When we get ill: musculoskeletal health
(When we get ill: musculoskeletal health)
- It is estimated that 17.8 million people in the UK live with a musculoskeletal condition, which equates to nearly 3 in 10 of the population. Prevalence is higher among females (31.8%) than males (25.9%). (2 Why is musculoskeletal health important)
- The burden of painful conditions also falls disproportionately on those who are more disadvantaged in society. Severe pain is more common in groups that are more deprived. (2 Why is musculoskeletal health important)
- It is estimated that nearly 1 in 5 Suffolk residents of all ages experience back pain, which equates to more than 131,000 people. (3.1 Prevalence)
- Musculoskeletal conditions present a significant burden on both GPs and hospitals, accounting for 3 in 10 GP consultations and over 1 in 4 surgical interventions in the NHS. (3.3 Primary care and hospital admissions)
- Like many other long-term conditions, physical inactivity and obesity are major risk factors for musculoskeletal conditions. Appropriate physical activity can prevent some conditions occurring and can reduce the impact of these conditions for people who develop them. (2 Why is musculoskeletal health important)
The musculoskeletal system is made up of the muscles, bones, tendons, ligaments and joints that move the body and help to maintain our structure and form. Several factors come together to produce good musculoskeletal health. The joints and spine need to be both stable and supple to support the body and carry out a wide range of movements. Muscles need to be strong enough to provide the power to move. Bones need to be sturdy enough to withstand the normal knocks of everyday living without breaking. Good mental health is required to provide energy and motivation to be physically active. What's more, all this should happen without pain, stiffness or fatigue.
Musculoskeletal conditions account for the largest cause of disability in the United Kingdom. In particular, low back pain accounts for more Years Lived with Disability (YLDs) than any other single cause. It is estimated that 17.8 million people in the UK live with a musculoskeletal condition, which equates to nearly 3 in 10 (28.9%) of the population. Prevalence is higher among females (31.8%) than males (25.9%). The burden of painful conditions also falls disproportionately on those who are more disadvantaged in society. Severe pain is more common in groups that are more deprived.
Musculoskeletal conditions, and the pain caused by them, can be a major barrier to people living full and active lives. The pain of a hip fracture from a fall may lead an older person to fear leaving their home. The pain of osteoarthritis may make it difficult for a once active person to exercise. And severe back pain may have a debilitating impact on someone's ability to work. Pain can affect every aspect of personal, family and working life.
Musculoskeletal conditions can indirectly contribute to an individual’s risk of death. Annually, around 75,000 hip fractures occur in the UK and, of these, one in four people (28.7%) die within a year of suffering the fracture.,  Rheumatoid arthritis is an autoimmune disease that causes inflammation, resulting in painful, stiff and swollen joints. People with rheumatoid arthritis have an increased risk of several health conditions.
An ageing population, alongside rising levels of obesity and physical inactivity, will increase the number of people living with a musculoskeletal condition. Increasing numbers of people of working age will struggle to work due to these conditions, particularly as the retirement age increases. More people than ever before will depend on health and social care services to manage their pain and disability. This economic pincer movement of lost productivity and increased costs will place greater demands on society.
The positive news is that many lifestyle behaviours that contribute to musculoskeletal ill health can be changed. Like many other long-term conditions, physical inactivity and obesity are major risk factors for musculoskeletal conditions. Appropriate physical activity can prevent some conditions occurring and can reduce the impact of these conditions for people who develop them.
Note that Suffolk is covered by three Clinical Commissioning Groups (CCGs) and one of them spans Suffolk and Norfolk (Great Yarmouth and Waveney CCG). Figures are presented at CCG level because the data cannot be disaggregated into Great Yarmouth and Waveney.
The true prevalence of musculoskeletal conditions is unknown because not all people consult their GP about the problem, particularly if symptoms are less extreme. However, survey responses can be used to estimate prevalence.
The GP Patient Survey asks a question about which long-term conditions the respondent suffers from. Almost 1 in 5 people reported suffering with arthritis or an ongoing back/joint problem in Ipswich and East Suffolk CCG (17%) and West Suffolk CCG (19%), whilst nearly 1 in 4 (24%) people reported this condition in Great Yarmouth and Waveney CCG. Applying these proportions to the estimated population, would suggest that around 165,000 individuals are living with arthritis or an ongoing back/joint problem across the three CCG areas.
Arthritis Research UK use different survey responses to estimate that nearly 1 in 5 (18.0%) residents of all ages in Suffolk experience back pain, which equates to more than 131,000 people. Among people aged 45+, the estimated prevalence of osteoarthritis of the knee and hip are 18.2% and 10.6%, respectively, which equates to more than 63,000 and 37,000 people.
The scale of these estimates indicate that musculoskeletal conditions are extremely common in Suffolk.
Years of life lived with disability (YLD) are a measure of the total disease experienced by the population of an area. If 10 people lived for one full year with a health condition, then the total number of years of life lived with a disability for that year would be 10.
In 2017, musculoskeletal disorders were the cause of nearly 26,000 years of life lived with disability by residents of Suffolk, which means that more years were lived with musculoskeletal conditions than any other long term condition (Figure 1). Considering specific musculoskeletal conditions, low back pain and neck pain were the first and third most common causes of years of life lived with disability in Suffolk, accounting for 14,554 and 5,391 years of life lived with disability, respectively.
Source: Institute of Health Metrics and Evaluation. Global Burden of Disease 2017 Compare tool. (2018).
In primary care, it is estimated that 1 in 5 people consult a GP about a musculoskeletal problem each year. Treatment and support for people with chronic pain (such as back pain or osteoarthritis) in primary care in the UK has been estimated to account for 4.6 million appointments per year, which is comparable to 793 whole time GPs.
In 2017/18, the age-sex standardised hospital admission rate for musculoskeletal conditions was significantly lower in Ipswich and East Suffolk CCG and West Suffolk CCG compared with the East of England (Table 1). However, the standardised hospital admission rate in Great Yarmouth and Waveney CCG was significantly higher than the East of England.
The higher admission rate in Great Yarmouth and Waveney CCG could be linked to unhealthy behaviours that are generally more common in areas that are relatively more deprived than the rest of the East of England region. Unhealthy behaviours include being overweight, eating an unhealthy diet, smoking and being physically inactive.
Table 1: Age-sex standardised hospital admission rate per 100,000 registered patients/residents for musculoskeletal conditions, CCGs, East of England, England, 2017/18
Source: Suffolk County Council. Analysis by Public Health Suffolk. (2018).Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.
The World Health Organisation (WHO) Action Plan for Europe recognises the burden of musculoskeletal conditions and the importance of musculoskeletal health as a prerequisite for mobility, economic independence and active healthy ageing. The Action Plan calls on all countries to promote musculoskeletal health at all ages to improve physical function, which can be achieved by encouraging increased physical activity, ideal body weight, smoking cessation, moderate use of alcohol and prevention of injuries due to occupation and sport.
Musculoskeletal related problems take up a considerable amount of GP time. The NHS Long Term Plan suggests that the majority of patients can be dealt with effectively by seeing a physiotherapist without any need to see the GP. Plans include expanding the number of physiotherapists working in GP networks, enabling people to see a physiotherapist without needing a GP referral.
NICE pathways allow users to navigate the breadth and depth of NICE recommendations on a given subject through topic-based diagrams, linking to the tools and resources that NICE has produced to support the implementation of the guidance. There are several pathways relating to musculoskeletal conditions, both in general and specific conditions: pathways.nice.org.uk/pathways/musculoskeletal-conditions
The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK. ARMAs mission is to transform the quality of life of people with musculoskeletal conditions. Further details about ARMA, including their 2018 Policy Position Paper can be found online. arma.uk.net
The PHE Musculoskeletal Diseases Fingertips Profile provides data about specific musculoskeletal conditions and the risk factors that can lead to such conditions. fingertips.phe.org.uk/profile/msk
The Global Burden of Disease (GBD) study provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated. The tools allow decision-makers to compare the effects of different diseases, such as malaria versus cancer, and then use that information at home. To make these results more accessible and useful, a suite of interactive data visualizations is available to analyse the data. Data on various measures of death and disability is now available at local authority level. vizhub.healthdata.org/gbd-compare
Arthritis Research UK are a charity who provide information and support for people living with arthritis. Arthritis Research UK have also produced a variety of policy and research documents, some of which have been used in researching this report. Arthritis Research UK and Arthritis Care have now merged and are called Versus Arthritis. More information can be found here: www.versusarthritis.org
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 Versus Arthritis, “The State of musculoskeletal health 2021,” 2022. Available: https://www.versusarthritis.org/media/24653/state-of-msk-health2-2021.pdf
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 Suffolk County Council and NHS Digital, “Analysis of Hospital Episode Statistics.” 2018.
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 Arthritis and Musculoskeletal Alliance, “Policy Position Paper Musculoskeletal and Mental Health,” 2018. Available: http://arma.uk.net/wp-content/uploads/2018/11/MSK-and-Mental-Health-Nov2018.pdf