Incidence of the musculoskeletal system diseases in children and the organization of specialized care in Saint Petersburg
- 作者: Baindurashvili A.G.1, Vissarionov S.V.1, Zaletina A.V.1, Lapkin Y.A.1, Schepina E.N.1
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隶属关系:
- H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
- 期: 卷 12, 编号 1 (2024)
- 页面: 43-52
- 栏目: Organization of trauma and orthopedic care
- ##submission.dateSubmitted##: 06.02.2024
- ##submission.dateAccepted##: 22.03.2024
- ##submission.datePublished##: 29.03.2024
- URL: https://journals.eco-vector.com/turner/article/view/626498
- DOI: https://doi.org/10.17816/PTORS626498
- ID: 626498
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详细
BACKGROUND: The high prevalence of musculoskeletal system and connective tissue diseases, effects on the quality of life of children, and disability level are among the main medical and social problems.
AIM: To assess the morbidity rates and provision of medical care to St. Petersburg children with musculoskeletal diseases between 2017 and 2021.
MATERIALS AND METHODS: Data on the incidence of musculoskeletal diseases in children of St. Petersburg were analyzed based on the Federal statistical observation forms submitted by the St. Petersburg State Budgetary Institution Medical Center for Information and Analysis, collections of N.N. Priorov National Medical Research Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation “Trauma, orthopedic morbidity, the state of trauma and orthopedic care for the population,” edited by Acad. S.P. Mironov, RAS, and data from the Federal State Statistics Service.
RESULTS: In Saint Petersburg, the morbidity rate of musculoskeletal and connective tissue diseases from 2017 to 2021 was 13%, excluding 2020, which was most likely due to the introduction of measures aimed at counteracting the spread of COVID-19 and the suspension of planned outpatient specialized care. The number of orthopedic beds for children decreased by 58, whereas the availability of beds for children remained at the same level and amounted to 4.3 beds per 10,000 children, which exceeded the indicator for the Russian Federation (1.0). The number of children with these disabilities increased 1.4-fold. Deaths of children due to musculoskeletal and connective tissue diseases were recorded in 2019 and 2020.
CONCLUSIONS: The results of the 5-year observation period of musculoskeletal and connective tissue diseases in children in St. Petersburg revealed increasing incidence because of the increase in the number of children newly diagnosed with these diseases.
全文:
BACKGROUND
Currently, musculoskeletal system diseases (MSSDs) represent a serious medical and social problem. MSSDs are common in children of all ages [1]. Modern research proves that MSSDs are one of the indicators of the general state of human health and affect the functioning of other body organs and systems [2, 3]. Musculoskeletal injuries and MSSDs result in limited performance of normal living activities, quality of life deterioration, limited choice of profession, conscription into military service, and disability. The treatment and rehabilitation of severe cases incur large financial costs [2, 4, 5]. Various etiological factors that lead to the development of MSSDs determine their high prevalence in the population. In recent years, the number of school-age children with MSSDs tended to increase [6–8].
Many scientific publications have focused on this condition in general and on individual nosological units because of the widespread prevalence of MSSDs and the high risk among all age groups [5, 9–14]. MSSDs are one of the leading causes of childhood morbidity [15].
Russian and international researchers note that MSSDs during childhood affect significantly the quality of life, morbidity, and disability of the adult population [16–18].
The study aimed to assess morbidity rates and the provision of medical care to children with MSSDs from 2017 to 2021 in St. Petersburg.
MATERIALS AND METHODS
The incidence rates of MSSDs in St. Petersburg from 2017 to 2021 were analyzed according to the Medical Information Analytical Center. The study used records of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics of the Ministry of Health of Russia “Injuries, orthopedic morbidity, the state of traumatological and orthopedic care to the population,” edited by RAS academician S.P. Mironov, which annually provide data on injuries in adults and children in the Russian Federation and for each region separately, and data from the Federal State Statistics Service (Rosstat).
The pediatric population of St. Petersburg in 2021 reached 963,262, including 839,321 children aged 0–14 years and 123,941 adolescents aged 15–17 years. Since 2017, the pediatric population (0–17 years old) has increased by 99,870, that is, by 84,604 children in the group aged 0–14 years inclusive and by 15,266 adolescents in the group aged 15–17 years. The ratio of boys (51%) to girls (49%) remained unchanged.
Six medical organizations in the city, including three city children’s hospitals, H.I. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery of the Ministry of Health of Russia, and two clinics based on Federal State Budgetary educational institutions of higher education (N.I. Pirogov Clinic of High Medical Technologies at St. Petersburg State University and Clinic of St. Petersburg State Pediatric Medical University) provided inpatient orthopedic care for children in St. Petersburg in 2021.
RESULTS
In St. Petersburg, MSSDs in children ranked third by incidence until 2019 and were registered on average in 203 per 1000 children, inferior to respiratory diseases (1558 per 1000 children) and diseases of the eye and its appendages (211 per 1000 children). Since 2019, MSSDs rank second among the main classes of diseases and account for 7% of the total number of diseases registered in children in St. Petersburg.
In St. Petersburg, the average incidence of MSSDs is 225 per 1000 children. For comparison, its incidence in the Russian Federation is 89 per 1000 children. The dynamics of the incidence of MSSDs in children in the Russian Federation and St. Petersburg is presented in Table 1.
Table 1. Incidence of musculoskeletal system diseases per 1000 child population (0–17 years old) in the Russian Federation and St. Petersburg in 2017–2021 (‰)
Territories/age | 2017 | 2018 | 2019 | 2020 | 2021 |
Children aged 0–14 years | |||||
Russian Federation | 75.7 | 78.8 | 82.3 | 71.7 | 76.7 |
Saint Petersburg | 167.2 | 174.8 | 190.9 | 167.8 | 190.4 |
Adolescents aged 15–17 years | |||||
Russian Federation | 160.7 | 163.9 | 167.8 | 149.0 | 177.8 |
Saint Petersburg | 430.5 | 419.3 | 449.2 | 409.5 | 476.6 |
MSSDs among children aged 0–14 years in St. Petersburg rank second by incidence in the Russian Federation, whereas they rank first among adolescents aged 15–17 years in all Russian regions.
In St. Petersburg, in 2017, 172,967 initial visits for medical help for diseases of the musculoskeletal system and connective tissue in children were recorded. In 2021, this figure increased to 218,850. In accordance with the data of Statistical Form No. 12, the federal statistical observation “Information on the number of diseases registered in patients” showed the incidence of MSSDs per 1000 children in St. Petersburg from 2017 to 2021 (Table 2).
Table 2. Incidence of musculoskeletal system diseases per 1000 child population (0–17 years old) in St. Petersburg in 2017–2021 (‰)
Name of classes and individual diseases | 2017 | 2018 | 2019 | 2020 | 2021 |
Diseases of the musculoskeletal system and connective tissue (M00–M99) | 200.3 | 205.9 | 224.1 | 199.04 | 227.2 |
Arthropathies (M00–M25) | 84.6 | 86.7 | 91.4 | 85.04 | 95.6 |
Pneumococcal arthritis and polyarthritis (М00.1) | – | – | 0.1 | 0.05 | 0.06 |
Reactive arthropathies (М02) | 1.04 | 1.2 | 1.1 | 1.1 | 0.9 |
Rheumatoid arthritis (seropositive and seronegative) (M05–M06) | 0.12 | 0.2 | 0.31 | 0.15 | 0.2 |
Juvenile arthritis (M08) | 1.6 | 1.6 | 1.5 | 1.3 | 1.35 |
Arthrosis (M15–M19) | 0.6 | 0.54 | 1.02 | 0.3 | 0.4 |
Systemic connective tissue disorders (M30–M35) | 1.02 | 1 | 1.4 | 1.2 | 1.1 |
Systemic lupus erythematosus (M32) | 0.008 | 0.005 | 0.004 | 0.01 | 0.02 |
Deforming dorsopathies (M40–M43) | 56 | 52.5 | 58.1 | 47.8 | 56.2 |
Spondylopathies (M45–M48) | 0.7 | 0.55 | 0.7 | 0.4 | 0.5 |
Ankylosing spondylitis (M45) | 0.01 | 0.005 | 0.02 | 0.001 | 0.001 |
Damage to synovial membranes and tendons (M65–M67) | 1.5 | 1.7 | 2.2 | 1.6 | 1.73 |
Osteopathies and chondropathies (M80–M94) | 6.8 | 7 | 7.9 | 7.1 | 8 |
Osteoporosis (M80–M81) | 0.04 | 0.001 | 0.05 | 0.05 | 0.01 |
The data analysis revealed that the incidence of diseases of the musculoskeletal system and connective tissue per 1000 children increased by 13% over 5 years in St. Petersburg.
The distribution of diseases under MSSDs in children aged 0–17 years has been maintained over the past several years. Among the total number of this pathology, arthropathies rank first (40%–43%), dorsopathies rank second (24%–28%), and osteopathies and chondropathies rank third (3%). However, considering the incidence by age groups in St. Petersburg, among adolescents (15–17 years old), deforming dorsopathies rank first accounting for 38.4%–45% of the total number of diseases of the musculoskeletal system and connective tissue, arthropathies rank second with 30%–34%, and osteopathies and chondropathies rank third with 2.5% (Table 3).
Table 3. Incidence of diseases of the musculoskeletal system and connective tissue in adolescents aged 15–17 years in St. Petersburg in 2017–2021 (‰)
Registered diseases | 2017 | 2018 | 2019 | 2020 | 2021 |
Deforming dorsopathies | |||||
n | 21,038 | 20,118 | 21,326 | 18,928 | 22,692 |
Per 1 thousand (‰) | 193.6 | 176 | 179.4 | 154.4 | 183.1 |
Arthropathies | |||||
n | 14,096 | 15,282 | 16,904 | 16,952 | 19,532 |
Per 1 thousand (‰) | 129.7 | 133.7 | 142.3 | 138.3 | 157.6 |
Osteopathies and chondropathies | |||||
n | 1092 | 1202 | 1334 | 1240 | 1314 |
Per 1 thousand (‰) | 10 | 10.5 | 11.2 | 10.1 | 10.6 |
Other | |||||
n | 10,563 | 11,331 | 13,813 | 13,074 | 15,538 |
Per 1 thousand (‰) | 97.2 | 99.1 | 116.2 | 106.7 | 125.4 |
Total number of diseases of the musculoskeletal system and connective tissue | |||||
n | 46,789 | 47,933 | 53,377 | 50,194 | 59,076 |
Per 1 thousand (‰) | 430.5 | 419.3 | 449.2 | 409.5 | 476.6 |
Over the past 5 years, the incidence of MSSDs in adolescents has increased by 11%. The incidence tended to increase among adolescents with arthropathies by 21%. In addition, the incidence of osteopathies and chondropathies increased by 6%. However, a positive trend was also observed, which was expressed as a decrease in the incidence of deforming dorsopathies by 5.5%.
The analysis of the incidence of MSSDs in children aged 0–14 years revealed that arthropathies rank first (45%–47%), dorsopathies rank second (19%–22%), osteopathies and chondropathies rank third (3%–4%). The incidence of MSSDs in children aged 0–14 years in St. Petersburg is presented in Table 4.
Table 4. Incidence of diseases of the musculoskeletal system and connective tissue in children aged 0–14 years in St. Petersburg in 2017–2021
Registered diseases | 2017 | 2018 | 2019 | 2020 | 2021 |
Arthropathies | |||||
n | 58,968 | 62,653 | 67,521 | 63,593 | 72,568 |
Per 1 thousand | 78.1 | 79.8 | 83.8 | 77.1 | 86.5 |
Deforming dorsopathies | |||||
n | 27,216 | 27,059 | 32,319 | 26,311 | 31,474 |
Per 1 thousand | 36.1 | 34.5 | 40.1 | 32 | 37.5 |
Osteopathies and chondropathies | |||||
n | 4751 | 4992 | 5948 | 5454 | 6414 |
Per 1 thousand | 6.1 | 6.3 | 7.4 | 6.6 | 7.6 |
Others | |||||
n | 35,243 | 42,456 | 47,918 | 42,949 | 49,318 |
Per 1 thousand | 46.7 | 54.1 | 59.5 | 52.1 | 58.8 |
Total number of diseases of the musculoskeletal system and connective tissue | |||||
n | 126,178 | 137,160 | 153,706 | 138,307 | 159,774 |
Per 1 thousand | 167.2 | 175 | 191 | 168 | 190.4 |
Over 5 years, in the group aged 0–14 years, the incidence of arthropathies increased by 11%, dorsopathies by 4%, and osteopathies by 24%. The overall incidence of MSSDs in children increased by 14% from 2017 to 2021.
The diagnosis of MSSDs in St. Petersburg in 2017 was established for the first time in 50,542 children. By 2021, this number increased to 65,068. The incidence of newly diagnosed MSSDs in children in St. Petersburg is presented in Figure.
Figure. Incidence of diseases of the musculoskeletal system newly diagnosed in children aged 0–17 years in St. Petersburg in 2017–2021 (‰)
The increasing number of children with newly diagnosed MSSDs in both age groups is of concern because MSSDs are chronic and children with MSSDs require long-term comprehensive inpatient and rehabilitation treatment and clinical monitoring by not only orthopedists but also neurologists, surgeons, and rheumatologists.
In St. Petersburg, six medical organizations in the city, including in federal centers, provided inpatient traumatology and orthopedic care for children. In 2017, 473 orthopedic beds were available for children, most of which (430 beds) were at federal clinics. Over 5 years, bed capacity has reduced, and by the end of 2021, the average number of orthopedic beds for children was 415, including 372 beds in federal centers. The performance indicators of orthopedic beds for children in St. Petersburg are presented in Table 5.
Table 5. Performance indicators of orthopedic beds specialized for children in St. Petersburg in 2017–2021
Indicator | 2017 | 2018 | 2019 | 2020 | 2021 |
Number of beds | 473 | 471 | 480 | 421 | 415 |
Patients admitted | 8119 | 8563 | 10,169 | 8154 | 10,196 |
Average bed day | 15.4 | 14.7 | 13.1 | 12.2 | 10.4 |
Bed turnover | 17.1 | 18.2 | 21.2 | 19.4 | 24.6 |
Bed work per year | 263.6 | 268.6 | 277.7 | 237.1 | 256.2 |
Bed occupancy, % | 72.2 | 73.6 | 76.1 | 64.8 | 70.2 |
In the analysis of orthopedic beds specialized for children in 2017–2021, despite the reduction in orthopedic beds for children in St. Petersburg (by 58) by 2021, the number of hospitalizations increased by 25%, and the average bed day reduced from 15.4 to 10.4 and bed turnover increased from 17.1 to 24.6.
The results of the analysis of surgical data by medical organizations in St. Petersburg providing assistance to children with various MSSDs are presented in Table 6.
Table 6. Surgical interventions on the musculoskeletal system in children in St. Petersburg in 2017–2021
Type of surgical intervention | 2017 | 2018 | 2019 | 2020 | 2021 |
TOTAL* surgeries on the musculoskeletal system | 20,729 (4414) | 22,618 (5222) | 23,369 (5745) | 21,812 (5442) | 24,502 (5432) |
Corrective osteotomies | 1245 | 999 | 1289 | 1600 | 1508 |
Maxillofacial area surgery | 9394 | 9345 | 9097 | 8882 | 10,037 |
Spine surgery | 661 | 615 | 608 | 611 | 694 |
Congenital hip dislocation surgery | 458 | 553 | 505 | 381 | 465 |
Amputation and disarticulation | 3 | 13 | 32 | 81 | 65 |
Endoprosthetics, total | 51 | 47 | 58 | 49 | 58 |
Hip joint surgery | 44 | 41 | 43 | 37 | 49 |
Knee joint surgery | 5 | 2 | 4 | 3 | 1 |
Chest wall surgery | 198 | 150 | 197 | 191 | 193 |
Thoracomyoplasty | 130 | 81 | 102 | 110 | 133 |
Thoracostomy | 14 | 1 | 0 | 5 | 0 |
Others | 8526 | 10,771 | 11,434 | 9862 | 11,299 |
* In brackets including the number of surgeries using high-tech medical care.
Along with the increase in the number of hospitalizations by orthopedic beds for children, the number of surgeries performed on children during hospitalizations also increased, except for thoracostomy and knee replacement. The number of musculoskeletal surgeries in children using high medical technologies in 2020–2021 decreased, which may be due to the restrictive measures aimed at countering the spread of COVID-19.
Along with the increase in morbidity rates among children in St. Petersburg, the number of children with disability tended to increase by 15.6% over the past 5 years. Information about children with disability in St. Petersburg is presented in Table 7.
Table 7. Children with disability in St. Petersburg for 2017–2021
Indicator | 2017 | 2018 | 2019 | 2020 | 2021 | |||||
M | F | M | F | M | F | M | F | M | F | |
Total number of children with disability | 16,341 | 17,143 | 17,902 | 18,510 | 19,360 | |||||
9828 | 6513 | 10,396 | 6747 | 10,930 | 6972 | 11,314 | 7196 | 11,845 | 7515 | |
Including those with newly diagnosed disabilities | 1980 | 1971 | 2077 | 1741 | 1999 | |||||
1178 | 802 | 1249 | 722 | 1289 | 788 | 1060 | 681 | 1248 | 751 | |
Including those with diseases of the musculoskeletal system and connective tissue | 369 | 418 | 414 | 447 | 517 | |||||
175 | 194 | 186 | 232 | 186 | 228 | 183 | 264 | 201 | 316 |
The incidence of MSSD-related disability in children accounts for 2.7% of the total number of all children with disability in St. Petersburg. The prevalence of MSSD-related disability is 5.3 per 10,000 children aged 0–17 years. From 2017 to 2021, the number of children with MSSD-related disability increased by 1.4 times. Among 517 children with MSSD-related disability registered in St. Petersburg in 2021, there were more girls (61%) than boys. The structure of children with MSSD-related disability in St. Petersburg with distribution by sex and age groups is presented in Table 8.
Table 8. Distribution of children with disability related to diseases of the musculoskeletal system by sex and age in St. Petersburg in 2017–2021
Year | Children with disability related to diseases of the musculoskeletal system | |||||||||
Total | Children aged 0–17 years (inclusive) | |||||||||
0–4 years | 5–9 years | 10–14 years | 15–17 years | |||||||
M | F | M | F | M | F | M | F | M | F | |
2017 | 175 | 194 | 15 | 10 | 61 | 48 | 56 | 70 | 43 | 66 |
2018 | 186 | 232 | 13 | 18 | 68 | 50 | 48 | 86 | 57 | 78 |
2019 | 186 | 228 | 14 | 22 | 69 | 49 | 52 | 79 | 51 | 78 |
2020 | 183 | 264 | 12 | 20 | 66 | 65 | 54 | 89 | 51 | 90 |
2021 | 201 | 316 | 9 | 24 | 73 | 81 | 68 | 111 | 51 | 100 |
In the analysis by sex, over 5 years, 122 girls had MSSD-related disability in all age groups, including 14 children aged 0–4 years, 33 aged 5–9 years, 41 aged 10–14 years, and 34 aged 15–17 years compared with 2017 data. Over the past 5 years, the number of girls with juvenile arthritis (M08) had increased by 2.5 times and that with osteopathies and chondropathies by 1.4 times (M80–M94). The number of boys with MSSD-related disability from 2017 to 2021 increased by only 26, and an increase of 1.2 times was noted girls with MSSD-related disability.
The mortality in children due to MSSD is low. In St. Petersburg, in 2019, a boy in the age group 5–9 years died of MSSDs, which accounted for 0.3% of the total mortality in children (n = 376). In 2020, a teenage boy died of MSSD (1 child out of 396 deceased children).
DISCUSSION
The results revealed a gradual decrease in the incidence of orthopedic morbidity in children in the Russian Federation over time [19]. Among other regions in Russia, St. Petersburg still records a higher number of pediatric patients with MSSDs among all childhood morbidities. This pathology is second only to respiratory diseases. This finding is attributed to the high level of diagnostics and timely detection of MSSDs in children in this region. Since 2019, MSSDs in St. Petersburg accounted for 7% of the total number of diseases registered in children. Our data are close to the values given in a study on MSSDs in Dutch children, that is, 7.5% of the total number of diseases [20].
Among conditions under MSSDs, arthropathies rank first, which accounts for up to 40%–43% of the total number of diseases, dorsopathies rank second (24%–28%), and osteopathies and chondropathies rank third (3%). These results are consistent with information obtained from a study conducted in Australia, where the predominance of upper and lower extremity disorders, followed by spinal disorders, was noted in children who sought medical help for MSSDs [21].
The rates of MSSD-related disability in children increased steadily; however, the increase in the number was mainly due to the high disability rates in girls, which may be caused by the worsening course of juvenile arthritis and requires more detailed study. Despite the increase in MSSD-related disability in children, in our region, 5.4 per 10,000 children have disability, which is much less than the national average index of 8.4 per 10,000 children of the corresponding age. This fact may be associated with timely and accurate diagnostics and adequate options for modern conservative and surgical treatment [22].
Physical inactivity and increased static load on muscles due to current social and hygienic features in children are among the probable causes of the increased incidence of MSSDs [6, 7]. The above changes, specifically in children, result in the deterioration of the quality of life at an older age. Research supports the relationship between physical activity and bone health in children and adults [23–26].
CONCLUSION
The results of this study revealed an increase in the incidence of MSSDs in children in St. Petersburg, which was attributed to the increase in the number of patients with newly diagnosed MSSDs. Moreover, a negative trend was observed in the incidence of MSSD-related disability in children. The main task of the traumatology and orthopedic service is to diagnose diseases early, provide timely and adequate treatment using high medical technologies, and offer comprehensive rehabilitation of patients with subsequent dispensary follow-up. A set of measures aimed at preventing pathological disorders and focusing on a healthy lifestyle presents the basis for reducing MSSDs and disability rates.
ADDITIONAL INFORMATION
Funding source. The study had no external funding.
Competing interests. The authors declare that they have no competing interests.
Author contributions. A.G. Baindurashvili and S.V. Vissarionov conceived the study and edited the text of the article; A.V. Zaletina, Yu.A. Lapkin, and E.N. Shchepina analyzed the material, studied the literary sources, and wrote the article.
All authors made significant contributions to the study and preparation of the article; they read and approved the final version before its publication.
作者简介
Alexey Baindurashvili
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
Email: turner011@mail.ru
ORCID iD: 0000-0001-8123-6944
SPIN 代码: 2153-9050
MD, PhD, Dr. Sci. (Med.), Professor, Member of RAS, Honored Doctor of the Russian Federation
俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603Sergey Vissarionov
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930
MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS
俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603Anna Zaletina
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
Email: omoturner@mail.ru
ORCID iD: 0000-0002-9838-2777
SPIN 代码: 4955-1830
MD, PhD, Cand. Sci. (Med.)
俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603Yuri Lapkin
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
Email: lapkin1950@mail.ru
ORCID iD: 0009-0007-9629-7601
SPIN 代码: 3283-8887
MD, PhD, Cand. Sci. (Med.)
俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603Elena Schepina
H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery
编辑信件的主要联系方式.
Email: ov-elena@mail.ru
ORCID iD: 0000-0003-1913-1118
SPIN 代码: 3934-0694
PhD, Cand. Sci. (Med.)
俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603参考
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