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Disclaimer: This chapter will be included in the forthcoming The Burden of Musculoskeletal Diseases in the United States, Fourth Edition. The United States Bone and Joint Initiative is making it available here prior to its final print publication. This chapter has not been finalized for publication; therefore, it may contain errors of fact, interpretation, or information. The United States Bone and Joint Initiative editors and staff are not responsible for the use of any potentially misleading or inaccurate information or data. Click here for the suggested citation.

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Lead Author(s): 

Stuart I. Weinstein, MD
Edward H. Yelin, PhD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

As noted previously, great progress in addressing fatal diseases is being made worldwide and nonfatal diseases pose the next major threat in terms of disease burden. Musculoskeletal conditions – in particular, trauma, back pain, and arthritis – constitute a major share of this morbidity burden, often restricting activities of daily living, causing lost work days, and are a source of lifelong pain. In spite of this, research funding to ease this burden remains well below that of other disease conditions.

In 1998, the Institute of Medicine wrote “In setting national priorities, NIH (National Institutes of Health) should strengthen its analysis in the use of health data, such as burdens of disease, and of data on the impact of research and the health of the public.”1 The Global Burden of Disease has identified low back pain, neck pain, and other musculoskeletal conditions as three of the top ten leading causes for years lived with disability.2 By current US estimates, more than 78% of the persons age 18 years and older reporting a disabling condition reported a musculoskeletal disorder. (Reference Table 1.5.1 PDF CSV)  Yet, research funding to alleviate these major health conditions remains substantially below that of other major health conditions such as cancer, respiratory, and circulatory (eg, heart) diseases. (Reference Table 1.1.2 PDF CSV)

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) was formed in 1987. Across the years, research funding for NIAMS has declined in relative terms, and since 2000, less than 2% of the annual National Institutes of Health (NIH) budget has been appropriated to musculoskeletal disease research. In fact, the funding share for 2016 was the lowest it has ever been, at 1.68% of the total NIH budget.

Over the last five years (2012 to 2016), funding for musculoskeletal conditions from NIH totaled $7.9 billion, while that of cancers and heart/circulatory disorders totaled $42.1 billion and $23.1 billion, respectively. (Reference Table 1.1.1 PDF CSV, and Table 1.1.2 PDF CSV)

In spite of the major health care burden presented by musculoskeletal conditions, research funding falls well below that of most other conditions. Injury research commands half of the musculoskeletal condition research dollars ($4 billion) from NIH for the years 2012 to 2016. Funding for arthritis research is second, at $1.4 billion, followed by osteoporosis ($965 million). These numbers are well below the $8.3 to $55.9 billion in funding for the top 25 NIH research conditions, diseases, and areas. (Reference Table 1.1.3 PDF CSV)

Looking at it another way shows the dominance of fatal diseases versus prevalence in the population. Three diseases with very high prevalence in the population – obesity, hypertension, and arthritis – are among the lowest research-funded diseases in the US. Arthritis, a major musculoskeletal disease, is responsible for an extra burden of pain and disability in nearly 1 in 4 persons. (Reference Table 1.3.1 PDF CVS)

Since 1999, NIAMS has received an average of 2.8% of research project grant funds, and 2.3% of project grant dollars. Career development awards during this period have risen from 3.1% in 1999 to 4.2% in 2015, as a share of total career awards. (Reference Table 1.1.4 PDF CSV)

Time and again, when the global burdens of disease are enumerated, musculoskeletal conditions rank high. Now we see that that rank is increasing. Although research funding reflects a long-term bias towards diseases with high mortality rates, the Global Burden of Disease project indicates that much of the growth in disease burdens has occurred for conditions that cause high disability rates. Redressing the funding disparity should become a high priority.

Although musculoskeletal conditions are common, disabling, and costly, they remain under-recognized, under-appreciated, and under-resourced. This book provides a strong case for the immediate and ongoing need to understand and support musculoskeletal conditions and reduce the burden they bring to people.

  • 1. Committee on the NIH Research Priority-Setting Process; Institute of Medicine: Scientific Opportunities and Public Needs: Improving Setting and Public Input. Washington, DC, National Academies Press, 1998. Available at: Accessed February 19, 2018.
  • 2. Murray CJL, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015 June 8. doi: 10.1016/S0140-6736(15)60692-4. ( ) Accessed August 15, 2016.


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