The Journal of Bone and Joint Surgery (American) 86:1819-1822 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
The Burden of Orthopaedic Disease in Developing Countries
Massey Beveridge, MD, FRCSC, DTM&H1 and
Andrew Howard, MSc, MD, FRCSC2
1 Sunnybrook and Womens' College Health Sciences Centre, D-738, 2075 Bayview
Avenue, Toronto, ON M4N 3M5, Canada. E-mail address:
massey.beveridge{at}sw.ca
2 Division of Orthopaedics, Hospital for Sick Children, S-103, 555 University
Avenue, Toronto, ON M5G 1X8, Canada. E-mail address:
andrew.howard{at}sickkids.ca
Investigation performed at University of Toronto, Toronto, Ontario,
Canada
The authors did not receive grants or outside funding in support of their
research or preparation of this manuscript. They did not receive payments or
other benefits or a commitment or agreement to provide such benefits from a
commercial entity. No commercial entity paid or directed, or agreed to pay or
direct, any benefits to any research fund, foundation, educational
institution, or other charitable or nonprofit organization with which the
authors are affiliated or associated.
* The World Health Organization uses disability-adjusted life years to
measure and compare the global burden of disease across populations.
Disability-adjusted life years are calculated by adding the years of life lost
to premature mortality and the years lived with a disability for incident
cases of the health condition. The years lived with a disability are weighted
according to the severity of the disability, and an age factor is added to the
calculation whereby death and disability among children and young adults is
weighted more than that among infants and the elderly. Disability-adjusted
life years divide the burden of disease according to etiology, and some recent
work has looked at the burden of disease in terms of the attributable risk of
certain behaviors, such as smoking and drinking alcohol. Another way to look
at the global burden of disease is by the skill set required to treat diseases
such as injury. Thus, orthopaedic disease includes fractures, congenital
abnormalities, and infectious and degenerative diseases of the bones and
joints, conditions that are all treatable by manipulation or incision and are
preventable by a common group of interventions.
The global burden of musculoskeletal disease in low and middle-income
countries is large, growing, and neglected. While there is considerable
funding for the control of communicable disease, there has been little
attention paid to either the prevention or the treatment of orthopaedic
problems in developing countries. "Safe Roads" was the theme for
World Health Day 2004, and this paper examines the magnitude of injury in low
and middle-income countries, as well as the motors powering its growth, and
addresses the balance between the prevention and the treatment of injuries.
Finally, it calls upon orthopaedic surgeons in developed countries to build
partnerships with their colleagues in less developed countries to improve
clinical care, teaching, and research aimed at reducing the global burden of
injury.
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J. Bone Joint Surg. Am.,
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