Zhihong Fu, Yunhui Zhang, Zhaojun Chen
Smoking-attributable MSDs remain a measurable component of global disability burden. The persistence of absolute burden despite declining ASDR may warrant greater consideration in future tobacco-related burden assessments and rehabilitation planning, while causal and policy interpretations warrant cautious interpretation as this is an ecological modelling study.
INTRODUCTION: Musculoskeletal disorders (MSDs) are a leading source of disability worldwide, but the population-level burden attributable to smoking remains insufficiently characterized. The aim of this study was to quantify global, regional, and national smoking-attributable burden of MSDs from 1990 to 2021, and to explore socioeconomic inequalities and projections to 2050.
METHODS: This secondary dataset analysis used Global Burden of Disease Study 2021 estimates for smoking-attributable DALYs due to MSDs. Eligible estimates included both sexes combined, the risk factor smoking, the aggregate cause category of MSDs, all-age DALYs, age-standardized DALYs rate (ASDR), age-specific rates, global, sociodemographic index (SDI), regional, and national locations, for years 1990-2021. Temporal trends were summarized using estimated annual percentage change (EAPC) and joinpoint regression. Socioeconomic inequality, frontier performance, and exploratory autoregressive integrated moving average projections to 2050 were assessed; Bayesian age-period-cohort forecasts were used as sensitivity analysis for global DALYs.
RESULTS: Global smoking-attributable DALYs due to MSDs increased from 6.82 million (95% UI: 3.85-10.12) in 1990 to 8.89 million (95% UI: 4.72-13.68) in 2021, whereas ASDR decreased from 153.57 (95% UI: 85.94-228.28) to 102.44 (95% UI: 54.60-157.30). The global EAPC in ASDR was -1.20% (95% CI: -1.24 - -1.16). The largest relative increases in DALYs occurred in Middle-SDI regions (89.15%) and Low-SDI regions (71.71%). High-SDI regions retained the highest ASDR in 2021 (154.13; 95% UI: 81.19-231.32). Exploratory projections suggested that global ASDR may decline to 45.40 (95% UI: 29.06-61.74) by 2050, while DALYs may reach 7.53 million (95% UI: 4.12-10.93).
CONCLUSIONS: Smoking-attributable MSDs remain a measurable component of global disability burden. The persistence of absolute burden despite declining ASDR may warrant greater consideration in future tobacco-related burden assessments and rehabilitation planning, while causal and policy interpretations warrant cautious interpretation as this is an ecological modelling study.