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Musculoskeletal health status in Europe

A key objective of the EUMUSC.Net project is to provide supporting evidence at a country level that highlight the impact of Musculoskeletal Conditions in terms of health, social, employment and economic measures.

It is hoped that national assessments completed by EUMUSC.Net will highlight those countries were the provision of care for musculoskeletal conditions is disproportionate to its prevalence and incidence.

To this end, Work Package 4 of the EUMUSC.Net project has completed 15 months of work to develop harmonised information on the health, social, employment and economic impact of musculoskeletal conditions across the 27 EU Member States (EU27). The results of this work are published on the EUMUSC.Net website and include:

A comprehensive report on the health, social, employment and economic impact of musculoskeletal conditions across all Member States

A summary report of the principal findings of the comprehensive report

Fact sheets for each of the EU27 which provide details of the status of musculoskeletal health in each country

Core indicators that provide the basis for measuring the impact of musculoskeletal health in each country

An assessment tool to collect and collate information on the impact of musculoskeletal conditions.

In addition to these publications, EUMUSC.Net, through the efforts of Work Package 4, has established a network across the Member States, with individuals in each country agreeing to take responsibility for entering data to the web based health information system. This is key to delivering a sustainable and comprehensive scientific and surveillance network that can continue after completion of the EUMUSC.net project.

Some interesting facts can be found in the comprehensive report. For example, there is evidence to suggest that there is a north-south gradient in certain conditions; high levels of activity-limiting pain were reported in Finland (44%) with much lower levels in Portugal (21%); for chronic pain again Finland had high levels (33%) with low levels in Greece (13%); the lifetime probability of hip fracture at 50 years are highest in Sweden and Norway and lowest in Hungary, Portugal and Greece; incidence of juvenile idiopathic arthritis are highest in Finland at 23 per 100,000 and lowest in Spain at 7 per 100,000. Reasons for these geographic differences are not well understood but may relate to generic and environmental issues.

Also of interest is a comparison of the burden of musculoskeletal disease in the EU Member States using Disability Adjusted Life Years (DALYs*), as a summary measure of disease related morbidity and mortality.

The graph below shows the age standardised DALYs for 25 of the EU27, only the Czech Republic and Estonia are missing; Poland, Slovakia, Bulgaria, Romania, Latvia, Lithuania and Hungary all show a relatively high burden of musculoskeletal disease including rheumatoid arthritis and osteoarthritis. These countries have the lowest GDP per capita in the EU27. This is compatible with the evidence that there is a correlation between osteoarthritis, rheumatoid arthritis and socioeconomic conditions (Sokka 2009; Young et al 2000).

Provision of healthcare does not compare well to the distribution of the burden of musculoskeletal disease in the EU Member States. Using the number of practising rheumatologists as an example it is concerning to see that in Latvia, Romania, Lithuania and Bulgaria the number of rheumatologists is disproportionately low compared with the high burden of musculoskeletal disease in these countries.

Of additional interest is Ireland which appears to be inadequately provisioned with healthcare specialists; compare France with 4.2 rheumatologists per 100,000 inhabitants ands Ireland with 0.5; compare Finland with 234 physiotherapists per 100,000 and Ireland with just 34. The reasons for this are worthy of more investigation.

*The DALY combines in one measure the time lived with disability and the time lost due to premature mortality. One DALY can be thought of as the loss of 1 year of healthy life. DALYs used in burden measurement are the gap between current health status and an ideal situation where everyone lives into old age free of disease and disability.

How common are MSC and are there differences in their incidence and prevalence across EU Member States?

Other important findings include the fact that patients who stopped working in high GDP countries had better clinical status than patients who continued working

in low GDP countries this highlights the importance of cultural and economic factors in influencing levels of work disability.

Perhaps, the most concerning finding of the work completed by Work Package 4 is the lack of comparable data relating to musculoskeletal conditions across Europe. The availability of data also varies significantly by region. Data availability is particularly poor for Central and Eastern Europe. For example, published studies of the incidence and prevalence of RA are available for only 13 European countries; studies of knee replacement was confined to 16 EU Member States; there is a very little comparative data between countries on quality of life relating to musculoskeletal conditions; a study of work disability again included only 16 EU Member States, which are members of the OECD. There are also concerns about differences in definitions and reporting of figures which requires caution to be exercised when attempting interpretation; this is particularly the case with data relating to injuries due to work related accidents.

It is clear that the case for raising awareness of musculoskeletal conditions will be improved by improving the completeness of data collection and comparability of measures in each of the EU Member States. A small first step towards this has been achieved by the EUMUSC.Net project being invited to formulate a question on musculoskeletal health for the European Health Interview Survey (EHIS). The survey is set to become a statutory requirement for all European Member States to complete every 5 years. Further, extensive work is required throughout Europe to improve data collection and it is hoped that the surveillance network that has been established through the efforts of Work Package 4 will contribute to this work.

To download the final report on "Musculoskeletal Health in Europe' click here