title: Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.
abstract: OBJECTIVE
  We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR).
  
  
  METHODS
  The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs).
  
  
  RESULTS
  For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries.
  
  
  CONCLUSIONS
  This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.|Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Maziar
authors.identifier: http://orcid.org/0000-0001-7381-5305
authors.initials: M
authors.lastname: Moradi-Lakeh
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfar
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.|Norwegian Institute of Public Health, Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Stein Emil
authors.initials: SE
authors.lastname: Vollset
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Charbel
authors.initials: C
authors.lastname: El Bcheraoui
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Farah
authors.initials: F
authors.lastname: Daoud
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Afshin
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Raghid
authors.initials: R
authors.lastname: Charara
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khalil
authors.affiliation: Japan International Cooperation Agency, Lusaka, Zambia.
authors.forename: Hideki
authors.initials: H
authors.lastname: Higashi
authors.affiliation: Ophthalmology resident in Aswan University Hospital, Aswan, Egypt.
authors.forename: Mohamed Magdy
authors.initials: MM
authors.lastname: Abd El Razek
authors.affiliation: Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
authors.forename: Aliasghar Ahmad
authors.initials: AA
authors.lastname: Kiadaliri
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|The University of Melbourne, Melbourne, Victoria, Australia.|The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Khurshid
authors.initials: K
authors.lastname: Alam
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Akseer
authors.affiliation: Food and Nutrition Administration, Ministry of Health, Safat, Kuwait.
authors.forename: Nawal
authors.initials: N
authors.lastname: Al-Hamad
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Raghib
authors.initials: R
authors.lastname: Ali
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohammad AbdulAziz
authors.initials: MA
authors.lastname: AlMazroa
authors.affiliation: Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Alomari
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Al-Rabeeah
authors.affiliation: Charité Universitätsmedizin, Berlin, Germany.
authors.forename: Ubai
authors.initials: U
authors.lastname: Alsharif
authors.affiliation: King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Altirkawi
authors.affiliation: Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
authors.forename: Suleman
authors.initials: S
authors.lastname: Atique
authors.affiliation: Public Health Agency of Canada, Toronto, Ontario, Canada.
authors.forename: Alaa
authors.initials: A
authors.lastname: Badawi
authors.affiliation: Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Lope H
authors.initials: LH
authors.lastname: Barrero
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Basulaiman
authors.affiliation: Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.|David Geffen School of Medicine, University of California at Los Angeles (UCLA), California, USA.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Bazargan-Hejazi
authors.affiliation: College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Bedi
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
authors.affiliation: Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: Walden University, Minneapolis, Minnesota, USA.
authors.forename: Hadi
authors.initials: H
authors.lastname: Danawi
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Samath D
authors.initials: SD
authors.lastname: Dharmaratne
authors.affiliation: Clinical Investigation Centre INSERM (the National Institute for Health and Medical Research), Université de Lorraine, Vandoeuvre les Nancy, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Maryam S
authors.initials: MS
authors.lastname: Farvid
authors.affiliation: Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden.
authors.forename: Seyed-Mohammad
authors.initials: SM
authors.lastname: Fereshtehnejad
authors.affiliation: Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
authors.affiliation: Bielefeld University, Bielefeld, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Fischer
authors.affiliation: West Virginia Bureau for Public Health, Charleston, West Virginia, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Arabian Gulf University, Manama, Bahrain.
authors.forename: Randah Ribhi
authors.initials: RR
authors.lastname: Hamadeh
authors.affiliation: Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
authors.forename: Samer
authors.initials: S
authors.lastname: Hamidi
authors.affiliation: Nevada Division of Behavior and Public Health, Carson City, Nevada, USA.|Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Masako
authors.initials: M
authors.lastname: Horino
authors.affiliation: Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia.
authors.forename: Damian G
authors.initials: DG
authors.lastname: Hoy
authors.affiliation: Salah Azaiz Institute, Tunis, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hsairi
authors.affiliation: Institute of Community and Public Health, Birzeit University, Birzeit, Palestine.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Husseini
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Javanbakht
authors.affiliation: Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
authors.forename: Jost B
authors.initials: JB
authors.lastname: Jonas
authors.affiliation: Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.|Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Kasaeian
authors.affiliation: Health Services Academy, Islamabad, Pakistan.
authors.forename: Ejaz Ahmad
authors.initials: EA
authors.lastname: Khan
authors.affiliation: Ball State University, Muncie, Indiana, USA.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Khubchandani
authors.affiliation: Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Ann Kristin
authors.initials: AK
authors.lastname: Knudsen
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jacek A
authors.initials: JA
authors.lastname: Kopec
authors.affiliation: Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK.|School of Medicine, University of Liverpool, Liverpool, UK.
authors.forename: Raimundas
authors.initials: R
authors.lastname: Lunevicius
authors.affiliation: Mansoura Faculty of Medicine, Mansoura, Egypt.
authors.forename: Hassan Magdy
authors.initials: HM
authors.lastname: Abd El Razek
authors.affiliation: Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Digestive Disease Research Institute, Tehran Universities of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Kedar
authors.initials: K
authors.lastname: Mate
authors.affiliation: College of Medicine, Howard University, Washington DC, USA.
authors.forename: Alem
authors.initials: A
authors.lastname: Mehari
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Meltzer
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.|College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.affiliation: Hunger Action Los Angeles, Los Angeles, California, USA.
authors.forename: Mojde
authors.initials: M
authors.lastname: Mirarefin
authors.affiliation: Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria.|Institute of Public Health, Heidelberg University, Heidelberg, Germany.
authors.forename: Shafiu
authors.initials: S
authors.lastname: Mohammed
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Aliya
authors.initials: A
authors.lastname: Naheed
authors.affiliation: Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon.
authors.forename: Carla Makhlouf
authors.initials: CM
authors.lastname: Obermeyer
authors.affiliation: Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
authors.forename: In-Hwan
authors.initials: IH
authors.lastname: Oh
authors.affiliation: Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
authors.forename: Eun-Kee
authors.initials: EK
authors.lastname: Park
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
authors.forename: Emmanuel Kwame
authors.initials: EK
authors.lastname: Peprah
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Farshad
authors.initials: F
authors.lastname: Pourmalek
authors.affiliation: Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.affiliation: Contech International Health Consultants, Lahore, Pakistan.|Contech School of Public Health, Lahore, Pakistan.
authors.forename: Anwar
authors.initials: A
authors.lastname: Rafay
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vafa
authors.initials: V
authors.lastname: Rahimi-Movaghar
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Rahman
authors.initials: R
authors.lastname: Shiri
authors.affiliation: Sweidi Hospital, Riyadh, Saudi Arabia.
authors.forename: Sajjad Ur
authors.initials: SU
authors.lastname: Rahman
authors.affiliation: Society for Health and Demographic Surveillance, Suri, India.
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Rai
authors.affiliation: Contech International Health Consultants, Lahore, Pakistan.|Contech School of Public Health, Lahore, Pakistan.
authors.forename: Saleem M
authors.initials: SM
authors.lastname: Rana
authors.affiliation: Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sadaf G
authors.initials: SG
authors.lastname: Sepanlou
authors.affiliation: Independent Consultant, Karachi, Pakistan.
authors.forename: Masood Ali
authors.initials: MA
authors.lastname: Shaikh
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.|Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Ivy
authors.initials: I
authors.lastname: Shiue
authors.affiliation: Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Abla Mehio
authors.initials: AM
authors.lastname: Sibai
authors.affiliation: Federal University of Santa Catarina, Florianópolis, Brazil.
authors.forename: Diego Augusto Santos
authors.initials: DAS
authors.lastname: Silva
authors.affiliation: University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Norwegian Institute of Public Health, Bergen, Norway.|Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Jens Christoffer
authors.initials: JC
authors.lastname: Skogen
authors.affiliation: Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.|Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.|Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdullah Sulieman
authors.initials: AS
authors.lastname: Terkawi
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
authors.affiliation: Federal Institute for Population Research, Wiesbaden, Germany.|German National Cohort Consortium, Heidelberg, Germany.
authors.forename: Ronny
authors.initials: R
authors.lastname: Westerman
authors.affiliation: Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Seok-Jun
authors.initials: SJ
authors.lastname: Yoon
authors.affiliation: Jackson State University, Jackson, Mississippi, USA.
authors.forename: Mustafa Z
authors.initials: MZ
authors.lastname: Younis
authors.affiliation: University Hospital, Setif, Algeria.
authors.forename: Zoubida
authors.initials: Z
authors.lastname: Zaidi
authors.affiliation: Mansoura Faculty of Medicine, Mansoura, Egypt.
authors.forename: Maysaa El Sayed
authors.initials: MES
authors.lastname: Zaki
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Lim
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Haidong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.|Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Christopher J L
authors.initials: CJL
authors.lastname: Murray
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
mesh_terms: D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D015730:Djibouti / Q000453:epidemiology; D005260:Female; D000071219:Global Burden of Disease; D006073:Gout / Q000453:epidemiology*; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology*; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009026:Mortality; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D019547:Neck Pain / Q000453:epidemiology*; D010003:Osteoarthritis / Q000453:epidemiology*; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012998:Somalia / Q000453:epidemiology
keywords: Epidemiology; Gout; Low Back Pain; Osteoarthritis; Rheumatoid Arthritis