Review article
Incidence, Prevalence, Costs, and Impact on Disability of Common Conditions Requiring Rehabilitation in the United States: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain

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Abstract

Objective

To determine the relative incidence, prevalence, costs, and impact on disability of 8 common conditions treated by rehabilitation professionals.

Data Sources

Comprehensive bibliographic searches using MEDLINE, Google Scholar, and UpToDate, (June, 2013).

Data Extraction

Two review authors independently screened the search results and performed data extraction. Eighty-two articles were identified that had relevant data on the following conditions: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain.

Data Synthesis

Back pain and arthritis (osteoarthritis, rheumatoid arthritis) are the most common and costly conditions we analyzed, affecting more than 100 million individuals and costing greater than $200 billion per year. Traumatic brain injury, while less common than arthritis and back pain, carries enormous per capita direct and indirect costs, mostly because of the young age of those involved and the severe disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability, is likely second to both arthritis and back pain in its impact on functional limitations.

Conclusions

Of the common rehabilitation diagnoses we studied, musculoskeletal conditions such as back pain and arthritis likely have the most impact on the health care system because of their high prevalence and impact on disability.

Section snippets

Methods

The 8 conditions covered in this review were chosen because they commonly require inpatient and outpatient rehabilitation care.7 They include spinal cord injury, traumatic brain injury (TBI), back pain, osteoarthritis, rheumatoid arthritis, multiple sclerosis, stroke, and limb loss.

There are few national guidelines for assessing the economic and social burden of disability. This article is an attempt to organize the differing methods, cost measures, and data sources in the available literature.

Results

After our structured review of the literature, we identified 173 articles of interest, over 85 of which are cited here. Almost all were analyses of national or regional surveys. Pertinent results for all 8 conditions may be found in table 1.

Discussion

Our review of the literature suggests that back pain and arthritis are the most common and costly conditions that we examined, affecting over 100 million individuals and costing more than $200 billion per year. Another condition to note is TBI, which, while less common than arthritis and back pain, carries enormous per capita costs, mostly because of the disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability (unpublished data from National

Conclusions

The limitations noted above highlight the problems in performing this sort of review. In many cases, the data are old, and there is a lack of uniformity in how certain elements, particularly costs and disability burden, are measured. Thus, it is problematic when one wants to compare one time point to the next as well as one disease to another. One solution, although an expensive one, would be to invest more resources in comprehensive national surveys that address the issues raised in this

References (90)

  • J.W. Frymoyer et al.

    An overview of the incidences and costs of low back pain

    Orthop Clin North Am

    (1991)
  • J. Adamson et al.

    Is stroke the most common cause of disability

    J Stroke Cerebrovasc Dis

    (2004)
  • A.J. Houtenville et al.

    2012 annual compendium of disability statistics

    (2012)

  • The Surgeon General's Call to action to improve the health and wellness of persons with disabilities

    (2005)
  • L. Chan et al.

    The effect of Medicare's payment system for rehabilitation hospitals on length of stay, charges, and total payments

    N Engl J Med

    (1997)
  • R.C. Lawrence et al.

    Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II

    Arthritis Rheum

    (2008)
  • National Center for Health Statistics

    Health, United States, 2011: with special feature on socioeconomic status and health

    (2012)
  • J.N. Katz

    Lumbar disc disorders and low-back pain: socioeconomic factors and consequences

    J Bone Joint Surg Am

    (2006)
  • B.G. Druss et al.

    The most expensive medical conditions in America

    Health Aff

    (2002)
  • J.A. Ricci et al.

    Back pain exacerbations and lost productive time costs in United States workers

    Spine

    (2006)
  • H.R. Guo et al.

    Back pain prevalence in US industry and estimates of lost workdays

    Am J Public Health

    (1999)
  • W.F. Stewart et al.

    Lost productive time and cost due to common pain conditions in the US workforce

    JAMA

    (2003)
  • X. Luo et al.

    Estimates and patterns of direct health care expenditures among individuals with back pain in the United States

    Spine

    (2004)
  • B.I. Martin et al.

    Expenditures and health status among adults with back and neck problems

    JAMA

    (2008)
  • H.R. Guo et al.

    Back pain among workers in the United States: national estimates and workers at high risk

    Am J Ind Med

    (1995)
  • Y.J. Cheng

    Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2007–2009

    MMWR Morb Mortal Wkly Rep

    (2010)
  • K.E. Barbour et al.

    Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation–United States, 2010-2012

    MMWR

    (2013)
  • J.M. Hootman et al.

    A public health approach to addressing arthritis in older adults: the most common cause of disability

    Am J Public Health

    (2012)
  • S.A. Oliveria et al.

    Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization

    Arthritis Rheum

    (1995)
  • E. Yelin

    National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions—United States, 2003

    MMWR Morb Mortal Wkly Rep

    (2007)
  • H. Kotlarz et al.

    Osteoarthritis and absenteeism costs: evidence from US National Survey Data

    J Occup Environ Med

    (2010)
  • J.P. Leigh et al.

    Estimating the costs of job related arthritis

    J Rheumatol

    (2001)
  • K.A. Theis et al.

    Prevalence and correlates of arthritis-attributable work limitation in the US population among persons ages 18-64: 2002 National Health Interview Survey Data

    Arthritis Rheym

    (2007)
  • C.G. Helmick et al.

    Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I

    Arthritis Rheum

    (2008)
  • P. Jacobs et al.

    Socioeconomic burden of immune-mediated inflammatory diseases—focusing on work productivity and disability

    J Rheumatol Suppl

    (2011)
  • E. Myasoedova et al.

    Is the incidence of rheumatoid arthritis rising? Results from Olmsted County, Minnesota, 1955-2007

    Arthritis Rheum

    (2010)
  • H. Birnbaum et al.

    Societal cost of rheumatoid arthritis patients in the US

    Curr Med Res Opin

    (2010)
  • K.L. Dominick et al.

    Health-related quality of life among older adults with arthritis

    Health Qual Life Outcomes

    (2004)
  • T. Sokka et al.

    Work disability in rheumatoid arthritis 10 years after diagnosis

    J Rheumatol

    (1999)
  • K. Eberhardt et al.

    Work disability in rheumatoid arthritis—development over 15 years and evaluation of predictive factors over time

    J Rheumatol

    (2007)
  • A.S. Go et al.

    Heart disease and stroke statistics—2013 update: a report from the American Heart Association

    Circulation

    (2013)
  • P.A. Heidenreich et al.

    Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association

    Circulation

    (2011)

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    Supported by resources from the National Institutes of Health Intramural Research Program.

    No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

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