Table 2_Global, regional, and national burden of musculoskeletal disorders, 1990–2021: an analysis of the global burden of disease study 2021 and forecast to 2035.doc

ObjectivesThis study aimed to assess the global, regional, and national burdens of musculoskeletal disorders (MSDs) since 1990. It also projected trends up to 2035 and explored potential improvements through frontier analysis.
MethodsUsing data from the Global Burden of Disease 2021 study, MSDs in 204 countries and territories were analyzed. Age-standardized rates (ASRs) for prevalence (ASPR), incidence (ASIR), DALYs (ASDR), and mortality (ASMR) were calculated. Trends were evaluated through estimated annual percentage changes (EAPC). The Bayesian age-period-cohort (BAPC) model was employed for projections to 2035, and frontier analysis was used to assess the potential for reducing MSD burdens.
ResultsIn 2021, 1.686 billion MSDs prevalent cases were recorded globally, representing a 95% increase since 1990. Although total cases and DALYs have increased, ASIR and ASMR showed declining trends, with global MSD-related mortality decreasing by 0.265% annually. By 2035, the number of MSD cases is projected to rise to 2.161 billion, along with corresponding increases in DALYs and mortality, although ASRs are expected to continue declining. Frontier analysis revealed significant gaps between current burdens and achievable benchmarks, particularly in high-SDI regions, while some low-SDI regions demonstrated effective management despite limited resources. A U-shaped relationship between SDI and MSDs burdens was observed, with middle-SDI regions generally performing better.
ConclusionThe global burden of MSDs is projected to rise in absolute case numbers, underscoring the necessity for strategically targeted interventions to manage their impact effectively. Frontier analysis illuminates potential improvements, particularly in high-SDI countries, while projections indicate that enhanced access to healthcare and better resource distribution could alleviate the global MSDs burden. Addressing disparities and implementing tailored interventions are crucial for reducing MSDs-related disability and mortality.

研究目标
本研究旨在评估1990年以来全球、区域及国家层面的肌肉骨骼疾病（musculoskeletal disorders, MSDs）负担，同时预测至2035年的流行趋势，并通过前沿分析（frontier analysis）探索潜在的负担改善空间。

研究方法
本研究采用《2021年全球疾病负担研究》（Global Burden of Disease 2021 Study）的数据，对204个国家和地区的肌肉骨骼疾病进行分析。研究计算了患病率、发病率、伤残调整寿命年（disability-adjusted life years, DALYs）与死亡率对应的年龄标化率（age-standardized rates, ASRs），具体包括年龄标化患病率（age-standardized prevalence rate, ASPR）、年龄标化发病率（age-standardized incidence rate, ASIR）、年龄标化伤残调整寿命年率（age-standardized DALY rate, ASDR）及年龄标化死亡率（age-standardized mortality rate, ASMR）。通过估计年度变化百分比（estimated annual percentage changes, EAPC）评估疾病流行趋势。本研究采用贝叶斯年龄-时期-队列（Bayesian age-period-cohort, BAPC）模型预测至2035年的疾病负担，并运用前沿分析评估肌肉骨骼疾病负担的潜在降低空间。

研究结果
2021年，全球累计报告肌肉骨骼疾病现患病例16.86亿例，较1990年增长95%。尽管总病例数与伤残调整寿命年总量均有所上升，但年龄标化发病率与年龄标化死亡率呈下降趋势，全球肌肉骨骼疾病相关死亡率年均下降0.265%。预计到2035年，肌肉骨骼疾病病例数将增至21.61亿例，伤残调整寿命年与死亡率也将相应上升，不过年龄标化率仍将持续下降。前沿分析显示，当前疾病负担与可达到的基准水平之间存在显著差距，尤其在高社会人口指数（Socio-demographic Index, SDI）地区；而部分低社会人口指数地区虽资源有限，却实现了有效的疾病管理。研究还观察到社会人口指数与肌肉骨骼疾病负担之间呈U型关系，中等社会人口指数地区的疾病管理表现普遍更佳。

研究结论
预计全球肌肉骨骼疾病负担的绝对病例数将持续上升，这凸显了制定针对性战略干预措施以有效管控其影响的必要性。前沿分析揭示了潜在的优化空间，尤其在高社会人口指数国家；预测结果同时表明，提升医疗服务可及性与优化资源配置，或可缓解全球肌肉骨骼疾病负担。消除健康不平等并实施个体化干预措施，对于降低肌肉骨骼疾病相关伤残与死亡率至关重要。