5.6.4. Societal impact

Musculoskeletal conditions have a major impact on society due to their frequency, chronicity and resulting disability. This has major cost implications and represents a great economic burden for policy makers when prioritizing resources for health and social care. Most of the costs are indirect related to work disability and social care, with a minor part of costs related to the direct costs of health care, although these are not negligible. The direct costs will increase with more expensive and widespread treatments for rheumatoid arthritis and osteoporosis and due to the ageing of population requiring more arthroplasties for osteoarthritis. There are many domains that need to be considered when considering the economic impact of musculoskeletal conditions (Woolf, 2008). The work disability and use of health resources are illustrated here below.

Work disability

In addition to functional limitations in everyday life, work disability is a major consequence of disease for the individual. A chronic pain condition might lead to permanent or temporary loss of work ability. Permanent disability in the economically active population can be estimated based upon register data on disability pensions. Temporary disability, on the other hand, might be the consequence in milder cases with varying intensity of complaints, and can be estimated from sick leave or worker’s compensation claims. A hindrance to these estimates is the lack of consistent diagnosis or causes given to such claims.

Musculoskeletal complaints are a major cause of sickness absence. In short term sickness absence (less than 1-2 weeks), musculoskeletal health complaints are second only to respiratory disorders (Stansfeld, 1995). Musculoskeletal complaints are the most common medical causes of long term absence, which is more important than short term absence for the individual in terms of consequences and for the society in terms of costs. Musculoskeletal injuries and disorders cause more than half of all sickness absence longer than two weeks in Norway (Brage, 1998). It is difficult to determine precisely the sickness absence that is caused by the different musculoskeletal conditions because of validity of diagnosis, but a Norwegian study found that 33% of those persons with sick leave over 4 days had low back pain, 20% neck and shoulder disorders whereas only 3% had rheumatoid arthritis (Table 5.6.11).

Table 5.6.11. Distribution (in per cent) of people with sick leave longer than 14 days due to musculoskeletal and connective tissue disorders by diagnosis and gender. Norway, 1994. (European Commission (2003): Indicators for Monitoring Musculoskeletal Problems and Conditions)

Musculoskeletal complaints are also common causes for disability pensions, along with mental disorders and cardiovascular disorders. The relative importance of these three groups varies, but in several countries, the mental and musculoskeletal disorders are 2-4 times more frequent than cardiovascular disorders as causes for disability pensions. In Norway, low back disorders are the most common reason (Table 5.6.12). (European Commission (2003): Indicators for Monitoring Musculoskeletal Problems and Conditions)

Table 5.6.12. Distribution (in per cent) of people on disability pensions due to musculoskeletal and connective tissue disorders by diagnosis and gender. Norway 1997.

Use of health care services

About one-quarter of all Europeans under long-term treatment give as major reason muscle, bone and joint problems (Eurobarometer Special Report No 283, 2007).

The associated health care costs that are generated by these musculoskeletal conditions are great. In 1994, musculoskeletal conditions were the second largest diagnostic group after mental retardation to generate healthcare costs in the Netherlands (Meerding, 1998). The total direct cost for health services due to musculoskeletal conditions was 0.7% of the gross national product.

Future trends

The impact on the individual and society is predicted to increase dramatically. Many of these conditions are more prevalent or have a greater impact in older age. The ageing of the population in Europe will result in the number of those affected by these conditions increasing markedly, in particular those affected by osteoporosis and osteoarthritis. Changes in lifestyle factors such as obesity and lack of physical activity will also increase the burden.