Burden of Musculoskeletal and Headache Disorders in Asian Countries, 1990–2021: A Cross-Sectional Analysis of the Global Burden of Disease Study 2021
Abstract
Background: Comprehensive and updated data on the prevalence, incidence, mortality, and disability rates of musculoskeletal (MSK) and headache disorders in Asia are scarce. We aimed to analyze the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) related to these disorders from 1990 to 2021.
Methods: We assessed the burden of MSK and headache disorders across Asia utilizing data from the Global Burden of Disease study. We evaluated the trends in DALYs, mortality, incidence, and prevalence and their changes over time. Correlations with the sociodemographic index were examined to determine potential influencing factors.
Results: In 2021, MSK and headache disorders accounted for 120 million DALYs (95% uncertainty interval: 72.5–182.3 million), reflecting a 94% increase since 1990. Furthermore, mortality increased by 138% over the same period. Lower back pain was the leading contributor to DALYs (36.9 million), followed by migraine (25.4 million) and knee osteoarthritis (7.4 million). From 1990 to 2021, DALYs due to osteoarthritis and gout increased by 15% and 170%, respectively. DALYs due to rheumatoid arthritis (RA) remained stable, although RA-related mortality increased by 117%. Age-standardized rates exhibited minimal variation, with the highest burden observed in individuals aged 50–54 years and a higher prevalence among females.
Conclusion: MSK and headache disorders were leading causes of disability in Asia, with significant increments in both DALYs and mortality over the past three decades. These trends underscore the urgent need for targeted prevention and management strategies, particularly for high-burden conditions like lower back pain, migraine, and osteoarthritis.
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7. Combe B, Landewe R, Daien CI, et al (2017). 2016 update of the EULAR rec-ommendations for the management of early arthritis. Ann Rheum Dis, 76(6): 948–959.
8. Zipf G, Chiappa M, Porter KS, et al (2013). Health and nutrition examination survey plan and operations, 1999–2010. Vital Health Stat 1, (56): 1–37.
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10. Cross M, Smith E, Hoy D, et al (2014). The global burden of hip and knee osteoar-thritis: estimates from the Global Bur-den of Disease 2010 Study. Ann Rheum Dis, 73(7): 1323–30.
11. Fransen M, Bridgett L, March L, et al (2011). The epidemiology of osteoarthritis in Asia. Int J Rheum Dis, 14(2): 113–121.
12. Murray CJL, Aravkin AY, Zheng P, et al (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Glob-al Burden of Disease Study 2019. Lancet, 396(10258): 1223–1249.
13. Lim SS, Allen K, Bhutta ZA, et al (2016). Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Bur-den of Disease Study 2015. Lancet, 388(10053): 1813–1850.
14. Roth GA, Abate D, Abate KH, et al (2018). Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159): 1736–1788.
15. Institute for Health Metrics and Evaluation (IHME) (2024). GBD Results [Internet]. Seattle: IHME. Available from: https://ghdx.healthdata.org/
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18. Naghavi M, Wang H, Lozano R, et al (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Glob-al Burden of Disease Study 2013. Lancet, 385(9963): 117–71.
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21. Stovner LJ, Hagen K, Linde M, et al (2022). The global prevalence of headache: an update. J Headache Pain, 23(1): 34.
22. Stanaway JD, Afshin A, Gakidou E, et al (2018). Global, regional, and national comparative risk assessment of 84 risks for 195 countries and territories, 1990–2017: a systematic analysis for the Glob-al Burden of Disease Study 2017. Lancet, 392(10159): 1923–1994.
23. Feigin VL, Vos T, Nichols E, et al (2020). The global burden of neurological dis-orders: translating evidence into policy. Lancet Neurol, 19(3): 255–265.
24. Institute for Health Metrics and Evaluation (IHME) (2024). Global Burden of Dis-ease 2021: Findings from the GBD 2021 Study. https://www.healthdata.org/research-analysis/library/global-burden-disease-2021-findings-gbd-2021-study
25. Institute for Health Metrics and Evaluation (IHME) (2021). GBD Results Tool [In-ternet]. Seattle: IHME. Available from: https://ghdx.healthdata.org/gbd-results-tool
26. Kyu HH, Abate D, Abate KH, et al (2018). Global, regional, and national disability-adjusted life-years (DALYs) for 359 dis-eases and injuries and healthy life ex-pectancy (HALE) for 195 countries and territories, 1990–2017: a systematic anal-ysis for the Global Burden of Disease Study 2017. Lancet, 392(10159): 1859–1922.
27. World Health Organization (2013). WHO methods and data sources for global burden of disease estimates 2000–2011 [Internet]. Geneva: Department of Health Statistics and Information Sys-tems, WHO. Available from: https://iris.who.int/handle/10665/43942
28. Kang S, Eum S, Chang Y, et al (2022). Bur-den of neurological diseases in Asia from 1990 to 2019: a systematic analysis using the Global Burden of Disease Study data. BMJ Open, 12(9): e059548.
29. Sparks JA (2019). Rheumatoid arthritis. Ann Intern Med, 170(1): ITC1–ITC16.
30. Mikkelsen L, Phillips DE, AbouZahr C, et al (2015). A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet, 386(10001): 1395–1406.
31. Safiri S, Kolahi AA, Hoy D, et al (2019). Global, regional and national burden of rheumatoid arthritis 1990–2017: a sys-tematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis, 78(11): 1463–1471.
32. Feigin VL, Abajobir AA, Abate KH, et al (2017). Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol, 16(11): 877–897.
33. Kerschbaumer A, Sepriano A, Bergstra SA, et al (2023). EULAR recommendations for the management of rheumatoid ar-thritis with synthetic and biological DMARDs: 2022 update. Ann Rheum Dis, 82(1): 3–18.
34. Andersson GB (1999). Epidemiological fea-tures of chronic low-back pain. Lancet, 354(9178): 581–5.
35. Hoogendoorn WE, Bongers PM, de Vet HC, et al (2000). Flexion and rotation of the trunk and lifting at work are risk fac-tors for low back pain: results of a pro-spective cohort study. Spine (Phila Pa 1976), 25(23): 3087–92.
36. Delitto A, George SZ, Van Dillen L, et al (2012). Low back pain: clinical practice guidelines linked to the ICF from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 42(4): A1–57.
37. Wu AM, Cross M, Elliott JM, et al (2024). Global, regional, and national burden of neck pain, 1990–2020, and projec-tions to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol, 6(3): e142–e155.
38. Jahn A, Andersen JH, Christiansen DH, et al (2023). Occupational mechanical ex-posures as risk factor for chronic low-back pain: a systematic review and meta-analysis. Scand J Work Environ Health, 49(7): 453–464.
39. World Health Organization (2010). Com-munity-based rehabilitation: CBR guide-lines [Internet]. Geneva: WHO. Availa-ble from: https://apps.who.int/iris/handle/10665/44405
40. Yu S, Liu R, Zhao G, et al (2012). The prev-alence and burden of primary head-aches in China: a population-based door-to-door survey. Headache, 52(4): 582–91.
41. Patel V, Saxena S, Lund C, et al (2018). The Lancet Commission on global mental health and sustainable development. Lancet, 392(10157): 1553–1598.
42. Kuo C-F, Grainge MJ, Zhang W, et al (2015). Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol, 11(11): 649–62.
43. Stark RJ, Ravishankar K, Siow HC, et al (2013). Chronic migraine and chronic daily headache in the Asia-Pacific re-gion: a systematic review. Cephalalgia, 33(4): 266–83.
44. Safiri S, Kolahi AA, Smith E, et al (2020). Global, regional and national burden of osteoarthritis 1990–2017: a systematic analysis of the Global Burden of Dis-ease Study 2017. Ann Rheum Dis, 79(6): 819–828.
2. Liu S, Wang B, Fan S, et al (2022). Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study. BMJ Open, 12(6): e062183.
3. Vos T, Allen C, Arora M, et al (2016). Glob-al, regional, and national incidence, prevalence, and years lived with disabil-ity for 310 diseases and injuries, 1990–2015: a systematic analysis for the Glob-al Burden of Disease Study 2015. Lancet, 388(10053): 1545–1602.
4. Steiner TJ, Stovner LJ, Vos T, et al (2018). Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain, 19(1): 17.
5. Stovner LJ, Nichols E, Steiner TJ, et al (2018). Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic anal-ysis for the Global Burden of Disease Study 2016. Lancet Neurol, 17(11): 954–976.
6. Wang Y, Liang J, Fang Y, et al (2023). Bur-den of common neurologic diseases in Asian countries, 1990–2019: an analysis for the Global Burden of Disease Study 2019. Neurology, 100(21): e2141–e2154.
7. Combe B, Landewe R, Daien CI, et al (2017). 2016 update of the EULAR rec-ommendations for the management of early arthritis. Ann Rheum Dis, 76(6): 948–959.
8. Zipf G, Chiappa M, Porter KS, et al (2013). Health and nutrition examination survey plan and operations, 1999–2010. Vital Health Stat 1, (56): 1–37.
9. Ferreira ML, De Luca K, Haile LM, et al (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol, 5(6): e316–e329.
10. Cross M, Smith E, Hoy D, et al (2014). The global burden of hip and knee osteoar-thritis: estimates from the Global Bur-den of Disease 2010 Study. Ann Rheum Dis, 73(7): 1323–30.
11. Fransen M, Bridgett L, March L, et al (2011). The epidemiology of osteoarthritis in Asia. Int J Rheum Dis, 14(2): 113–121.
12. Murray CJL, Aravkin AY, Zheng P, et al (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Glob-al Burden of Disease Study 2019. Lancet, 396(10258): 1223–1249.
13. Lim SS, Allen K, Bhutta ZA, et al (2016). Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Bur-den of Disease Study 2015. Lancet, 388(10053): 1813–1850.
14. Roth GA, Abate D, Abate KH, et al (2018). Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159): 1736–1788.
15. Institute for Health Metrics and Evaluation (IHME) (2024). GBD Results [Internet]. Seattle: IHME. Available from: https://ghdx.healthdata.org/
16. Parisi P, Belcastro V, Verrotti A, et al (2018). Ictal epileptic headache and the revised International Headache Classification (ICHD-3). Epilepsy Behav, 87: 243–245.
17. Deuschl G, Beghi E, Fazekas F, et al (2020). The burden of neurological diseases in Europe: an analysis for the Global Bur-den of Disease Study 2017. Lancet Public Health, 5(10): e551–e567.
18. Naghavi M, Wang H, Lozano R, et al (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Glob-al Burden of Disease Study 2013. Lancet, 385(9963): 117–71.
19. Wang H, Abbas KM, Abbasifard M, et al (2020). Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10258): 1160–1203.
20. Fent T (2008). Department of Economic and Social Affairs, Population Division, United Nations Expert Group Meeting on Social and Economic Implications of Changing Population Age Structures. Eur J Popul, 24(4): 451–452.
21. Stovner LJ, Hagen K, Linde M, et al (2022). The global prevalence of headache: an update. J Headache Pain, 23(1): 34.
22. Stanaway JD, Afshin A, Gakidou E, et al (2018). Global, regional, and national comparative risk assessment of 84 risks for 195 countries and territories, 1990–2017: a systematic analysis for the Glob-al Burden of Disease Study 2017. Lancet, 392(10159): 1923–1994.
23. Feigin VL, Vos T, Nichols E, et al (2020). The global burden of neurological dis-orders: translating evidence into policy. Lancet Neurol, 19(3): 255–265.
24. Institute for Health Metrics and Evaluation (IHME) (2024). Global Burden of Dis-ease 2021: Findings from the GBD 2021 Study. https://www.healthdata.org/research-analysis/library/global-burden-disease-2021-findings-gbd-2021-study
25. Institute for Health Metrics and Evaluation (IHME) (2021). GBD Results Tool [In-ternet]. Seattle: IHME. Available from: https://ghdx.healthdata.org/gbd-results-tool
26. Kyu HH, Abate D, Abate KH, et al (2018). Global, regional, and national disability-adjusted life-years (DALYs) for 359 dis-eases and injuries and healthy life ex-pectancy (HALE) for 195 countries and territories, 1990–2017: a systematic anal-ysis for the Global Burden of Disease Study 2017. Lancet, 392(10159): 1859–1922.
27. World Health Organization (2013). WHO methods and data sources for global burden of disease estimates 2000–2011 [Internet]. Geneva: Department of Health Statistics and Information Sys-tems, WHO. Available from: https://iris.who.int/handle/10665/43942
28. Kang S, Eum S, Chang Y, et al (2022). Bur-den of neurological diseases in Asia from 1990 to 2019: a systematic analysis using the Global Burden of Disease Study data. BMJ Open, 12(9): e059548.
29. Sparks JA (2019). Rheumatoid arthritis. Ann Intern Med, 170(1): ITC1–ITC16.
30. Mikkelsen L, Phillips DE, AbouZahr C, et al (2015). A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet, 386(10001): 1395–1406.
31. Safiri S, Kolahi AA, Hoy D, et al (2019). Global, regional and national burden of rheumatoid arthritis 1990–2017: a sys-tematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis, 78(11): 1463–1471.
32. Feigin VL, Abajobir AA, Abate KH, et al (2017). Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol, 16(11): 877–897.
33. Kerschbaumer A, Sepriano A, Bergstra SA, et al (2023). EULAR recommendations for the management of rheumatoid ar-thritis with synthetic and biological DMARDs: 2022 update. Ann Rheum Dis, 82(1): 3–18.
34. Andersson GB (1999). Epidemiological fea-tures of chronic low-back pain. Lancet, 354(9178): 581–5.
35. Hoogendoorn WE, Bongers PM, de Vet HC, et al (2000). Flexion and rotation of the trunk and lifting at work are risk fac-tors for low back pain: results of a pro-spective cohort study. Spine (Phila Pa 1976), 25(23): 3087–92.
36. Delitto A, George SZ, Van Dillen L, et al (2012). Low back pain: clinical practice guidelines linked to the ICF from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 42(4): A1–57.
37. Wu AM, Cross M, Elliott JM, et al (2024). Global, regional, and national burden of neck pain, 1990–2020, and projec-tions to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol, 6(3): e142–e155.
38. Jahn A, Andersen JH, Christiansen DH, et al (2023). Occupational mechanical ex-posures as risk factor for chronic low-back pain: a systematic review and meta-analysis. Scand J Work Environ Health, 49(7): 453–464.
39. World Health Organization (2010). Com-munity-based rehabilitation: CBR guide-lines [Internet]. Geneva: WHO. Availa-ble from: https://apps.who.int/iris/handle/10665/44405
40. Yu S, Liu R, Zhao G, et al (2012). The prev-alence and burden of primary head-aches in China: a population-based door-to-door survey. Headache, 52(4): 582–91.
41. Patel V, Saxena S, Lund C, et al (2018). The Lancet Commission on global mental health and sustainable development. Lancet, 392(10157): 1553–1598.
42. Kuo C-F, Grainge MJ, Zhang W, et al (2015). Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol, 11(11): 649–62.
43. Stark RJ, Ravishankar K, Siow HC, et al (2013). Chronic migraine and chronic daily headache in the Asia-Pacific re-gion: a systematic review. Cephalalgia, 33(4): 266–83.
44. Safiri S, Kolahi AA, Smith E, et al (2020). Global, regional and national burden of osteoarthritis 1990–2017: a systematic analysis of the Global Burden of Dis-ease Study 2017. Ann Rheum Dis, 79(6): 819–828.
| Files | ||
| Issue | Vol 54 No 9 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i9.19856 | |
| Keywords | ||
| Musculoskeletal disorder Headache Osteoarthritis Disability-adjusted life years | ||
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How to Cite
1.
Bae Y, Jang S, Jeong W, Tak J, Lee SW. Burden of Musculoskeletal and Headache Disorders in Asian Countries, 1990–2021: A Cross-Sectional Analysis of the Global Burden of Disease Study 2021. Iran J Public Health. 2025;54(9):1883-1893.
