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Conditions that affect the bones, muscles and joints are known as musculoskeletal conditions. These conditions include long-term (chronic) conditions such as osteoarthritis, rheumatoid arthritis, juvenile arthritis, back problems, gout, and osteoporosis or osteopenia (low bone density) (see Glossary).
Chronic musculoskeletal conditions for 2020–21
Data for 2020–21 are based on information self-reported by the participants of the Australian Bureau of Statistics (ABS) 2020–21 National Health Survey (NHS).
Previous versions of the NHS have primarily been administered by trained ABS interviewers and were conducted face-to-face. The 2020–21 NHS was conducted during the COVID-19 pandemic. To maintain the safety of survey respondents and ABS Interviewers, the survey was collected via online, self-completed forms.
Non-response is usually reduced through Interviewer follow-up of households who have not responded. As this was not possible during lockdown periods, there were lower response rates than previous NHS cycles, which impacted sample representativeness for some sub-populations. Additionally, the impact of COVID-19 and lockdowns might also have had direct or indirect impacts on people’s usual behaviour over the 2020–21 period.
Due to these changes, comparisons with previous chronic musculoskeletal conditions data over time are not recommended.
On this page, comparisons over time (trends) only contain data from the NHS 2017–18 and prior collections.
Chronic musculoskeletal conditions affect about 3 in 10 Australians. Self-reported data from the ABS 2020–21 NHS provide estimates of the number of Australians affected by musculoskeletal conditions. These data indicate that, of the nearly 6.9 million people with chronic musculoskeletal conditions (27% of all Australians), 3.9 million (16%) had back problems (the most common musculoskeletal condition), 3.1 million (12%) had arthritis and 889,000 (3.6%) had osteoporosis (ABS 2022). For more detailed information see Arthritis, Back pain and problems and Osteoporosis.
Note: The information below is from the 2017–18 and earlier NHS.
Rates of chronic musculoskeletal conditions were relatively consistent from 2007–08 to 2017–18 (Figure 1).
Figure 1: Prevalence of chronic musculoskeletal conditions, by sex, 2007–08 to 2017–18
This time-series shows that the proportion of persons with arthritis has remained similar between 2007–08 and 2017–18 for both males (around 12%) and females (around 18%).
Females and older people are at greater risk
Females and older people were more likely to have chronic musculoskeletal conditions. The 2017–18 NHS shows that:
- Females were 1.2 times as likely to have a musculoskeletal condition and more than 4 times as likely to have osteoporosis compared with males.
- The prevalence of arthritis was similar in males and females aged 0–44, but overall females were 1.5 times as likely to have arthritis compared with males.
- The prevalence of back problems was similar in males and females across all age groups.
- More than 2 in 3 (68%) people aged 75 and over had a musculoskeletal condition (Figure 2).
Figure 2: Prevalence of chronic musculoskeletal condition, by sex and age, 2017–18
This chart shows that 3% of females and 2% of males aged 0–44 had arthritis, while 61% of females and 40% of males aged 75 and over had arthritis. A similar pattern of increasing prevalence in females and older persons was observed in the prevalence of musculoskeletal conditions; 13% of females and 14% of males aged 0–44 had a musculoskeletal condition, while 76% of females and 59% of males aged 75 and over had a musculoskeletal condition.
People with musculoskeletal conditions often have other long-term conditions. This is called ‘comorbidity’, which describes any additional disease that is experienced by a person with a disease of interest (the index disease) (Figure 3).
Prevalence of comorbidity
Osteoporosis, 85% had at least one other chronic condition
Arthritis, 74% had at least one other chronic condition
Back pain and problems, 64% had at least one other chronic condition
The number of comorbidities varies by age and sex. For example, the proportion of people with back problems who had at least one other chronic condition increased with age, from 47% (aged 15–44) to 85% (aged 65 and over). Among those with back problems, the proportion of people with comorbidities was higher in females than males across all age groups (Figure 3).
Figure 3: Proportion of people with musculoskeletal conditions who have at least one other chronic condition in people aged 15 and over, by sex and age, 2017–18
Among persons with arthritis aged 15–44, 76% of females and 63% of males had at least one other chronic condition. For those aged 65 and over, 76% of females and males with arthritis had at least one other chronic condition.
Musculoskeletal conditions often co-occur. In comparison to those without the condition, people aged 45 and over with:
- arthritis were 1.8 times as likely to also have back problems
- back problems were 1.6 times as likely to also have arthritis
- osteoporosis were 2.1 times as likely to also have arthritis.
Mental and behavioural conditions commonly co-occur with musculoskeletal conditions. Compared with people without these musculoskeletal conditions, for people aged 45 and over with mental and behavioural conditions were:
- 1.9 times as likely in people with back problems
- 1.6 times as likely in people with arthritis
- 1.5 times as likely in people with osteoporosis (Figure 4).
Adjusting for differences in the age structure of the groups did not affect the pattern of these results.
Figure 4: Prevalence of other chronic conditions in people aged 45 and over, with and without musculoskeletal conditions, 2017–18
Among persons aged 45 and over with arthritis, 36% had back problems, compared with 20% in persons without arthritis. Additionally, 30% of persons aged 45 and over with arthritis had mental and behavioural conditions, compared with 18% of persons without arthritis.
The prevalence of musculoskeletal conditions generally increases with increasing socioeconomic disadvantage, but is similar across remoteness areas, after adjusting for differences in age structures (Figure 5 shows a comparison for people aged 45 and over).
Figure 5: Prevalence of chronic musculoskeletal conditions in people aged 45 and over, by remoteness and socioeconomic area, 2017–18
Among persons aged 45 and over, the prevalence of arthritis was higher in the lowest socioeconomic area (most disadvantaged, 41%) compared with persons in the highest socioeconomic area (least disadvantaged, 25%). The prevalence of arthritis was similar in Major cities (31%) compared with Remote areas (34%).
Chronic musculoskeletal conditions are large contributors to illness, pain and disability in Australia. People with these conditions report higher rates of poor health, psychological distress and pain, after adjusting for age (Figure 6). This may affect their ability to participate in social, community and occupational activities (Briggs et al. 2016). The 2018 Survey of Disability, Ageing and Carers found that, of the people with disability in Australia, an estimated 13% had back problems and another 13% had arthritis as the main long-term health condition causing the disability (ABS 2019b).
Figure 6: Impact of musculoskeletal conditions in people aged 45 and over, with and without the condition, 2017–18
This graph shows that 11% of persons with arthritis rated their self-assessed health status as ‘poor’, compared with 4.0% of persons without arthritis. Similarly, persons with arthritis were more likely to self-report very high psychological distress (8.6% compared with 3.1%) and very severe bodily pain (4.4% compared with 1.4%).
Burden of disease
What is burden of disease?
Burden of disease analysis is a way of measuring the impact of diseases and injuries on a population. It is the difference between a population’s actual health and its ideal health, where ideal health is living to old age in good health (without disease or disability). It combines health loss from living with illness and injury (non-fatal burden, or years lived with disability, or YLD) and dying prematurely (fatal burden, or years of life lost, or YLL) to estimate total health loss (total burden, or disability-adjusted life years, or DALY). One DALY is one year of 'healthy life' lost due to illness and/or death (AIHW 2022a).
In 2022, the musculoskeletal conditions disease group accounted for 12.6% of total disease burden (DALY); 23.7% of non-fatal burden (YLD), and 0.8% of fatal burden (YLL). It was the second leading disease group contributing to total burden after cancer.
Within the musculoskeletal conditions disease group, back pain and problems accounted for 34% of burden (DALY), other musculoskeletal (31%), osteoarthritis (19%) and rheumatoid arthritis (16%).
At the individual condition level, back pain and problems was the third leading cause of total burden of disease (accounting for 4.2% of total burden in 2022) after coronary heart disease and dementia.
Variation by age and sex
- The rate of burden from musculoskeletal conditions increased with age peaking at age 75–79 (65.8 DALY per 1,000 population).
- The age-standardised rate of total burden from musculoskeletal conditions was higher among females compared with males (25.7 and 21.8 per 1,000 population respectively) (Figure 7).
Figure 7: Burden of disease due to musculoskeletal conditions by sex, age and year
This bar chart shows the DALY, YLD and YLL due to musculoskeletal conditions for different age groups by sex in selected years (2003, 2011, 2015, 2018 and 2022). For males, DALY peaked in the 60–64 age group at 35,193. Among females, DALY peaked in the 65–69 age group at 45,218.
In 2022, there were 20,505 YLL in persons from musculoskeletal conditions. YLL peaked in the 75–79 age group at 2,851.
In 2022, there were 678,926 YLD in persons from musculoskeletal conditions. YLD peaked in the 60–64 age group at 78,659.
Trends over time
The rate of burden from musculoskeletal conditions decreased slightly between 2003 and 2022 (25.3 to 23.8 DALY per 1,000 population, respectively) – 0.3% per year on average, after adjusting for changes in age structure.
Further detail is available in the Australian Burden of Disease Study 2022.
Variation between population groups
In 2018, after adjusting for age:
- Inner regional areas had the highest total burden for musculoskeletal conditions compared with Remote and very remote areas (27.8 and 19.6 DALY per 1,000 population, respectively).
- Total burden (DALY) had the greatest contrast between socioeconomic groups compared with fatal (YLL) and non-fatal burden (YLD) in the musculoskeletal conditions group, for example, the lowest socioeconomic group (people living in areas with the most disadvantage) had 1.5 times the rate of burden than the highest group (people living in areas with the least) (29.2 and 19.1 DALY per 1,000 population, respectively) (AIHW 2021a) (Figure 8).
Further detail is available in the Australian Burden of Disease Study 2018: Interactive data on disease burden.
Figure 8: Burden of disease due to musculoskeletal conditions by sex, remoteness area, socioeconomic group and year
This data visualisation includes 2 charts, the first presents DALY, YLD and YLL due to musculoskeletal conditions by remoteness in selected years (2011, 2015 and 2018). In 2018, the DALY due to musculoskeletal conditions was highest in Inner regional areas, and lowest in Remote and very remote areas.
The second chart presents DALY, YLD and YLL due to musculoskeletal conditions by socioeconomic group and year. In 2018, DALY was highest in the lowest socioeconomic group, and lowest in the highest socioeconomic group.
Modifiable risk factors contribute to burden
In 2018, 16% of the total burden due to musculoskeletal conditions could be attributed to modifiable risk factors. Overweight and obesity contributed to:
- 8.9% of the total burden of all musculoskeletal conditions
- 28% of the burden from osteoarthritis.
Occupational exposures and hazards contributed to:
- 5.6% of the total burden of all musculoskeletal conditions
- 17% of the burden of back problems.
Tobacco use contributed to 2% of the total burden of musculoskeletal conditions (AIHW 2021a).
See Burden of disease for information on definitions and the burden of disease associated with these conditions.
Health system expenditure
In 2019–20, an estimated $14.6 billion of expenditure in the Australian health system was for musculoskeletal conditions, representing 10% of total health expenditure (AIHW 2022c).
Where is the money spent?
Figure 9 presents a detailed breakdown of estimated expenditure for musculoskeletal conditions by area of the health system, showing that:
- Hospital services represented 63% ($9.2 billion) of musculoskeletal conditions expenditure, which was the same as the proportion of total health expenditure for hospital services. The private hospital service proportion musculoskeletal expenditure was relatively high, at more than double that for total health expenditure (33% compared with 16%).
- Primary care accounted for 26% ($3.7 billion) of musculoskeletal condition spending, which is less than the primary care portion of total health expenditure (28%). However, the pharmaceutical benefit scheme proportion of musculoskeletal conditions expenditure was relatively high, at 1.3 times that for total health expenditure (16% compared with 12%).
- Referred medical services represented 12% of musculoskeletal condition spending, which was more than the referred medical services portion of total health expenditure (9%). The medical imaging proportion of musculoskeletal expenditure was especially large in comparison to the average, at 3 times the proportion for total health expenditure (8% compared with 2.8%).
Figure 9: Amount and proportion (%) of musculoskeletal condition expenditure attributed to each area of the health system, compared to expenditure for all disease groups, 2019–20
This icicle chart shows the health expenditure on musculoskeletal conditions compared to total health expenditure by area of expenditure, in 2019–20. In total, musculoskeletal conditions cost the Australian health system an estimated $14.6 billion. This included $9.2 billion for hospitals, $3.7 billion for primary care services, and $1.7 billion for referred services.
Figure 10 presents the component (%) that musculoskeletal conditions expenditure makes up for each for each area of the health system, showing that in 2019–20, musculoskeletal conditions accounted for:
- 29% ($1.2 billion) of all medical imaging expenditure – ranking first of all disease groups.
- 21% ($4.9 billion) of all private hospital service expenditure – ranking first of all disease groups.
Further detail is available in Disease expenditure in Australia 2019–20.
Figure 10: Proportion of expenditure attributed to musculoskeletal conditions, for each area of the health system, 2019–20
This bar chart shows the proportion of area expenditure for musculoskeletal conditions by sex for 2019–20. The highest proportion of expenditure was spent on medical imaging (29.1%) and the least proportion of expenditure was on dental expenditure (2.8%).
Who is the money spent on?
- the age distribution of spending on musculoskeletal conditions reflects the prevalence distribution, with most spending being for older age groups (80% for people aged 45 and over)
- more musculoskeletal conditions expenditure was attributed to females than males ($7.7 billion and $6.4 billion, respectively with a remainder $527 million (3.6%) not specified.
In 2018–19, it was estimated that musculoskeletal conditions expenditure per case was equal for females and males ($1,200 per case) (AIHW 2022d).
Further detail is available in Health system spending per case and for certain risk factors.
How many deaths were associated with musculoskeletal conditions?
Musculoskeletal conditions were recorded as an underlying or associated cause for 9,277 deaths or 26.5 deaths per 100,000 population in Australia in 2021, representing 5.4% of all deaths. Musculoskeletal conditions were the underlying cause for 1,602 deaths (17% of musculoskeletal condition deaths) and an associated cause only, for 7,675 deaths (83% of musculoskeletal condition deaths).
Of the specific conditions analysed in this report, osteoporosis and osteoarthritis contributed the most substantially to any-cause musculoskeletal deaths (26% and 24% respectively). While rheumatoid arthritis contributed the most substantially to underlying-cause musculoskeletal deaths (14%).
Variation by age and sex
In 2021, musculoskeletal condition mortality (as the underlying and/or associated cause) was concentrated amongst:
- older people (78% aged 75 and over), which was slightly more than the proportion of people aged 75 and over for total deaths (67%)
- females (62% of musculoskeletal deaths were female compared with 48% of total deaths) (Figure 11).
Figure 11: Age profile of musculoskeletal mortality statistics, by sex
This line chart shows the death rate due to musculoskeletal conditions in 2021 as the underlying condition, an associated-only cause of conditions and any cause of condition, by sex and age group. Mortality increased with increasing age for both males and females. Overall, mortality was more common amongst females than males.
Trends over time
Age standardised mortality rates for musculoskeletal conditions (as the underlying and/or associated cause) between 2011 and 2021:
- fluctuated between 24 and 27 per 100,000 population
- was 1.2 to 1.3 times higher amongst females compared with males (Figure 12).
Figure 12: Historical musculoskeletal mortality statistics, by sex, 2011–2021
This line chart shows the deaths due to musculoskeletal conditions as the underlying condition, an associated-only cause of conditions and any cause of condition from 2011 to 2021. Deaths increased from 6,918 in 2011 to 9,277 in 2021.
Variation between population groups
Remote and very remote areas had 1.3 times more musculoskeletal condition deaths per population compared with Outer regional.
The lowest socioeconomic group (people living in areas with the most disadvantage) had 1.5 times more musculoskeletal condition deaths per population than the highest group (people living in areas with the least disadvantage) in 2021.
Musculoskeletal conditions are usually managed by general practitioners and allied health professionals. Treatment can include physical therapy, medicines (for pain and inflammation), self-management (such as diet and exercise), education on self-management and living with the condition, and referral to specialist care where necessary (WHO 2019). Based on survey data, an estimated 1 in 6 (18%) general practice visits in 2015–16 were for management of musculoskeletal conditions (Britt et al. 2016). See General practice, allied health and other primary care services.
People with musculoskeletal conditions that are very severe, or who require specialised treatment or surgery, can also be managed in hospitals. In 2020–21, there were around 832,500 hospitalisations for musculoskeletal conditions – 7.0% of all hospitalisations in that year (AIHW 2022e). These hospitalisations included:
- osteoarthritis (34% of all musculoskeletal hospitalisations)
- back problems (23%)
- rheumatoid arthritis (1.5%)
- osteoporosis (1.2%)
- gout (1.0%)
- other musculoskeletal conditions (39%).
Osteoarthritis is the most common condition leading to hip and knee replacement surgery in Australia (AOANJRR 2021).
Between 2010–11 and 2020–21, rates of total hip replacement and total knee replacement surgery, where osteoarthritis was the principal diagnosis, both trended up. Over this period these rates increased by 2.6% and 2.0% per year on average, respectively, after standardising age structures (Figure 13).
Figure 13: Rate of total hip and knee replacement surgeries for osteoarthritis, 2010–11 to 2020–21
This time-series shows the trends of hospitalisations for total hip and knee replacement surgeries, where osteoarthritis was the principal diagnosis from 2010–11 to 2020–21. Between 2010–11 to 2018–19, rates for total knee and hip replacement surgeries increased, but dipped during 2019–20. In 2020–21 rates exceeded the pre-pandemic rates.
The COVID-19 pandemic had substantial impacts on hospital activity. The range of social, economic, business and travel restrictions, including restrictions on, or suspension of, some hospital services, and associated measures in other healthcare services to support physical distancing in Australia resulted in an overall decrease in hospital activity between 2019–20 and 2020–21 (AIHW 2022a).
In 2019–20, there were 7.8% fewer hospitalisations for musculoskeletal conditions than in 2018–19. This decrease was driven by the April–June 2020 quarter, which saw 33% fewer hospitalisations than April–June 2019. However, in 2020–21, rates exceeded pre-pandemic levels.
At the beginning of the COVID-19 pandemic in Australia, non-urgent elective surgery was suspended for one month, from late March to late April 2020. For more information on how the pandemic has affected the population’s health in the context of longer-term trends, see 'Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.
In 2019–20, the age standardised rate of total hip and knee replacement surgery where osteoarthritis was the principal diagnosis declined 8.6% and 11.4% respectively from 2018–19 (Figure 13). However, in 2020–21, rates exceeded pre-pandemic levels.
April and May 2020 saw large decreases in admissions for hip and knee replacement surgeries, relative to the same months in 2019 and 2018. This was followed by slight increases on previous years for June and July 2020 (Figure 14).
Figure 14: Total hip and knee replacement surgeries, by month, 2018 to 2020
This figure shows the total hip and knee replacement surgeries, by month, from 2018 to 2020. April and May 2020 saw large decreases in admissions for hip and knee replacement surgeries, relative to the same months in 2019 and 2018.
Restrictions continued in some jurisdictions during 2020–21, and the associated impacts are still relatively unknown. Waiting times for elective surgeries increased notably for 2020–21 admissions.
In 2020–21, the median waiting times for total hip replacement surgery and total knee replacement surgery increased from 2019–20 by 49% and 38% respectively. This compares to an increase of 23% for all elective surgery (AIHW 2021b).
In 2020–21, the percentage of total hip replacements and total knee replacements with waiting times exceeding one year were 21% and 32% respectively. These represent 13 and 20 percentage point increases on 2019–20, which compares to a 4.8 percentage point increase for all elective surgeries (AIHW 2021b).
The prevention, management and treatment of musculoskeletal conditions beyond hospital settings cannot currently be examined in detail due to limitations in available data on:
- primary and allied health care at the national level
- use of over-the-counter medicines to manage pain and inflammation
- diagnosis information for prescription pharmaceuticals (which would allow a direct link between musculoskeletal conditions and use of subsidised medicines)
- patient outcomes, pathways through the health system and quality of care.
For more information on the musculoskeletal conditions covered in this report, see:
Australian Bureau of Statistics (ABS) (2019a) Microdata: National Health Survey, 2017–18, AIHW analysis of detailed microdata, accessed 17 February 2022.
ABS (2019b) Disability, ageing, and carers, Australia: summary of findings, 2018, ABS website, accessed 18 February 2022.
ABS (2022) Health conditions prevalence, ABS website, accessed 21 March 2022.
Australian Institute of Health and Welfare (AIHW) (2021a) Australian Burden of Disease Study 2018: Interactive data on risk factor burden, AIHW website, accessed 10 March 2022.
AIHW (2021b) Elective Surgery, AIHW website, accessed 22 February 2022.
AIHW (2022a) Admitted Patients, AIHW website, accessed 7 March 2022.
AIHW (2022b) Australian Burden of Disease Study 2022, AIHW, Australian Government, accessed 22 May 2023. doi:10.25816/e2v0-gp02.
AIHW (2022c) Disease expenditure in Australia 2019–20, AIHW, Australian Government, accessed 19 May 2023.
AIHW (2022d) Health system spending per case of disease and for certain risk factors, AIHW, Australian Government, accessed 19 May 2023.
AIHW (2022e) National Hospital Morbidity Database 2019–20. Findings based on unit record analysis, AIHW, Australian Government, accessed 28 February 2022.
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (2021) Annual report 2021: hip, knee and shoulder arthroplasty, Annual Report, AOA, Adelaide.
Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD and March L (2016) ‘Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization World report on ageing and health’, The Gerontologist, 56(2):243–255, doi:10.1093/geront/gnw002.
Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C et al. (2016) A decade of Australian general practice activity 2006–07 to 2015–16, General Practice Series, 43(1):1–155.
RACGP (The Royal Australian College of General Practitioners) (2018) Guideline for the management of knee and hip osteoarthritis, 2nd edn, RACGP, Melbourne.
WHO (World Health Organization) (2019) Musculoskeletal conditions, WHO website, accessed 18 February 2022.