability] to 28.9% of YLDs between 188 countries. Low back pain was the leading cause of YLDs in 86 countries and the second or third leading cause in 67 countries."
• "Musculoskeletal disorders combined with fractures and soft tissue injuries reached a total of 20.8% of global YLDs in 2013 ... Our analysis of time trends showed that this category of disorders was an important driver of rising YLD rates per person. Increases were driven by ageing of the population in most countries with trends in obesity and physical inactivity likely exacerbating the problem. Musculoskeletal disorders were not only an important contributor to the burden of disease but were also a crucial component of health expenditure in many high-income and middle-income countries."

Nonmusculoskeletal Burden

As a doctor of chiropractic, you concern yourself with much more than your patients' musculoskeletal health, of course, which is why the findings from GBD 2013 have even more relevance to you and your practice. For example, while back pain maintains the No. 1 position in terms of its impact on years living with disability, diabetes now occupies the No. 7 spot, moving up three positions from 1990 to 2013. In the U.S. alone, diabetes prevalence increased 71 percent over that time period.² What's more, almost a quarter of the global population suffers from tension headaches, while one in eight suffers migraines.³

From Analysis to Action?

Will data drive health-care decision-making? If so, the chiropractic profession – and the millions of people worldwide stricken with musculoskeletal pain and related disability – stand to benefit exponentially. Comments by the GBD 2013 collaborators and other health policy experts suggest something has to give:

The GBD 2013 authors emphasize, "Although the GBD 2010 analysis brought more attention to these disorders, there remains little policy discussion of the options available to prevent and address these disorders."¹

Rifat Atun, professor of global health systems and director of the Global Health Systems Cluster at Harvard University's T.H. Chan School of Public Health, authored a commentary to the latest Lancet report and urges adoption of a prevention and wellness model to as a vital step to address the chronic disease burden:

"Don't wait for illness, invest in the maintenance of health," he said. "We can't manage these chronic conditions in hospitals, so there needs to be an emphasis on maintaining good health, preventing disease and slowing progression of disease when it does happen. There's no choice; it has to happen."⁴

For doctors interested in reviewing the complete report, GBD 2013 provides the latest trends in disease and injury incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries – but be prepared. Reporter John Ross perhaps sums up the grim findings best:

"A focus on cheating death rather than keeping people healthy has transformed the planet's population into a world of walking wounded, a massive inventory of global illness levels has found. ... Premature death rates are in decline. But the death toll has been replaced by a colossal disability burden, with hundreds of millions of years of productive life lost each year to pain and disease."⁵

References

1. Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, epub ahead of print June 8, 2015.
2. Tavernise S. "Global Diabetes Rates Are Rising as Obesity Spreads." New York Times, June 8, 2015.
3. Macrae F. "Back Pain Is the Biggest Cause of Ill Health in the World: Issues Cause More "Years Lived With Disability" Than Any Other Condition." Daily Mail, June 8, 2015.
4. Coghlan A. "Defying Death Is Causing Back Pain, Bad Teeth and Depression." New Scientist, June 8, 2015.
5. Ross J. "Illness Study a 'Call to Arms.'" The Australian, June 9, 2015.