Estimating the population health burden of musculoskeletal conditions using primary care electronic health records

Dahai Yu, George Peat, Kelvin P Jordan, James Bailey, Daniel Prieto-Alhambra, Danielle E Robinson, Victoria Y Strauss, Karen Walker-Bone, Alan Silman, Mamas Mamas, Steven Blackburn, Stephen Dent, Kate Dunn, Andrew Judge, Joanne Protheroe, Ross Wilkie

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Better indicators from affordable, sustainable data sources are needed to monitor population burden of musculoskeletal conditions. We propose five indicators of musculoskeletal health and assessed if routinely available primary care electronic health records (EHR) can estimate population levels in musculoskeletal consulters.


We collected validated patient-reported measures of pain experience, function and health status through a local survey of adults (≥35 years) presenting to English general practices over 12 months for low back pain, shoulder pain, osteoarthritis and other regional musculoskeletal disorders. Using EHR data we derived and validated models for estimating population levels of five self-reported indicators: prevalence of high impact chronic pain, overall musculoskeletal health (based on Musculoskeletal Health Questionnaire), quality of life (based on EuroQoL health utility measure), and prevalence of moderate-to-severe low back pain and moderate-to-severe shoulder pain. We applied models to a national EHR database (Clinical Practice Research Datalink) to obtain national estimates of each indicator for three successive years.


The optimal models included recorded demographics, deprivation, consultation frequency, analgesic and antidepressant prescriptions, and multimorbidity. Applying models to national EHR, we estimated that 31.9% of adults (≥35 years) presenting with non-inflammatory musculoskeletal disorders in England in 2016/17 experienced high impact chronic pain. Estimated population health levels were worse in women, older aged and those in the most deprived neighbourhoods, and changed little over 3 years.


National and subnational estimates for a range of subjective indicators of non-inflammatory musculoskeletal health conditions can be obtained using information from routine electronic health records.

Original languageEnglish
Pages (from-to)4832-4843
Number of pages12
JournalRheumatology (Oxford, England)
Issue number10
Early online date9 Feb 2021
Publication statusPublished - Oct 2021


  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cost of Illness
  • Electronic Health Records/statistics & numerical data
  • England/epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Musculoskeletal Diseases/epidemiology
  • Primary Health Care/statistics & numerical data
  • Sex Factors
  • Surveys and Questionnaires


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