Aggregate total expenditures increased from $367.1 billion to $796.3 billion, in 2011 dollars, during this time frame, or more than doubling. In 1996 to 1998, aggregate total expenditures for persons with a musculoskeletal disease, whether for musculoskeletal disease or other conditions, represented 3.2% of the GDP in 2011 dollars. By 2009 to 2011, the proportion had grown to 5.2% of the GDP.
Aggregate incremental expenditures, due to the higher number of persons with a musculoskeletal condition and the increased incremental expenditures per person, increased from $97.3 billion in 1996-1998 to $212.7 billion, in 2009 to 2011 when expressed in constant (2011) dollars, or by about 119%. Incremental cost associated with a musculoskeletal condition represented the equivalent of 0.25% and 0.5% of the GDP in 2011 dollars, for the respective time frames.
Over the full time range of 1996 to 1999 through 2009 to 2011, the annual average rate of increase in total and incremental costs for musculoskeletal diseases has been 9%. (Reference Table 10.7 PDF [1] CSV; [2] Table 10.9 PDF [3] CSV [4]; Table 10.11 PDF [5] CSV [6]; Table 10.14 PDF [7] CSV [8])
Because of the higher prevalence and relatively high level of expenditures per person, aggregate expenditures have consistently been greatest for arthritis and joint pain, accounting for $580.9 billion in health care costs in 2009 to 2011. Spine conditions, with an estimated $253.0 billion aggregate cost in 2009 to 2011, have held steady as the second most expensive musculoskeletal health care condition. Aggregate costs for injuries and other musculoskeletal conditions were $176.1 and $190.6, respectively, in 2009 to 2011. (Reference Table 10.6 PDF [9] CSV [10])
The magnitude of increase in aggregate total expenditures between 1996 to 1998 and 2009 to 2011 is greatest for the diseases within the category including osteoporosis (about 160%), but was substantial for all musculoskeletal diseases. The aggregate total cost of health care for spine conditions increased by more than 91%; musculoskeletal injuries by 86%; and other musculoskeletal diseases by about 142% over the period 1996 to 1991 through 2009 to 2001. (Reference Table 10.7 PDF [1] CSV [2])
Sampling variability limits inference about time trends in incremental expenditures associated with the subcondition groups. However, while estimates do not have the same precision as those for all musculoskeletal diseases, it is fair to conclude that 2009 to 2011 aggregate incremental expenditures, at $116.1 billion, were largest for arthritis and joint pain. (Reference Table 10.6 PDF [9] CSV [10])
Using the more expansive definition of musculoskeletal diseases, aggregate total medical care expenditures on behalf of persons with a musculoskeletal disease were $1.068 trillion in 2009 to 2011.
Women account for both a higher proportion of the population with musculoskeletal disease and more than half of total costs. With 36% of women reporting musculoskeletal diseases compared to 30% of men, women accounted for 56% of aggregate costs in 2011.
Whites and non-Hispanics account for the majority of cost, with 84% and 92%, respectively. Although a similar share of one-third of all persons in all education levels report musculoskeletal diseases, due to lower numbers with higher education, these groups represent a smaller share of aggregate total cost.
About one in four persons with no insurance report musculoskeletal disease, but the much lower cost and smaller group of persons means that only 3% of aggregate total cost is represented by the uninsured. (Reference Table 10.8 PDF [11] CSV [12])
While persons age 65 years and older represent about 25% of all persons with a musculoskeletal disease, this age group accounted for 37%, or $294.1 billion, of total aggregate health care costs for musculoskeletal diseases in 2009 to 2011. However, incremental aggregate musculoskeletal health care for the 65 years and older population is estimated to comprise 25%, or $53.0 billion, of the total $212.7 billion aggregate incremental cost of these conditions, in part because in this age group, high medical care costs become the norm. Persons age 45 to 64 years represent 38% of persons these ages with musculoskeletal conditions, but 42% of aggregate medical care costs and 47% of aggregate incremental costs. (Reference Table 10.9 PDF [3] CSV [4] and Table 10.10 PDF [13] CSV [14])
Estimated 2009 to 2011 aggregate total expenditures for persons age 18 to 64 years were $474.9 billion, or 60% of aggregate total health care expenditures for musculoskeletal diseases in that year. Thus, although musculoskeletal conditions are more prevalent with age, because of the size of the group 18 to 64 years, a majority of medical costs occur in the adult, nonelderly population. Only $27.4 billion of total aggregate musculoskeletal health care costs, or less than 4% of the total, went for persons under the age of 18 years.
The share of aggregate total and incremental costs accounted by persons 45 to 64 years has been growing over time, by 40% in relative terms for aggregate total costs (from 30% in 1996 to 1998 to 42% in 2009 to 2011) and by 68% in relative terms for incremental aggregate costs (from 28% in the first three years to 47% in the last three years). The share of total and incremental aggregate costs for all other age groups has been falling over this same period of time. The cumulative increase in aggregate cost has been 204% and 262%, respectively, for total and incremental costs from 1996 to 2011 for the 45- to 64-year age group, while all other age groups have increased between 60% and 92%. This reflects the importance of the size of the baby boom generation in overall musculoskeletal costs. However, that large cohort will soon be concentrated among the elderly and aggregate costs are likely to increase as a share of the total among those 65 years and older in the years to come. (Reference Table 10.10 PDF [13] CSV [14]; Table 10.11 PDF [5] CSV [6])
Links:
[1] https://www.boneandjointburden.org/docs/T10008.7.pdf
[2] https://www.boneandjointburden.org/docs/T10008.7.csv
[3] https://www.boneandjointburden.org/docs/T10010.9.pdf
[4] https://www.boneandjointburden.org/docs/T10010.9.csv
[5] https://www.boneandjointburden.org/docs/T10012.11.pdf
[6] https://www.boneandjointburden.org/docs/T10012.11.csv
[7] https://www.boneandjointburden.org/docs/T10015.14.pdf
[8] https://www.boneandjointburden.org/docs/T10015.14.csv
[9] https://www.boneandjointburden.org/docs/T10007.6.pdf
[10] https://www.boneandjointburden.org/docs/T10007.6.csv
[11] https://www.boneandjointburden.org/docs/T10009.8.pdf
[12] https://www.boneandjointburden.org/docs/T10009.8.csv
[13] https://www.boneandjointburden.org/docs/T10011.10.pdf
[14] https://www.boneandjointburden.org/docs/T10011.10.csv