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Musculoskeletal (MSK) disorders encompass any form of discomfort or permanent and disabling injury affecting the motor organs, including muscles, tendons, bones, cartilage, ligaments, and nerves (1). MSK health is fundamental to quality of life across all age groups. Research has demonstrated that individuals with MSK disorders face twice the risk of developing other chronic systemic diseases compared to those without such disorders (2). As a major contributor to global disability, MSK disorders pose significant and increasing threats to public health worldwide.
The BRICS group originally comprised Brazil, Russia, India, China, and South Africa, with five additional members — Saudi Arabia, Egypt, the United Arab Emirates (UAE), Iran, and Ethiopia — officially joining on January 1st, 2024, forming “BRICS+”. As of 2022, BRICS+ nations represented 45.5% of the global population and approximately 37% of global GDP by 2023 (3-4), establishing them as increasingly influential contributors to global health and development initiatives. Despite their significance, a comprehensive assessment of MSK disorder burden across these countries remains lacking. This cross-country study utilizes data from the Global Burden of Disease (GBD) 2021 database to examine the disease burden and temporal trends of MSK disorders in BRICS+ nations from 1990 to 2021. The findings will enhance understanding of MSK disorder burden patterns and support the development of effective intervention strategies.
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The GBD 2021 database, developed by the Institute for Health Metrics and Evaluation (IHME) at University of Washington (5), provides a systematic scientific assessment of disease and injury incidence, prevalence, and mortality across 204 countries and territories for 371 diseases and injuries. The GBD database has standardized crude rates of incidence, prevalence, DALYs, and other metrics by age with reference to the world population.
According to the International Classification of Diseases, 10th Version (ICD-10), GBD 2021 categorizes MSK disorders into 6 major groups: rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP), neck pain (NP), gout, and other MSK diseases (6). Since MSK disorders are age-dependent, we primarily used age-standardized indicators, including rates and uncertainty intervals (UI) of incidence, prevalence, and DALYs in this study.
In the GBD study, countries are categorized into four income groups — low, lower-middle, upper-middle, and high — based on their Gross National Income (GNI) per capita, following the World Bank’s classification system.
We used the Joinpoint regression program (version 5.0.2, National Cancer Institute, Bethesda, United States) for analysis. The average annual percentage change (AAPC) and its 95% confidence interval (CI) from 1990 to 2021 were calculated to determine both the direction and magnitude of the overall trends in disease burden. The significance level was set at ɑ of 0.05.
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Globally, the age-standardized incidence rate of MSK disorders decreased from 4.64% in 1990 to 4.35% in 2021. Females consistently exhibited higher age-standardized incidence rates than males. For males, the rate decreased from 3.78% in 1990 to 3.51% in 2021, while for females, it declined from 5.47% to 5.17%. Among BRICS+ nations, Russia reported the highest age-standardized incidence rates in both 1990 (5.93%) and 2021 (5.83%), while China had the lowest rates at 4.04% in 1990 and 3.63% in 2021 (Table 1).
Country Sex Age-standardized incidence (%) Age-standardized prevalence (%) Age-standardized DALYs (per 100,000) 1990 2021 1990 2021 1990 2021 Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Global Both 4.64 4.20−5.10 4.35 3.96–4.76 19.18 18.08–20.28 19.83 18.81–20.94 1,886 1,380–2,523 1,909 1,395–2,548 Male 3.78 3.42–4.14 3.51 3.20–3.84 16.06 15.11–17.04 16.72 15.81–17.70 1,493 1,083–1,995 1,518 1,104–2,029 Female 5.47 4.94–6.03 5.17 4.69–5.67 22.16 20.94–23.39 22.85 21.69–24.07 2,261 1,667–3,015 2,286 1,675–3,051 High-income countries Saudi Both 4.62 4.17–5.09 4.79 4.33–5.28 17.61 16.48–18.74 19.58 18.37–20.85 1,685 1,219–2,237 1,866 1,364–2,483 Arabia Male 3.96 3.57–4.34 4.11 3.72–4.53 14.66 13.67–15.70 16.37 15.26–17.55 1,319 952–1,782 1,452 1,042–1,963 Female 5.60 5.05–6.19 5.80 5.22–6.39 22.04 20.44–23.63 24.38 22.91–26.08 2,234 1,625–2,967 2,489 1,807–3,261 UAE Both 4.32 3.91–4.72 4.47 4.06–4.89 17.54 16.49–18.59 19.19 18.14–20.34 1,668 1,204–2,219 1,813 1,310–2,433 Male 3.78 3.39–4.12 3.96 3.57–4.34 15.26 14.28–16.25 17.15 16.14–18.22 1,378 988–1,860 1,551 1,115–2,071 Female 5.45 4.94–5.98 5.69 5.12–6.24 22.45 21.02–23.96 24.66 23.26–26.19 2,282 1,665–3,019 2,542 1,870–3,357 Upper-middle-income countries Brazil Both 5.00 4.51–5.54 5.15 4.65–5.68 22.39 21.1–23.72 22.66 21.37–24.02 2,251 1,664–2,995 2,267 1,670–3,018 Male 4.07 3.67–4.48 4.20 3.80–4.62 19.19 17.97–20.44 19.44 18.25–20.69 1,824 1,330–2,427 1,837 1,341–2,456 Female 5.87 5.27–6.53 6.03 5.42–6.67 25.38 23.94–26.78 25.60 24.17–27.13 2,648 1,978–3,513 2,658 1,977–3,518 Russia Both 5.93 5.34–6.54 5.83 5.26–6.42 20.00 18.72–21.27 20.23 19.00–21.48 1,978 1,449–2,688 2,003 1,470–2,717 Male 4.96 4.48–5.45 4.86 4.39–5.34 16.45 15.40–17.51 16.72 15.68–17.86 1,491 1,087–2,052 1,519 1,105–2,087 Female 6.72 6.04–7.43 6.65 6.00–7.32 22.77 21.28–24.27 23.11 21.71–24.54 2,343 1,730–3,149 2,387 1,760–3,218 China Both 4.04 3.65–4.44 3.63 3.31–3.95 16.97 15.95–17.98 17.40 16.41–18.41 1,616 1,170–2,151 1,578 1,140–2,129 Male 3.30 2.99–3.60 3.08 2.82–3.37 14.40 13.51–15.33 15.20 14.28–16.19 1,306 944–1,739 1,318 946–1,774 Female 4.79 4.30–5.29 4.18 3.80–4.55 19.56 18.37–20.70 19.59 18.37–20.70 1,930 1,400–2,580 1,839 1,333–2,484 South Both 4.26 3.86–4.65 4.12 3.74–4.51 17.70 16.67–18.72 18.35 17.32–19.37 1,707 1,255–2,256 1,713 1,262–2,267 Africa Male 3.52 3.19–3.84 3.51 3.20–3.83 15.31 14.41–16.22 16.30 15.44–17.21 1,359 990–1,831 1,428 1,043–1,920 Female 4.91 4.44–5.39 4.66 4.22–5.14 19.77 18.58–20.97 20.18 18.99–21.36 2,003 1,476–2,654 1,962 1,447–2,591 Egypt Both 4.80 4.33–5.31 4.95 4.48–5.46 18.62 17.51–19.85 20.48 19.26–21.76 1,836 1,339–2,445 2,018 1,473–2,678 Male 4.00 3.61–4.43 4.14 3.75–4.56 15.25 14.23–16.33 17.06 16.05–18.22 1,421 1,025–1,912 1,589 1,154–2,131 Female 5.63 5.10–6.22 5.83 5.25–6.45 22.15 20.74–23.73 24.24 22.77–25.79 2,269 1,651–2,997 2,489 1,818–3,266 Lower-middle-income countries India Both 4.13 3.72–4.55 3.80 3.44–4.17 18.95 17.83–20.15 19.95 18.83–21.24 1,835 1,361–2,417 1,906 1,407–2,510 Male 3.04 2.74–3.33 2.66 2.41–2.91 15.36 14.4–16.39 15.86 14.83–16.92 1,411 1,044–1,864 1,419 1,037–1,880 Female 5.31 4.77–5.87 4.94 4.45–5.44 22.85 21.55–24.26 24.07 22.75–25.55 2,294 1,705–3,016 2,394 1,773–3,143 Iran Both 5.65 5.08–6.23 5.40 4.88–5.94 19.99 18.63–21.34 21.02 19.74–22.35 2,036 1,489–2,707 2,112 1,540–2,812 Male 4.76 4.29–5.23 4.35 3.92–4.76 16.35 15.22–17.47 17.07 16.02–18.22 1,581 1,152–2,127 1,612 1,167–2,172 Female 6.59 5.94–7.29 6.49 5.86–7.16 23.82 22.2–25.38 25.06 23.5–26.62 2,515 1,840–3,324 2,621 1,910–3,479 Low-income countries Ethiopia Both 4.47 4.02–4.92 4.32 3.91–4.75 16.40 15.34–17.44 17.24 16.20–18.29 1,581 1,166–2,105 1,613 1,171–2,156 Male 3.82 3.44–4.20 3.71 3.35–4.06 14.28 13.35–15.23 15.25 14.28–16.22 1,325 975–1,775 1,372 990–1,851 Female 5.12 4.61–5.66 4.94 4.45–5.45 18.53 17.32–19.67 19.25 18.05–20.44 1,841 1,354–2,444 1,855 1,359–2,479 Abbreviation: MSK=musculoskeletal; DALYs=disability-adjusted life years; UI=uncertainty interval. Table 1. Age-standardized incidence, prevalence, and DALYs rates of MSK disorders in 1990 and 2021 in BRICS+ nations.
Between 1990 and 2021, Saudi Arabia, UAE, Brazil, and Egypt experienced increases in age-standardized incidence of MSK disorders, led by Saudi Arabia with a 3.55% increase. Conversely, other BRICS+ countries exhibited decreases, with China demonstrating the most substantial decline (−11.28%) (
Supplementary Figure S1A ). In 2021, sex disparities in age-standardized incidence were most pronounced in India and Iran (Table 1).The global age-standardized prevalence rate of MSK disorders increased from 19.18% in 1990 to 19.83% in 2021. Among BRICS+ nations, Brazil reported the highest age-standardized prevalence rates in both 1990 (22.39%) and 2021 (22.66%), while Ethiopia had the lowest rates at 16.40% in 1990 and 17.24% in 2021. Saudi Arabia demonstrated the largest increase in prevalence rate (11.19%) from 1990 to 2021.
The global age-standardized DALYs per 100,000 population for MSK disorders increased from 1,886 in 1990 to 1,909 in 2021, with consistently higher rates in females than males. Among BRICS+ nations, Brazil had the highest age-standardized DALYs in both 1990 and 2021, while Ethiopia had the lowest in 1990 and China in 2021. From 1990 to 2021, China exhibited a slight decline with fluctuations in age-standardized DALYs (−2.35%), South Africa showed relatively stable trends, and other BRICS+ countries experienced increases, with Saudi Arabia reporting the largest increase (10.74%) (Supplementary Figure S1). Notably, DALYs were consistently lower in males than females across all global regions and BRICS+ nations in both 1990 and 2021 (Table 1).
Regarding specific disease types, LBP was the leading cause of MSK disorder DALYs globally, decreasing from 937 per 100,000 in 1990 to 832 in 2021, while gout and RA contributed relatively low DALYs (Table 2). Gout DALYs increased slightly from 17 in 1990 to 20 in 2021. Russia exhibited the highest LBP DALYs were at 1,255 per 100,000 in 1990, while India reported the lowest (575) in 2021. Globally, LBP DALYs declined from 1990 to 2021, while RA, OA, NP, and gout remained relatively stable, and other MSK disorders increased. Except for gout, all MSK disorders caused higher DALYs in females than males, a pattern consistent across BRICS+ nations. In 2021, high-income countries had the highest average NP DALYs (309/100,000), upper-middle-income countries had the highest LBP DALYs (900/100,000), and lower-middle-income countries had the highest DALYs for other MSK disorders (582/100,000). Males in high and upper-middle-income countries experienced higher MSK disorder burdens, with high-income countries reporting the highest LBP and gout DALYs. Females in lower-middle-income countries had the highest LBP DALYs, and DALYs for other MSK disorders increased with national income levels (Figure 1).
Country Sex RA OA LBP NP Gout Other MSK disorders 1990 2021 1990 2021 1990 2021 1990 2021 1990 2021 1990 2021 Global Both 36
(29–46)36
(27–46)223
(107–450)245
(117–493)937
(669–1,261)832
(596–1,115)242
(162–344)242
(163–343)17
(11–24)20
(14–29)431
(306–585)534
(375–724)Male 22
(17–28)22
(17–29)182
(88–369)201
(96–405)721
(512–974)635
(454–854)203
(135–288)199
(134–284)26
(18–38)32
(21–45)338
(237–467)429
(298–589)Female 50
(39–64)49
(36–64)258
(123–520)284
(136–573)1–142
(817–1,533)1–022
(732–1,370)280
(187–399)285
(190–402)8
(5–12)10
(7–14)523
(375–704)637
(450–858)High-income countries Saudi Arabia Both 9
(6–12)15
(10–21)193
(93–389)233
(112–468)888
(629–1191)907
(646–1,205)331
(220–471)331
(221–471)15
(10–22)20
(14–28)249
(169–356)361
(253–509)Male 4
(2–5)7
(5–10)173
(83–347)207
(100–416)753
(524–1013)768
(548–1,021)210
(137–297)208
(136–297)20
(13–30)26
(18–38)160
(96–246)235
(156–352)Female 17
(11–23)26
(18–38)222
(107–444)271
(130–541)1–083
(774–1,443)1–110
(783–1,481)519
(346–747)518
(346–749)7
(5–11)10
(6–14)387
(279–532)553
(400–757)UAE Both 14
(10–19)16
(12–23)201
(96–407)221
(105–444)803
(571–1,068)824
(589–1,101)302
(201–428)287
(192–408)18
(12–26)24
(16–34)331
(231–457)442
(308–604)Male 8
(6–11)8
(6–12)181
(87–369)207
(98–418)693
(494–935)724
(518–974)210
(138–302)210
(137–298)23
(15–33)27
(19–40)262
(171–373)374
(251–526)Female 26
(18–37)41
(28–55)234
(111–480)268
(128–543)1–016
(724–1,356)1–059
(758–1,403)520
(346–752)517
(347–750)8
(5–12)10
(6–14)478
(344–647)647
(471–869)Upper-middle-income countries Brazil Both 29
(21–38)28
(21–37)228
(109–460)260
(125–525)1–002
(715–1,345)1–034
(745–1,388)276
(185–397)276
(185–398)6
(4–9)8
(5–11)709
(509–961)660
(469–899)Male 17
(13–23)16
(12–22)206
(99–416)229
(110–462)767
(548–1,031)793
(563–1,061)246
(166–356)247
(165–358)9
(6–12)11
(7–15)578
(413–798)541
(380–750)Female 39
(29–52)39
(28–51)247
(119–497)286
(138–575)1–222
(871–1,639)1–254
(908–1,677)304
(202–435)304
(202–435)4
(3–6)6
(4–8)832
(602–1,118)770
(554–1,034)Russia Both 35
(28–44)38
(29–49)279
(133–566)286
(137–579)1–255
(899–1,690)1–206
(867–1,623)268
(180–384)268
(180–384)11
(8–16)13
(9–19)130
(92–179)191
(139–263)Male 16
(13–21)19
(15–24)242
(116–493)250
(120–506)955
(683–1,293)923
(657–1,241)242
(162–349)243
(163–350)20
(14–29)23
(15–32)15
(12–22)61
(41–93)Female 49
(38–61)53
(40–69)300
(142–601)310
(147–623)1–481
(1–065–1,985)1–433
(1–032–1,926)290
(192–417)290
(192–416)6
(4–9)7
(5–11)218
(155–305)294
(212–400)China Both 42
(33–54)42
(31–55)211
(102–424)245
(117–492)749
(530–1,014)603
(428–810)248
(164–353)255
(167–358)20
(13–29)25
(17–36)346
(241–476)408
(283–564)Male 28
(20–36)31
(23–40)169
(81–341)197
(94–397)572
(402–779)488
(347–658)214
(142–308)216
(145–308)30
(20–44)39
(26–55)293
(202–410)347
(238–485)Female 58
(44–74)54
(39–73)251
(121–503)290
(139–583)926
(658–1,253)716
(506–960)284
(188–406)294
(194–414)10
(7–15)12
(8–18)402
(284–547)472
(333–647)South Africa Both 73
(57–92)56
(43–72)242
(116–487)260
(126–521)759
(540–1,019)693
(498–928)293
(195–422)289
(192–413)16
(11–23)17
(12–25)324
(236–443)397
(287–532)Male 59
(44–76)44
(34–60)234
(113–471)250
(121–504)574
(409–769)557
(396–748)227
(150–332)226
(149–326)27
(18–39)29
(20–42)239
(170–336)322
(230–443)Female 85
(66–108)66
(50–83)247
(118–497)266
(128–537)913
(650–1,225)812
(582–1,086)353
(233–506)348
(230–495)8
(5–11)9
(6–12)397
(290–532)462
(338–616)Egypt Both 11
(8–16)16
(11–22)184
(89–376)213
(103–441)944
(670–1,267)965
(698–1,290)364
(240–521)358
(238–510)14
(9–20)18
(12–26)319
(213–447)448
(310–610)Male 4
(3–6)6
(4–9)165
(79–329)189
(90–397)778
(546–1,052)800
(567–1,081)211
(136–303)210
(138–303)21
(14–30)25
(16–36)242
(159–347)358
(245–508)Female 19
(13–26)28
(19–38)205
(98–421)241
(116–493)1–117
(801–1,508)1–145
(826–1,520)523
(345–757)520
(343–755)7
(5–11)9
(6–13)398
(274–552)547
(382–743)Lower-middle-income countries India Both 35
(26–44)41
(32–52)185
(90–375)221
(106–447)824
(594–1,107)714
(509–955)157
(105–226)159
(105–228)12
(8–17)13
(9–19)621
(441–842)758
(535–1,027)Male 21
(14–27)24
(17–30)144
(70–291)168
(81–340)556
(396–747)445
(315–599)138
(92–201)139
(92–201)17
(12–25)19
(13–28)535
(378–727)625
(435–852)Female 49
(38–64)57
(44–73)229
(110–460)272
(130–545)1–114
(804–1,493)984
(704–1,320)179
(118–256)179
(118–256)6
(4–9)7
(5–10)717
(509–967)896
(638–1,210)Iran Both 10
(7–14)13
(9–19)187
(89–377)215
(103–433)1–132
(811–1,523)1–028
(740–1,370)432
(287–618)433
(289–618)14
(9–20)15
(10–22)263
(178–371)407
(284–560)Male 3
(2–5)5
(3–7)167
(80–337)187
(90–380)936
(667–1,256)804
(573–1,074)289
(192–417)290
(192–415)20
(13–29)22
(15–32)166
(104–246)304
(209–433)Female 17
(12–23)22
(15–30)207
(99–419)242
(115–484)1–335
(962–1,788)1–257
(909–1,674)582
(385–830)580
(384–825)7
(5–10)8
(5–12)366
(254–503)512
(361–698)Low-income country Ethiopia Both 12
(8–20)11
(7–15)174
(84–354)221
(106–444)884
(632–1,180)822
(584–1,106)236
(155–337)237
(156–338)13
(9–19)14
(9–20)262
(183–358)307
(207–427)Male 10
(7–14)9
(6–12)155
(75–312)198
(95–397)720
(511–960)673
(479–903)208
(137–295)209
(137–294)19
(13–28)21
(14–30)214
(144–303)263
(172–375)Female 14
(9–29)13
(8–20)195
(94–396)245
(118–491)1–052
(753–1,405)973
(689–1,306)264
(172–376)266
(173–379)7
(4–10)7
(5–11)310
(224–419)352
(243–478)Abbreviation: DALYs=disability adjusted life years; MSK=musculoskeletal; RA=rheumatoid arthritis; OA=osteoarthritis; LBP=low back pain; NP=neck pain;
UI=uncertainty interval.Table 2. Age-standardized DALYs (95% UI) per 100,000 population for different MSK disorders in BRICS+ nations by sex in 1990 and 2021.
Figure 1.Age-standardized DALYs caused by different types of MSK disorders by sex in BRICS+ nations, 2021. (A) Both sexes; (B) Male; (C) Female.
Abbreviations: DALYs=disability adjusted life years; MSK=musculoskeletal; RA=rheumatoid arthritis; OA=osteoarthritis; LBP=low back pain; NP=neck pain.Table 3 and
Supplementary Table S1 present the joinpoint regression analysis for age-standardized MSK disorder indicators from 1990 to 2021. Globally, MSK incidence rates declined significantly, with an AAPC of −0.21 [95% confidence interval (CI): −0.22, −0.20]. Among BRICS+ nations, Saudi Arabia, UAE, Brazil, and Egypt showed increasing trends, while others declined, with China experiencing the largest decrease [average annual percentage change (AAPC)=−0.34; 95% CI: −0.38, −0.30] and Saudi Arabia had the largest increase (AAPC=0.12; 95% CI: 0.11, 0.12). Age-standardized prevalence rates increased globally and across all BRICS+ nations, with Saudi Arabia showing the most substantial increase (AAPC=0.34; 95% CI: 0.33, 0.35). China’s MSK DALYs demonstrated a significant decline, while other nations, except Brazil and South Africa, showed growth, with Saudi Arabia and UAE leading the increase. Globally, DALYs exhibited a fluctuating trend with an AAPC of 0.04% (95% CI: 0.02%, 0.06%). High-income countries like Saudi Arabia experienced a consistent increase in DALYs, while lower-middle-income countries like India and Iran showed M-shaped trends. Ethiopia, a low-income nation, experienced a down-up-down trend. Upper-middle-income countries displayed varied trends, with Egypt’s DALYs increasing until 2019 before stabilizing. Russia, China, and South Africa initially showed declining DALYs, with China exhibiting a unique down-stable-up-stable-up pattern. Sex differences in DALY trends were complex and varied by country. The trend in DALYs among males in China was more complex compared to females, while the opposite was true in South Africa. Moreover, the AAPCs for males in both countries were positive, differing from those for females.Country Age-standardized incidence Age-standardized prevalence Age-standardized DALYs AAPC 95% CI P AAPC 95% CI P AAPC 95% CI P Global −0.21 −0.22, −0.20 <0.001 0.11 0.09, 0.13 <0.001 0.04 0.02, 0.06 <0.001 High-income countries Saudi Arabia 0.12 0.11, 0.12 <0.001 0.34 0.33, 0.35 <0.001 0.33 0.32, 0.34 <0.001 UAE 0.11 0.11, 0.12 <0.001 0.29 0.28, 0.30 <0.001 0.27 0.25, 0.29 <0.001 Upper-middle-income countries Brazil 0.10 0.08, 0.11 <0.001 0.04 0.03, 0.05 <0.001 0.02 −0.01, 0.04 0.066 Russia −0.05 −0.06, −0.04 <0.001 0.04 0.03, 0.06 <0.001 0.04 0.01, 0.08 0.033 China −0.34 −0.38, −0.30 <0.001 0.09 0.07, 0.11 <0.001 −0.06 −0.10, −0.02 0.005 South Africa −0.11 −0.12, −0.10 <0.001 0.12 0.10, 0.13 <0.001 0.01 −0.01, 0.03 0.273 Egypt 0.10 0.09, 0.11 <0.001 0.31 0.30, 0.31 <0.001 0.30 0.29, 0.32 <0.001 Lower-middle-income countries India −0.27 −0.33, −0.21 <0.001 0.16 0.10, 0.21 <0.001 0.12 0.06, 0.17 <0.001 Iran −0.13 −0.15, −0.11 <0.001 0.17 0.15, 0.18 <0.001 0.12 0.10, 0.15 <0.001 Low-income country Ethiopia −0.11 −0.11, −0.10 <0.001 0.16 0.15, 0.17 <0.001 0.07 0.06, 0.08 <0.001 Abbreviation: DALYs=disability-adjusted life years; MSK=musculoskeletal; CI=confidence interval; AAPC=average annual percentage change. Table 3. The trend of age-standardized incidence, prevalence, and DALYs rates (per 100,000 population) for MSK disorders in BRICS+ nations from 1990 to 2021.
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This study analyzed the disease burden, major types, and trends of MSK disorders in BRICS+ nations between 1990 and 2021 using the GBD 2021 database. The 10 countries are classified into different income levels, including high, upper-middle, lower-middle, and low-income countries. Overall, MSK disorders imposed a heavier disease burden on females than males across BRICS+ countries, with higher rates observed in lower-middle and upper-middle income countries.
From 1990 to 2021, Russia maintained the highest age-standardized incidence of MSK disorders, while China consistently reported the lowest. Among BRICS+ nations, Saudi Arabia showed the largest increase (3.55%) in age-standardized incidence, with Brazil and Egypt are also demonstrating upward trends. Conversely, China experienced the most substantial decline (−11.28%) in age-standardized incidence. Regarding age-standardized prevalence, MSK disorders were most common in Brazil, followed by Iran and Russia, and least common in Ethiopia and China. Saudi Arabia exhibited the largest increase in prevalence (11.19%) over the past three decades.
Brazil had the highest age-standardized DALYs per 100,000 population for MSK disorders among BRICS+ nations in both 1990 and 2021. Saudi Arabia, UAE, and Egypt showed consistent increasing trends in DALYs, with Saudi Arabia experiencing the largest increase (10.74%). YLDs caused by metabolic, behavioral, and environmental or occupational risk factors have been increasing across all age groups in Saudi Arabia, thereby exacerbating the burden of MSK disorders (7). China demonstrated the largest decrease in DALYs (−2.35%), primarily due to reductions in low back pain, related to improvements in sanitation and healthcare services. However, with rapid population aging, China will face immense challenges in managing the burden of MSK disorders in the future (8−9). The DALYs attributed to MSK disorders in Ethiopia remained relatively low, which may be related to poor documentation of the magnitude of NCDs at both national and subnational levels (10).
Sex disparities in MSK disorders are evident, with females experiencing a greater disease burden than males both globally and across BRICS+ nations. These differences likely stem from physiological factors such as ligament relaxation, hormonal influences (estrogen and progesterone), and behavioral factors, including exercise habits and work posture (11). Pregnancy and menopause significantly contribute to MSK disorders in females (12). Saudi Arabia exhibited the largest sex disparity in 2021, followed by Iran, which can be attributed to differences in life expectancy and cultural gender inequalities (13).
LBP was the predominant contributor to MSK-related DALYs in 2021, with Russia showing the highest burden, followed by Brazil and Iran. High body mass index (BMI), a significant risk factor for MSK disorders, may explain the elevated DALYs in these countries (14−15). Additionally, increased tobacco use in Iran potentially influences LBP prevalence (15). While gout had comparatively low DALYs globally and across BRICS+ nations, it imposed a greater burden on males, possibly due to unhealthy lifestyle behaviors such as smoking and alcohol consumption, as well as hormonal differences.
As life expectancy increases across BRICS+ nations, maintaining physical function and quality of life becomes increasingly challenging, particularly for females who generally live longer. MSK health is fundamental to quality of life across all age groups. Occupational risks, tobacco use, high BMI, and kidney dysfunction were the primary contributors to MSK disorder DALYs globally, accounting for over 20% of the global burden (6). BRICS+ countries could benefit from strengthened coordination in policy development and implementation to collectively advance global MSK health.
This study has several limitations. First, it relies on GBD modeling, which may not fully capture the actual situation, particularly in less developed countries. Second, some MSK disorders were grouped together without specific analysis. Finally, the study did not consider different age groups, which will be addressed in future research.
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The team of IHME for their work.
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