Global Burden of Musculoskeletal Injuries

Injuries are a leading cause of death and disability around the world. In 2016 injuries killed 4.6 million people globally, corresponding to a rate of 64.4 per 100,000 people. Fig. 2.1A shows the relative distribution of global deaths, from communicable diseases (Group A, in red ), noncommunicable diseases (Group B, in blue ), and injuries (Group C, in green ) in 2016. The area each box represents is proportional to the associated mortality rate. Of the 54.7 million people who died in 2016, 8.4% died due to an injury (Group C, Fig. 2.1A ). In addition to deaths, nonfatal injuries result in substantial disability. Public health researchers use disability-adjusted life years (DALYs) lost ( Box 2.1 ) to quantify the total public health burden of ill health. DALYs provide a comparable measure of the health loss due to fatal and nonfatal diseases and injuries. Fig. 2.1B shows the relative distribution of global DALYs, from communicable diseases (group A, in red ), noncommunicable diseases (Group B, in blue ), and injuries (Group C, in green ) in 2016. The area each box represents is proportional to the associated burden of disability. In 2016, 10.7% of the global DALYs lost from all causes were due to injuries (Group C, Fig. 2.1B ).

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Relative distribution of global deaths (A) and disability-adjusted life years (DALYs) (B) from communicable diseases (red), noncommunicable diseases (blue), and injuries (green) in 2016. The area each box represents is proportional to the health burden. AA, Aortic aneurysm; AFib, atrial fibrillation; Alzh, Alzheimer disease; CKD, chronic kidney disease; CMP, cardiomyopathy; COPD, chronic obstructive pulmonary disease; Glom, acute glomerulonephritis; HD, heart disease; Hep, hepatitis; HIV, human immunodeficiency virus; HTN, hypertension; IHD, ischemic heart disease; LRI, lower respiratory infection; MDD, major depressive disorder; Oth, other; Oth Endo, other endocrine; PEM, protein-energy malnutrition; PUD, peptic ulcer disease; Rheum HD, rheumatic heart disease; TB, tuberculosis.

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Over the past two decades, global population health has been in the midst of a transition away from communicable, maternal, neonatal, and nutritious disorders (Group A causes) and toward noncommunicable diseases and injuries. Whereas the number of deaths from Group A causes declined by 23.9% from 2006 to 2016, deaths from injuries in that period rose by 0.5%. This is a remarkably slower increase than seen in previous time points; for example, from 1990 to 2010 there was a 24% increase in deaths due to injury. Perhaps most interesting, however, is the differential associated with causes of injury worldwide. The recent increase in deaths from conflict and terrorism is not spread homogeneously throughout the world. The areas most afflicted are North Africa and the Middle East, which accounted for 77.2% of deaths from terrorism in 2014 to 90.9% of global deaths from terrorism in 2016.

Globally, 3 of the top 25 leading causes of years of healthy life lost (measured in DALYs lost) are due to injuries, including road injuries (ranks sixth), falls (ranks twentieth), and self-harm (ranks twenty-first) ( Fig. 2.2 ). Two other major drivers of disability, low back and neck pain (ranks fourth) and other musculoskeletal pain (ranks twenty-fourth), are also likely to reflect primarily injury and trauma. However, the rankings can vary dramatically across different regions. For example, road injury is a top-five cause of DALYs lost in five global regions, including third overall in North Africa and the Middle East. Falls and self-harm are top-seven causes of DALYs lost in Central Europe and the high-income Asia–Pacific Island regions, respectively. Low back and neck pain, which we believe has primarily an injury etiology, is a top-five cause of DALYs lost in 12 regions of the world, although it tends to rank lower in sub-Saharan Africa.

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Heat map showing the top global causes of years of healthy life lost (disability-adjusted life years) and their ranking in different regions in 2016. AIDS, Acquired immunodeficiency syndrome; COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus.

Causes of Injury

Road traffic crashes killed 1.43 million people in 2016 and resulted in 78 million DALYs lost. They are the tenth leading cause of death, ninth leading cause of life-years lost, and twelfth leading cause of DALYs lost globally. In 2016 road injuries killed more people than tuberculosis and malaria, two diseases that have been a central focus of the global health agenda. Road injury deaths have actually been on the decline since 2006, decreasing by 1.9%. Road traffic crashes are still the leading cause of injury deaths, accounting for 29% of all injury deaths ( Fig. 2.3 ). The authors of Disease Control Priorities highlight the fact that road traffic deaths are distributed unequally with respect to socioeconomic status of the countries most heavily affected. They additionally highlight that working-age and adolescent males are more frequently afflicted by these injuries.

Violence, both self-inflicted and interpersonal injuries, together killed another 1.2 million people in 2016. Intentional self-harm killed 0.81 million people, making it the second leading cause of injury deaths, accounting for 17.7% of injury deaths. Interpersonal violence (homicide) killed 0.39 million people in 2016, accounting for 8.5% of injury deaths. The authors of Disease Control Priorities highlight that deaths from interpersonal violence disproportionally affect developing countries. They note that in 2011 the estimated homicide rate in developing countries was 8 per 100,000, whereas it was 3.3 per 100,000 in developed countries. From 2010 to 2016, deaths from interpersonal violence declined by 1.9%.

Falls were the third leading cause of injury deaths, resulting in 0.68 million global deaths in 2016; 14.7% of all injury deaths. Deaths from falls have grown by 20% since 2006. These trends may reflect an increasing mean age of the global population.