The impact of population ageing on musculoskeletal disorders in 204 countries and territories, 1990-2021: global burden and healthcare costs

This study aims to quantify the impact of population ageing on the global burden and healthcare costs of musculoskeletal (MSK) disorders across 204 countries and territories from 1990 to 2021, stratified by geographic region, sociodemographic index (SDI), sex, and major MSK subcategories. The global burden of MSK disorders attributed to population ageing was evaluated using decomposition analysis, while related healthcare costs were estimated through an extrapolation approach. Between 1990 and 2021, population ageing was the largest contributor to the increases in incident cases, prevalent cases, and disability-adjusted life-years (DALYs) in 33.3%, 37.7%, and 35.8% of countries and territories, respectively. Inverted U-shaped associations were observed between SDI and the proportions of incident cases, prevalent cases, and DALYs attributed to population ageing, with middle SDI countries exhibiting the highest proportions. Declines in incidence rates have partially offset the increase in incident cases due to population ageing globally. However, population ageing contributed more to the increases in prevalent cases and DALYs than increases in epidemiological rates. Males were more affected by population ageing globally, particularly in high and high-middle SDI countries, whereas females were more impacted in low-to-middle SDI countries. Osteoarthritis was the MSK disorder most influenced by population ageing globally, followed by gout and rheumatoid arthritis. In 2021, population ageing contributed US$96.0 billion to global healthcare costs for MSK disorders, equivalent to 0.10% of global gross domestic product. Over the past 3 decades, the global burden of MSK disorders attributed to population ageing has consistently increased. Public health strategies, tailored to SDI level, sex, and specific MSK subcategories, should not only enhance prevention efforts but also strengthen long-term management to mitigate the rising global burden and economic impact of MSK disorders driven by population ageing.