abstract: 'IMPORTANCE The degree to which health and economic outcomes of

  musculoskeletal disorders are attributable to high body mass index (BMI)

  has not been quantified on a global scale.

  OBJECTIVE To estimate global health and economic outcomes associated

  with musculoskeletal disorders-low back pain (LBP), gout, and

  osteoarthritis attributable to high BMI in 2019.

  DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data

  of 192 countries and territories from the Global Burden of Diseases,

  Injuries, and Risk Factors Study, World Health Organization Global

  Health Expenditure, World Bank, and International Labour Organization

  databases. Data analyses were conducted from February 24 to June 16,

  2022.

  MAIN OUTCOMES AND MEASURES Prevalence, years lived with disability

  (YLDs), health care costs, and productivity losses due to morbidity from

  LBP, gout, and osteoarthritis attributable to high BMI by region and

  country. Prevalence and YLDs were calculated with the population

  attributable fraction approach. The economic burden, including health

  care costs and productivity losses due to morbidity, was also

  quantified. Health care costs borne by the public, private, and

  out-of-pocket sectors were estimated based on their corresponding

  payment shares. Productivity losses were estimated based on the output

  per worker. A sensitivity analysis was conducted to arrive at the base,

  minimum, and maximum estimates (ie, uncertainty interval {[}UI]) by

  using the mean, lower, and upper bounds of all input variables.

  RESULTS High BMI was estimated to be responsible for 36.3 million (UI,

  18.4-61.0 million), 16.9 million (UI, 7.5-32.5 million), and 73.0

  million (UI, 32.4-131.1 million) prevalent cases of LBP, gout, and

  osteoarthritis, respectively, which accounted for 7.3 million (UI,

  3.0-15.0 million) YLDs across 192 countries and territories in 2019.

  Globally, the YLDs of musculoskeletal disorders attributable to high BMI

  accounted for 1.0\% of all-cause YLDs in the working-age population aged

  15 to 84 years. The global total costs of musculoskeletal disorders

  attributable to high BMI reached \$180.7 billion (UI, \$83.8-\$333.1

  billion), including \$60.5 billion (UI, \$30.7-\$100.5 billion) in

  health care costs and \$120.2 billion (UI, \$53.1-\$232.7 billion) in

  productivity losses. In terms of the global health care costs, 58.9\%

  (\$35.6 billion; UI, \$17.8-\$59.6 billion) was borne by the public

  sector, 24.0\% (\$14.5 billion; UI, \$7.8-\$23.2 billion) by the private

  sector, and 17.1\%(\$10.3 billion; UI, \$5.1-\$17.6 billion) by the

  out-of-pocket sector. On average, the total costs accounted for 0.2\% of

  global gross domestic product. Great inequalities in the disease and

  economic burden existed across regions and countries. Nearly 80\% of

  global health care (82.4\%) and morbidity-related costs (82.9\%) were

  paid by high-income countries, whereas more than 60\%(61.4\%) of global

  YLDs occurred in middle-income countries.

  CONCLUSIONS AND RELEVANCE In this cross-sectional study of 192 countries

  and territories, a substantial amount of the health and economic impact

  of musculoskeletal disorders was attributable to high BMI. Developing

  effective policies and active participation from health professionals to

  prevent excessive weight gain are needed. More available estimates are

  also needed to facilitate a global analysis.'
affiliation: 'Fong, DYT (Corresponding Author), Univ Hong Kong, Li Ka Shing Fac Med,
  Sch Nursing, 3 Sassoon Rd, Hong Kong, Peoples R China.

  Chen, Ningjing; Fong, Daniel Yee Tak; Wong, Janet Yuen Ha, Univ Hong Kong, Li Ka
  Shing Fac Med, Sch Nursing, Hong Kong, Peoples R China.

  Wong, Janet Yuen Ha, Hong KongMetropolitan Univ, Sch Nursing \& Hlth Studies, Hong
  Kong, Peoples R China.'
article-number: e2250674
author: Chen, Ningjing and Fong, Daniel Yee Tak and Wong, Janet Yuen Ha
author-email: dytfong@hku.hk
author_list:
- family: Chen
  given: Ningjing
- family: Fong
  given: Daniel Yee Tak
- family: Wong
  given: Janet Yuen Ha
da: '2023-09-28'
doi: 10.1001/jamanetworkopen.2022.50674
files: []
issn: 2574-3805
journal: JAMA NETWORK OPEN
keywords-plus: LOW-BACK; OBESITY; IMPACT; PAIN
language: English
month: JAN
number: '1'
number-of-cited-references: '47'
orcid-numbers: Fong, Daniel/0000-0001-7365-9146
papis_id: 8a5aa85030f98d040b0c435d4a491aa1
ref: Chen2023healtheconomic
researcherid-numbers: Fong, Daniel/C-4269-2009
times-cited: '1'
title: Health and Economic Outcomes Associated With Musculoskeletal Disorders Attributable
  to High Body Mass Index in 192 Countries and Territories in 2019
type: Article
unique-id: WOS:001059414400004
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '6'
web-of-science-categories: Medicine, General \& Internal
year: '2023'