Burden of disease
Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury.
Ill health caused by musculoskeletal conditions can have both a human and a financial cost. According to the Australian Burden of Disease Study 2018, musculoskeletal conditions contributed to:
- 13% of the total disease burden (fatal and non-fatal) in Australia. This disease group was the second leading contributor to total burden after cancer.
- 24% of non-fatal burden (that is, the impact of living with illness and injury). This was the leading disease group contributing to non-fatal burden.
- a higher total burden among females than males – musculoskeletal conditions contributed to 15% of total female burden compared with 11% of total male burden
- a higher total burden among people aged 60–64 years compared to other 5-year age groups
- the largest component of non-fatal burden for people aged 50–84 years (AIHW 2021a).
Modifiable risk factors contribute to burden
Some of the total burden due to musculoskeletal conditions can be attributed to modifiable risk factors. In 2018, overweight and obesity contributed to:
- 8.9% of the total burden of all musculoskeletal conditions
- 28% of the burden from osteoarthritis.
Occupational exposures and hazards contributed to:
- 5.6% of the total burden of all musculoskeletal conditions
- 17% of the burden of back problems (AIHW 2021b).
See Burden of disease for information on definitions and the burden of disease associated with these conditions.
The Australian Disease Expenditure Study found that musculoskeletal conditions was the disease group with the highest estimated expenditure in 2018–19, costing the Australian health system $13.9 billion (10% of total disease expenditure) (AIHW 2021c). See Disease expenditure in Australia 2018–19.
Condition specific expenditure
Of the $13.9 billion health system expenditure attributed to musculoskeletal conditions in 2018–19, an estimated:
- 28% ($3.9 billion) was attributed to osteoarthritis
- 24% ($3.3 billion) was attributed to back problems
- 6.5% ($902 million) was attributed to rheumatoid arthritis
- 1.5% ($203 million) was attributed to gout
- 40% ($5.6 billion) was attributed to other musculoskeletal conditions.
Areas of expenditure
In 2018–19, private hospital services and public hospital admissions were the areas of expenditure with the highest spending for all musculoskeletal conditions, at 36% and 18% respectively ($5.0 billion, and $2.5 billion).
In 2018–19, musculoskeletal conditions was the disease group with the highest spending for the following areas:
- medical imaging (29% of all disease groups)
- private hospital services (21% of all disease groups)
- public hospital outpatient services (12% of all disease groups).
Age and sex breakdown of expenditure
The relative expenditure on musculoskeletal conditions by age and sex reflects the relative prevalence of musculoskeletal conditions by age and sex. Both expenditure and prevalence are higher for females and higher for older people. In 2018–19:
- Musculoskeletal expenditure was 1.2 times higher for females compared with males ($7.4 billion and $6.1 billion, respectively).
- People aged 55 and older represented 67% of musculoskeletal expenditure.
Treatment and management
Musculoskeletal conditions are usually managed by general practitioners and allied health professionals. Treatment can include physical therapy, medicines (for pain and inflammation), self-management (such as diet and exercise), education on self-management and living with the condition, and referral to specialist care where necessary (WHO 2019). Based on survey data, an estimated 1 in 6 (18%) general practice visits in 2015–16 were for management of musculoskeletal conditions (Britt et al. 2016). See General practice, allied health and other primary care services.
People with musculoskeletal conditions that are very severe, or who require specialised treatment or surgery, can also be managed in hospitals. In 2020–21, there were around 832,500 hospitalisations for musculoskeletal conditions – 7.0% of all hospitalisations in that year (AIHW 2022b). These hospitalisations included:
- osteoarthritis (34% of all musculoskeletal hospitalisations)
- back problems (23%)
- rheumatoid arthritis (1.5%)
- osteoporosis (1.2%)
- gout (1.0%)
- other musculoskeletal conditions (39%).
Osteoarthritis is the most common condition leading to hip and knee replacement surgery in Australia (AOANJRR 2021).
- Between 2010–11 and 2020–21, rates of total hip replacement and total knee replacement surgery, where osteoarthritis was the principal diagnosis, both trended up. Over this period these rates increased by 2.6% and 2.0% per year on average, respectively, after standardising age structures (Figure 7).
Impact of COVID-19 on hospital treatment
The COVID-19 pandemic had substantial impacts on hospital activity. The range of social, economic, business and travel restrictions, including restrictions on, or suspension of, some hospital services, and associated measures in other healthcare services to support physical distancing in Australia resulted in an overall decrease in hospital activity between 2019–20 and 2020–21 (AIHW 2022a).
In 2019–20, there were 7.8% fewer hospitalisations for musculoskeletal conditions than in 2018–19. This decrease was driven by the April–June 2020 quarter, which saw 33% fewer hospitalisations than April–June 2019. However in 2020–21, rates exceeded pre-pandemic levels.
At the beginning of the COVID-19 pandemic in Australia, non-urgent elective surgery was suspended for one month, from late March to late April 2020. For more information on how the pandemic has affected the population’s health in the context of longer-term trends, see 'Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.
- In 2019–20, the age standardised rate of total hip and knee replacement surgery where osteoarthritis was the principal diagnosis declined 8.6% and 11.4% respectively from 2018–19 (Figure 7). However in 2020–21, rates exceeded pre-pandemic levels.
- April and May 2020 saw large decreases in admissions for hip and knee replacement surgeries, relative to the same months in 2019 and 2018. This was followed by slight increases on previous years for June and July 2020 (Figure 8).
Figure 7: Rate of total hip and knee replacement surgeries, for osteoarthritis, 2010–11 to 2020–21