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1 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 Sydney
2 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
3 GBD 2010 Overall Aims To produce new, robust, and reliable estimates of burden for all major diseases, injuries, and risks that are widely disseminated, understood, and easily used by policymakers, researchers, funders, and practitioners.
4 Why now? Changing global demography Changing global economy Changing patterns of disease and disability Need for a comprehensive e e and systematic revision of global burden of disease estimates
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6 GBD 1990 and onwards GBD 1990 began in 1991, first estimates in the World Development Report in 1993, final estimates published in Collaboration of Harvard University, World Bank and World Health Organization. 107 Diseases and Injuries, 10 Risk Factors, Forecasts to WHO produced updates; ongoing methodological l enhancements GBD 2010 underway since 2008 (>175 diseases and di injuries, i 20 risk kf factors)
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8 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
9 External Advisory Board Global Burden of Disease Organizational Structure Core Team More than 480 experts globally participated in GBD 2010 Tools and Curricula Development Sub- Team Cause of Death Sub-Team Alan Lopez and Chris Murray Comparative Risk Sub-Team Majid Ezzati Disability Weights Sub-Team Josh Salomon and Colin Mathers Mortality Estimation Sub-Team Ken Hill and Kenji Shibuya Cluster A: CVD, COPD, Cancer Majid Ezzati Harvard University Cluster B: Child/Maternal Bob Black Johns Hopkins University Cluster C: Injuries and Mental Health Theo Vos University of Queensland Cluster D: Communicable Diseases Neff Walker Johns Hopkins University Cluster E: Noncommunicable Diseases Catherine Michaud Harvard University Expert Groups: Air Pollution (Risk) Cancers CVD and Related Risks Global Climate Change Respiratory Disease Tobacco (Risk) Expert Groups: ARI Meningitis Sepsis Child Nutrition (Risk) Congenital and Neonatal Enteric Infectious Disease Maternal Conditions Malaria Other Childhood Diseases Expert Groups: Alcohol (Risk) Childhood Sexual Abuse (Risk) Mental Disorders Musculoskeletal Neurological Conditions Occupational Risks (Risk) Suicide id Unintentional Injuries War and Civil Conflict Expert Groups: Hepatitis HIV/AIDS Other Infectious Diseases Other Parasitic and Vector Diseases STDs Tuberculosis Expert Groups: Anemia Dental Health Diabetes Digestive Disease Endocrine Disorders Genitourinary Skin Diseases Traffic Injuries Vision and Hearing
10 Musculoskeletal conditions in GBD: evolution over time Osteoarthritis (GBD 1990, 2000, 2010) Rheumatoid arthritis t (GBD 1990, 2000,2010) 0 0) Low Back pain ( LBP in GBD 2000, 2010) Neck Pain (GBD 2010) Gout (GBD 2010) Other MSK (GBD 2010)
11 Low Back Pain: the old GBD Model (GBD2000) LBP resulting in limitations on usual activities, Duration=4 days, no mortality Acute (<6 weeks) intervertebral disc displacement or herniation Chronic intervertebral disc displacement or herniation i.e. not regional/ garden variety low back pain
12 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
13 New definition Case definition: iti Activity-limiting it iti low back pain (+/-pain referred to one or both legs) that lasts for at least one day. Low back=area area on the posterior aspect of the body from the lower margin of the 12 th ribs to the lower gluteal folds Acute/subacute < 3mths; Chronic 3 mths or more
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15 How would you describe these low back pain health states so that they could be understood by lay people in different communities and countries around the world? How would you do this for all the different diseases in GBD 2010?
16 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: Rise from lying position on the ground (Yes/No); Rise from g y g p g ( ); sitting position on the ground (Yes/No)
17 Building a lay description from the Health State Checklist The second set of questions asks about specific symptoms 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 Feeling worried or anxious (Yes/No; # days per week;# hours per day)
18 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 length and content t Why? GBD is a RANKING exercise
19 The final lay 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, standing, walking, and lifting 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, standing, walking, and lifting things. The person sleeps poorly, is worried, and has lost some enjoyment in life.
20 Prior GBD estimates used disability weights based on valuations from health professionals only (?how accurate) 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 disability
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23 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
24 Democratization of 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: /gbd/visualizations/country
25 h t l ti / i li ti / t
26 htt // h lth t i d l ti / bd/ i li ti /
27 htt // h lth t i d l ti / bd/ i li ti /
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32 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, severity and length of episodes of LBP or neck pain)
33 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
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38 Australia s Health 2012 Report (Australian Institute of Health and Welfare): People with living with disability (minimum 6 months duration, restricting everyday activity)
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42 Australia s Health 2012 Report (Australian Institute of Health and Welfare): Health service use for MSK conditions GP management: medications, imaging,referrals, advice about self-management?other primary care? Risk assessment/stratification
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46 Key findings Working age people with long-term back problems were more than two and a half times more likely not to be in the labour force With three or more additional conditions, this goes up substantially more than nine times more likely not to be in the labour force Early retirement due to back problems will substantially reduce accumulated wealth
47 Conclusion A clearer picture is emerging of the heavy global and national toll of low back 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
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