Lower back pain: Global burden of disease and community-based care
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Lower back pain: Global burden
of disease and community-based
care
Associate Professor Fiona Blyth MBBS (Hons)
FAFPHM, PhD
Discipline of Pain Medicine & Sydney School of
Public Health
University of SydneyOverview of talk Overview of GBD 2010 background and methods Results for the burden of disease from low back pain globally and in Australia Other Australian data on the population impact of back pain
GBD 2010 O
Overallll Ai
Aims
To produce new
new, robust
robust, and reliable
estimates of burden for all major diseases,
injuries and risks that are widely
injuries,
disseminated, understood, and easily used
by policymakers, researchers, funders,
f
and practitioners.
pWhy now?
Changing global demography
Changing global economy
Changing patterns of disease and
di bilit
disability
eed for
Need o a comprehensive
co p e e s e a andd syste
systematic
at c
revision of global burden of disease
estimatesGBD 1990 and onwards
GBD 1990 began in 1991, first estimates in the
World Development Report in 1993, final
estimates published in 1996
1996.
Collaboration of Harvard University, World Bank
and World Health Organization.
Organization
107 Diseases and Injuries, 10 Risk Factors,
F
Forecasts
t to
t 2020
2000-
2000-2004 WHO produced updates; ongoing
methodological
th d l i l enhancements
h t
GBD 2010 underway since 2008 (>175 diseases
and
d iinjuries,
j i 20 risk
i k ffactors)
t )GBD 2010 globalburden.org Key collaborators: Johns Hopkins University Harvard University University of Queensland Institute for Health Metrics and Evaluation at the University of Washington World Health Organization
Global Burden of Disease Organizational Structure
More than 480
experts globally
Core Team
External Advisory
Board
participated in
GBD 2010
Tools and Curricula
Development Sub-
Team
Mortality
Cause of Death Disability Weights
Comparative Risk Estimation
Sub-Team Sub-Team
Sub-Team Sub-Team
Alan Lopez and Josh Salomon and
Majid Ezzati Ken Hill and
Chris Murray Colin Mathers
Kenji Shibuya
Cluster A: Cluster B: Cluster C: Cluster D: Cluster E:
CVD, COPD, Cancer Child/Maternal Injuries and Mental Health Communicable Diseases Noncommunicable Diseases
Majid Ezzati Bob Black Theo Vos Neff Walker Catherine Michaud
Harvard University Johns Hopkins University University of Queensland Johns Hopkins University Harvard University
Expert Groups: Expert Groups: Expert Groups: Expert Groups: Expert Groups:
Air Pollution (Risk) ARI Meningitis Sepsis Alcohol (Risk) Hepatitis Anemia
Cancers Child Nutrition (Risk) Childhood Sexual Abuse (Risk) HIV/AIDS Dental Health
CVD and Related Risks Congenital and Neonatal Mental Disorders Other Infectious Diseases Diabetes
Global Climate Change Enteric Infectious Disease Musculoskeletal Other Parasitic and Vector Diseases Digestive Disease
Respiratory Disease Maternal Conditions Neurological Conditions STDs Endocrine Disorders
Tobacco (Risk) Malaria Occupational Risks (Risk) Tuberculosis Genitourinary
Other Childhood Diseases S i id
Suicide Skin Diseases
Unintentional Injuries Traffic Injuries
War and Civil Conflict Vision and HearingMusculoskeletal conditions in GBD:
evolution over time
• Osteoarthritis (GBD 1990, 2000, 2010)
• Rheumatoid
eu ato d a arthritis
t t s (G
(GBD 1990,
990, 2000,2010)
000, 0 0)
• Low Back pain ( LBP in GBD 2000, 2010)
• Neck Pain (GBD 2010)
• Gout (GBD 2010)
• Other MSK (GBD 2010)Low Back Pain: the old GBD Model (GBD2000)
LBP resulting in limitations on usual activities
activities,
Duration=4 days, no mortality
Acute ((Low back pain: the new GBD model Based on extensive systematic review of the literature Had to be consistent w natural history of LBP Major constraints on how health states could be described
New definition
Case d
C definition:
fi iti A
Activity-limiting
ti it li iti lowl b
backk pain
i ((+/-pain
/ i referred
f d
to one or both legs) that lasts for at least one day.
Low back=area
Lo back area on the posterior aspect of the bod
body from the lower
lo er margin
of the 12th ribs to the lower gluteal folds
Acute/subacute < 3mths; Chronic 3 mths or moreHow would you describe these low back
pain health states so that they
p y could be
understood by ‘lay people’ in different
communities and countries around the
world?
How would you do this for
f all the different
ff
diseases in GBD 2010?Building a lay description from the Health State
Checklist
The first set of questions asks about capacity along several dimensions
of functioning. Indicate by checking either ‘yes’ or ‘no’ whether a
person would be able to perform the following functions.
Rising:
g Rise from lying
y g position
p on the ground
g (Yes/No);
( ); Rise from
sitting position on the ground (Yes/No)Building a lay description from the Health State
Checklist
The second
Th d set off questions
i asks
k about
b specific
ifi symptoms
t or
problems. Indicate by checking either ‘yes’ or ‘no’ whether a person
would experience the symptom or problem, and indicate average
duration and/or frequency where relevant
Feeling worried or anxious (Yes/No; # days per week;# hours per
day)Quite a process!
Final versions had to be concise
Modified after feedback from
GBD central team which had
oversight of all disease groups
Major restrictions on both
l
length
th and
d content
t t
Why? GBD is a RANKING exerciseThe final lay descriptions
descriptions...
ACUTE BACK PAIN WITH LEG PAIN
- “person with severe back and leg pain”
This person has severe back and leg pain, which causes difficulty
dressing sitting
dressing, sitting, standing,
standing walking,
walking and lifting things
things. The person sleeps
poorly and feels worried.
CHRONIC LOW BACK PAIN WITH LEG PAIN
- “person with constant back and leg pain”
This person has constant back and leg pain, which causes difficulty
dressing sitting
dressing, sitting, standing,
standing walking,
walking and lifting things
things. The person sleeps
poorly, is worried, and has lost some enjoyment in life.Prior GBD estimates used disability weights based on valuations
f
from h lth professionals
health f i l only
l (?h
(?how accurate)
t )
Last GBD round, musculoskeletal conditions assigned low disability
weights→low ranking
This time: community surveys as well as health professional surveys
in different countries – asking a broader range of people to assess
disabilityOverview of talk Overview of GBD 2010 background and methods Results for the burden of disease from low back pain globally and in Australia Other Australian data on the population impact of back pain
‘Democratization
Democratization of data’
data
International launch of results in triple
issue of The Lancet in London (13(
December 2012)
Open access data visualisation tools
rapidly made available on Institute of
Health Metrics Evaluation website:
http://www.healthmetricsandevaluation.org
/gbd/visualizations/countryhtt //
http://www.healthmetricsandevaluation.org/gbd/visualizations/country
h lth t i d l ti / bd/ i li ti / thttp://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-arrow- htt // h lth t i d l ti / bd/ i li ti / bd diagram
http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-cause- htt // h lth t i d l ti / bd/ i li ti / bd patterns
Musculoskeletal conditions
Widespread recognition of the huge disability
burden globally and within Australia related to
MSK conditions (NB low back pain and neck
pain)
Surprisingly low disability weights for
osteoarthritis
Significant gaps in basic data from many
countries
Lack of consistent data to be addressed in the
future (eg,
(eg severity and length of episodes of
LBP or neck pain)Overview of talk Overview of GBD 2010 background and methods Results for the burden of disease from low back pain globally and in Australia Other Australian data on the population impact of back pain
Australia’s Health 2012 Report (Australian Institute of Health and Welfare): People with living with disability (minimum 6 months duration, restricting everyday activity)
Australia’s Health 2012 Report (Australian Institute of
Health and Welfare): Health service use for MSK conditions
GP management: medications
medications,
imaging,referrals, advice about
self-management
?other primary care
? Risk assessment/stratificationKey findings
Working age people with long-term back
problems were more than two and a half
p
times more likely not to be in the labour
force
With three or more additional conditions,
this goes up substantially – more than nine
y not to be in the labour
times more likely
force
Early retirement due to back problems will
substantially reduce accumulated wealthConclusion A clearer picture is emerging of the heavy global and national toll of low back p g pain (and other MSK conditions) Important that it is used to argue for resources Also important to keep up the ‘back room’ efforts to improve how this burden is measured
You can also read
