Smoking-attributable burden of musculoskeletal disorders, 1990–2021, with exploratory projections to 2050: A secondary dataset analysis of the Global Burden of Disease Study 2021

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.