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Burden of musculoskeletal conditions,best diet pills uk 2015 yorkshire,ultimate testosterone boosting foods 2014,fat burning injections - PDF Review

1 in 8 persons of prime working age reported lost work days due to a musculoskeletal condition - a total of 216 million days - in 2012.
In any given year, 12% to 14% of the adult population will visit their physician for back pain.
Musculoskeletal diseases account for more than 50% of disabling health conditions reported by adults.
54 of every 100 persons in the US, 126.6 million age 18 and over, reported suffering a musculoskeletal disease in 2012.
Musculoskeletal diseases were diagnosed in 18% of the 1.3 billion health care visits in 2011.
More than three of every five unintentional injuries that occur annually in the United States are to the musculoskeletal system. Musculoskeletal injuries are injuries occurring to the neck, spine, pelvis, and extremities. A traumatic injury is defined as "an injury or wound to a living body caused by the application of external force or violence,"1 and includes injuries incurred in vehicular accidents, machinery, falls, sports, and other injuries caused by something outside a person’s body. In 2012, 8.86 million persons reported seeking medical care for an injury during the prior three months. The type of self-reported injury reported varied somewhat by demographic group, particularly with respect to sex and age. In spite of the widespread prevalence of musculoskeletal conditions and three of the most costly healthcare conditions—trauma, back pain, and arthritis—being musculoskeletal, musculoskeletal conditions are not among the top ten health conditions receiving research funding,1 primarily due to the low mortality from musculoskeletal conditions in comparison with other health conditions. In 1998, the Institute of Medicine wrote “In setting national priorities NIH should strengthen its analysis in the use of health data, such as burdens of disease, and of data on the impact of research and the health of the public.”2 National health data in several countries show that musculoskeletal conditions rank among the top health concerns for citizens in the United States and worldwide. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) was formed in 1987.
In spite of the major health care burden presented by musculoskeletal conditions, research funding falls well below that of most other conditions.
Since 1998, NIAMS has received 2.2% of research project grants, with funding at less than 2% of total grant dollars. Although musculoskeletal conditions are common, disabling, and costly, they remain under-recognized, under-appreciated, and under-resourced. A large annual health care survey is conducted in the United States by the National Center for Health Statistics for the purpose of identifying the incidence and prevalence of select health conditions. About 1 in 13 persons (7.5%) in the population age 18 or older report they have a physical, mental, or emotional problem or illness that precludes work.
The estimated annual direct medical cost for all back related conditions was $253 billion in 2012. For purposes of further analysis, we decided to divide the diagnostic codes defining the burden of spine problems into three groups: back disorders, disc disorders, and back injuries. In the tables and text, we define back disorders by diagnostic ICD-9-CM Codes 720, 721, and 724. In the tables and graphs, total health care visits include hospital discharges obtained from the National Hospital Discharge Survey (NHDS) in 2010, emergency department visits obtained from the National Hospital Ambulatory Medical Care Survey Emergency Departments (NHAMCS-ED) in 2010, hospital outpatient visits obtained from the National Hospital Ambulatory Medical Care Survey Outpatients (NHAMCS-OP) 2010, and physician office visits obtained from the National Ambulatory Medical Care Survey (NAMCS) in 2010, all part of the National Health Care Surveys (NHCS) compiled annually by the Centers for Disease Control and Prevention (CDC) .
For comparative purposes, data are also analyzed for the Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS), created annually by the Agency for Health Care Research and Quality (AHRQ). Using the diagnostic code grouping discussed above, back disorders accounted for 76% of low back pain health care resource utilization in 2010. Disc disorders accounted for 19% of low back pain resource visits, and approximately 27% of hospitalizations. Back injuries, which include fractures, sprains, and strains, are often reported as caused by overexertion or overuse. In 2012, nearly 29% of the US population age 18 years and older self-reported having had low back pain during the past three months. As discussed previously, the health care utilization by people with low back pain is only in part understood because of lack of information about visits to chiropractors, physical therapists, and others involved in the care of back pain.
The prevalence of low back pain health care visits is greatest in the 45- to 64-year age group, which comprises 26% of the US population; it is followed by the 18- to 44-year age group, comprising 37% of the population.
Low back pain is found more frequently among females than males, with females representing 55% of health care resource visits. Although females are likely to have slightly shorter hospital stays for all causes of back pain, it is only for lumbar back injuries that there is a real difference between the sexes in length of stay.
Prescription medications for musculoskeletal injuries nearly doubled over the time frame, jumping from 201 million prescriptions to 397 million between 1996-1998 and 2009-2011, an increase of 97%. In recent years, ambulatory care visits account for the largest share of per-person direct cost for persons with a musculoskeletal injury, with the share increasing while inpatient costs share drops. Total direct per-person health care cost for those with a musculoskeletal injury were $7,104, and increase of 75% since 1996-1998. Indirect costs associated with lost wages for those aged 18 to 64 years are not calculated for persons with a musculoskeletal injury. Musculoskeletal workplace injuries are a major concern, accounting for a large proportion of all nonfatal injuries that result in days away from work. Musculoskeletal health care utilization is examined for the MEPS for the following types of care: ambulatory physician visits, ambulatory nonphysician visits, prescription medications filled, home health care days, and hospital discharges for all musculoskeletal conditions and by type of condition. Over the 13 3-year average periods, 1996 to 1998 to 2009 to 2011, for which the MEPS data is analyzed, prescription medications and ambulatory nonphysician care visits increased more than other categories of health care percentage-wise. Persons with musculoskeletal diseases account for a large and growing share of health care utilization.
In contrast to the relatively stable number of physician office visits, there was an increase in the proportion of the US population with visits to ambulatory providers other than medical physicians; the average number of visits to nonphysician providers by persons with musculoskeletal diseases also increased. During this same time frame of 1996 to 2011, the use of prescription medications among persons with musculoskeletal diseases rose substantially.
Despite widespread concerns that an aging population would use an increasing amount of home health care, there is no evidence that this is occurring. Utilization of health care services increased in several service categories for musculoskeletal disease conditions. The annual National Health Interview Survey asks participants if they are limited in activities of daily living, such as the ability to dress oneself, to get in or out of bed or a chair, or to work due to health issues. Help required with routine needs was reported by 23% of people requiring help with activities of daily living; nearly one in three of those with a fracture reported needing help with routine needs.
Medical conditions in MEPS are self-reported and may result in misreporting of some conditions. Average total direct cost for all four conditions studied—disorders of the back, rheumatoid arthritis, osteoarthritis and allied disorders, and gout—are relatively large. Average total earnings losses were highest for rheumatoid arthritis, $13,886 per year, followed by osteoarthritis at $7,548 per year.
Women are more likely to seek medical care for musculoskeletal injuries that occur from a fall, accounting for as much as 60% of hospital discharges for musculoskeletal injuries. Although the incidence of total unintentional injuries is difficult to estimate, numerous databases and reports since the early 1990s have shown that between 60% and 77% of injuries occurring annually involve the musculoskeletal system.


As defined by medical diagnosis codes, musculoskeletal injuries include fractures, derangements, dislocations, sprains and strains, contusions, crushing injuries, open wounds, and traumatic amputations. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), based on the World Health Organization's Ninth Revision, International Classification of Diseases (ICD-9). National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC). The number of self-reported injuries, even when extrapolated out to a full year, is much lower than the number of health care visits to physicians, emergency departments, outpatient clinics, and hospitals reported over the course of a year, suggesting that self-reported injuries are underreported. Overall, the most common type of musculoskeletal injury for which medical attention was sought was a sprain or strain. However, the morbidity cost of musculoskeletal conditions is tremendous because musculoskeletal conditions often restrict activities of daily living, cause lost work days, and are a source of lifelong pain.
By current US estimates, more than 50% of the disabling conditions reported by of persons age 18 years and older are related to musculoskeletal disorders, yet research funding to alleviate these major health conditions remains substantially below that of other major health conditions such as cancer and respiratory and circulatory (eg, heart) diseases. In subsequent years, research funding for these conditions has declined in relative terms, and since 2000, less than 2% of the annual National Institutes of Health (NIH) budget has been appropriated to musculoskeletal disease research. Injury research commands half of the musculoskeletal condition research dollars ($4 billion) from NIH for the years 2009 to 2013. This book provides a strong case for the immediate and ongoing need to understand and support musculoskeletal conditions and reduce the burden it brings to our people. Pain from any muscle, joint, or bone (musculoskeletal pain) was reported by 52.1% of persons aged 18 years and older in 2012.
Among these persons, 27%, or nearly 4 of the 13, are unable to work due to chronic back or neck problems.
This is further discussed under the Economic Burden topic in this Spine section, and in the Economic Cost topic at this site. Many causes of back pain are likely related to degeneration, but the actual underlying cause of a given back pain episode is often uncertain. United States Bone and Joint Decade: The Burden of Musculoskeletal Diseases in the United States, First Edition.
These codes include inflammatory spine conditions, spondylosis, spinal stenosis, lumbago, sciatica, backache, and disorders of the sacrum.
Sometimes diagnoses are provided primarily for reimbursement purposes, with little emphasis on accuracy. These databases are much larger than the NHCS databases, but do not include outpatient and physician office visits. Emergency department visits for disc disorders were rare, comprising only 2% of all visits to the ED. Among persons reporting low back pain, one in three (36%) suffered from back pain radiating into the leg. Together, the 18- to 64-year group represents 63% of the population, but is responsible for 72% of all low back pain health care visits. Back disorders, in particular, are more frequent in females, while disc disorders are slightly more common in males. However, the distribution of the population with a musculoskeletal injury, by age group, showed a consistent shift upward as the population ages, reflecting the overall aging of the US population. Ambulatory health care visits for musculoskeletal injuries rose by 85% between the years 1996-1998 and 2009-2011, from 54 million to 99 million visits. At an average cost of $2,648 per person in 2009-2011, an increase of 80% from 1996-1998, ambulatory care accounted for 34% of per person direct cost in 2009-2011. Incremental direct per-person costs, those costs most likely attributable to a musculoskeletal injury, rose from $1,213 to $1,913, in 2011 dollars, an increase of 58%.
However, musculoskeletal injuries are a primary cause of lost work days by persons in the labor force. The former showed an average annual increase of more than 8%, while the latter showed an increase of 6.6%. In any given year, about 85% of persons with musculoskeletal diseases have at least one ambulatory care visit to a physician’s office, averaging just under six such visits per year. Nonphysician ambulatory health care providers include physical therapists, occupational therapists, chiropractors, social workers, physician assistants, nurse practitioners, and other related health care workers.
Both the proportion of persons with a musculoskeletal disease using home health care and the average number of home health care visits declined slightly in the past 13 years. The number of hospital discharges per person and overall has declined, reflecting the increase in management of these conditions on an ambulatory basis. The largest increase was found for persons with arthritis and joint pain in the service categories of physician visits, nonphysician visits, prescription medications, and hospital discharges. For all health concerns,1 more than 13 in 100 people in the United States reported they had limitations in a prior three-month period due to health issues.
When broken down into specific types of help, help with personal care was identified more frequently than other types of care.
Participants were asked, "What condition or health problem causes you to have difficulty with or need help with the following activities?" The list included conditions of vision, hearing, arthritis, back problems, injuries, heart and circulation conditions, diabetes, lung conditions, mental conditions, genitourinary system problems, tumors, alcohol or drug abuse, and old age," and responses included "yes" to at least one condition. With respect to musculoskeletal diseases, under-reporting might occur when physicians do not provide patients with a discrete diagnosis. Over the period 2008 to 2011, per-person direct costs exceeded $12,000 a year for gout, $11,000 a year for osteoarthritis, $17,000 a year for rheumatoid arthritis, and just under $8,000 for disorders of the back. Lawrence R, Helmick C, Arnett F, et al: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Musculoskeletal injuries to men are more likely to be the result of trauma or an accident, accounting for about 60% of emergency department visits by men. They are often caused by sudden physical contact of the body with external objects, but the most common cause is falls.
ICD-9-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. However, the proportion of these injuries that were musculoskeletal was similar to that reported by the national health care databases for injury-related health care visits, 72% and 77%, respectively.
Funding for arthritis research is second, at $1.4 billion, followed by osteoporosis ($965 million). In any given year, between 12% and 14.0% of the United States’ adult population (above 18 years of age) will visit their physician with complaints of back pain. Another 1 out of 25 persons is limited in the type and duration of work they can do because of back and neck pain.
As discussed elsewhere, this is not the true cost because chiropractic care, physical therapy, massage therapy, and other types of alternative care are not included in the analysis.
In reviewing administrative data for prevalence, it is important to realize that the diagnostic categories may be inaccurate because they reflect differing interpretations about the source of the back problem rather than an absolute diagnosis. We are aware there may be substantial overlap, and that some of the back disorders may be related to degenerative disc changes and some of the disc disorders may have another origin. Disc disorders include herniations, disc degeneration, and post-laminectomy syndromes (ICD-9-CM Code 722).


When the weighted analysis is compared, the two sets of databases produce very similar results. Back injuries were most commonly seen in the emergency room (35%), but constituted only 9% of hospitalizations, indicating that most were manageable in an outpatient setting, and were most likely soft tissue injuries.
This is a greater percentage of pain than is reported for the upper limbs (shoulder, arm, elbow, wrist, and hands) and the lower limbs (hip, knees, ankles, and feet). Data from the NCHS reports more than 52 million visits to hospitals, emergency departments, outpatient clinics, and physician offices with a diagnosis of low back pain. However, when adjusting for the 2010 US census population estimates, the frequency of health care visits for low back pain per 100 US populations is highest in the 65- to 74-year age group, where it is 33.4%.
Nearly 8 in 10 (78%) female health care visits in 2010 for low back pain were classified as back disorders, compared to 73% for males. However, physician office visits continue to account for the largest share of treatment visits.
While the share of mean per-person cost for inpatient care dropped from 35% to 27% between 1996-1998 and 2009-2011, the mean cost rose from $1,367 to $1,928, an increase of 26%. In 2010, musculoskeletal disorders (MSD) accounted for nearly one-third (30.5%) of the 933,200 injuries involving days away from work. Of note, however, the increases for all services were much slower in the most recent three-year period, at 1.4% across the board.
In 1996 to 1998, approximately 40% of persons with musculoskeletal diseases visited a nonphysician health care provider at least once; by 2009 to 2011 the proportion had jumped to nearly 52%. However, a large proportion of these increases are due to the increase in the numbers of individuals with arthritis and joint pain, which is due at least in part to changes in MEPS methodology in 2001 and 2007. Fractures accounted for 8% of the primary causes of limitation, resulting in limitation in 1 in 100 people in the United States. Four of ten reported not being able to work at all due to health care issues, with half with a fracture unable to work. For example, osteoarthritis may not be reported because it may be too mild to be recognized or treatment is included with other conditions and not distinct.
Persons with both gout and back disorders actually had higher earnings than the corresponding populations without those conditions.
Sports injuries and other causes of injuries occur in relatively similar proportions to both men and women.
People age 75 years and older were most likely to report a contusion, but this age group also reported higher proportions of fractures than other ages. In addition, an unknown, but very high number will visit a chiropractor or physical therapist for these complaints. Three in four persons with pain in multiple areas of the back and neck report work limitations.
Also, outpatient treatment cost from outpatient clinics is currently not collected; hence, this data is missing or incomplete. Back injuries include fractures, dislocations, and sprains (ICD-9-CM Codes 805, 806, 839, 846, and 847). For example, a patient with back pain of unknown origin could be given the diagnosis of lumbago, placing him or her in the back disorder category. The advantage of the HCUP databases is the reliability of data for conditions that are rare, and often have a very small number of records. This is probably a reflection of the prevalence of spinal stenosis and degenerative spondylolisthesis in both sexes. Hospital discharges for musculoskeletal injuries remain a very small proportion of overall treatment visits, indicating that most musculoskeletal injuries are not serious enough to require hospitalization. In addition, MSD injuries consistently across the years result in more median days away from work than all workplace injuries.
Growth in the number of persons with musculoskeletal diseases, rather than an increase in the number of visits by individuals, is primarily responsible for this increase.
Home health care days increased fastest among those with osteoporosis and related conditions, but this was closely followed by persons with arthritis and joint pain. An additional one in four reported they were limited in the type of work that could be done.
Over-reporting of a condition could occur when respondents indicate they have a specific form of arthritis, for example, rheumatoid arthritis, even though their physician did not so indicate it. Open wounds requiring medical attention were more likely to be reported by males and people 18 to 44 years than by other demographic groups. Intervertebral disc degeneration and associated facet joint osteoarthritis seem to be a natural process of aging, but can alter the biomechanics and function of the spine.
He or she may also have disc degeneration with a diagnosis of degenerative disc disease and, therefore be placed in the disc disorder category.
Disc disorders are uncommon in the below-18-years age group, but increase in frequency as the population ages. In 2011, MSDs had a median of 11 days away from work compared to a median of 8 days for all injuries, which includes the MSDs in this median. The lowest increase in hospital discharges occurred among those reporting musculoskeletal injuries, while those with spine conditions experienced the lowest growth in the remaining services.
Fractures were responsible for limitations in daily activities in 14% of men in the age range of 45 to 64 years who reported limitations. Walking without equipment was difficult for one-third of those with a medical problem, while one-half of those with a fracture required some sort of medical equipment to walk. Sprains and strains as well as fractures were the most common musculoskeletal injury type reported for children ages 0 to 17 years; overall, children had a lower proportion of musculoskeletal injuries for which medical attention was sought than did other age groups. Studies have identified a strong genetic predisposition, but there are modifying influences including age, obesity, activity level, and smoking.
Or, if his or her problem developed after a lift or twist, it could be diagnosed as a back strain, falling into the back injury category.
Back injuries are more common under the age of 44 years (22%), and declines to only 7% to 9% in those 65 years and older. Overall, women reported being limited due to fractures more often than men until they reached the age of 75 years or older. These discussions are based on larger samples, such as all musculoskeletal disease, or major subcategories, such as all forms of arthritis. Nevertheless, the data on expenditures do indicate, in broad stroke, the average economic impact for self-recognized disease and for conditions likely to be under-reported, such as osteoarthritis, a conservative estimate of aggregate economic impact. Estimates for discrete musculoskeletal diseases merged four years of MEPS data (2008-2011) to provide more stable estimates given the relatively few cases of each condition reported in individual years.



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