f r e q u e n c y o f r h e u m a t i c d i s e a s e s
i n p o r t u g a l
:
a s y s t e m a t i c r e v i e wTeresa Monjardino
*, Raquel Lucas
*, Henrique Barros
**Observatório Nacional das Doenças Reumáticas; Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública – Faculdade de Medicina da Universidade do Porto; Instituto de Saúde Pública da Universidade do Porto
fibromyalgia ranged from 3.6% (95%CI: 2.0-5.2) to 3.7% (95%CI: 2.0-5.4). The prevalence estimates of ankylosing spondylitis and of spondyloarthritis were 0.6% and 1.6% (95%CI: 0.8-2.7), respectively. The prevalence of systemic lupus erythematosus was estimated in 0.2% (95%CI: 0.1-0.8).
Conclusions: There is a broad spectrum of infor-mation available that indicates an important bur-den of rheumatic diseases in the general Por-tuguese population. Gaps were identified particu-larly regarding inflammatory arthropathies and other systemic rheumatic diseases.
Keywords: Rheumatic Diseases; Burden of Disease; Frequency; Prevalence; Incidence; Portugal.
Introduction
Rheumatic diseases are conditions and functional disorders of the musculoskeletal system of non--traumatic causes. These diseases are a diverse group of conditions with regard to pathophysiolo-gy which are linked not only by the musculoskele-tal structures affected but by their association with pain and consequent reduction in the range of mo-tion and funcmo-tion1,2. They encompass a wide spec-trum of conditions, from those of acute onset and short duration to chronic progressive course disor -ders including osteoarthritis, rheumatoid arthritis, osteoporosis and low back pain3.
Rheumatic conditions are a major cause of mor-bidity throughout the world3,4. They represent an important social and economic problem inflicting enormous costs on health and social care sys-tems4,5. They cause more pain and disability than any other group of conditions with consequent or-gan dysfunction, limitation in activity and restric-tion in social participarestric-tion4. In Europe, nearly one quarter of adults are affected by longstanding mus-culoskeletal problems that limit daily activities6. Al-though affecting all ages, rheumatic diseases become increasingly common with ageing. Conside
-Abstract
Objectives: To describe the frequency of rheuma tic diseases in Portugal through a systematic review of published literature, critically appraising availa ble information and identifying data collection gaps. Methods: We systematically reviewed the literature to retrieve data on the occurrence of rheumatic di -seases in Portugal through MEDLINE and Índex das Revistas Médicas Portuguesas searches, PhD the-ses, and national health surveys reports. Original articles in English or Portuguese published be-tween 1 January 2000 and 31 December 2010 were included.
Results: We retrieved information for the preva-lence of rheumatic diseases, osteoarthritis, back pain, work-related musculoskeletal disorders (WRMDs), osteoporosis, fibromyalgia, rheumatoid arthritis, spondyloarthritis and other systemic rheumatic diseases and for the incidence of back pain, osteoporotic fracture and other systemic rheumatic diseases.
The prevalence of rheumatic diseases ranged from 16.0% to 24.0% and the prevalence of os-teoarthritis was 11.1% (95% confidence intervals (95%CI): 9.4-13.1) in the knee and 5.5% (95%CI: 4.3-7.0) in the hip. Regarding back pain, period prevalence ranged from 8.0% (95%CI: 6.1-10.1) to 29.5% (95%CI: 23.4-36.2) in children and from 12.3% (95%CI: 10.5-14.3) to 51.3% (95%CI: 48.6--53.9) in adults. The prevalence of WRMDs ranged from 5.9% to 84.2% (95%CI: 80.8-87.3). The yearly incidence of osteoporotic fracture (per 100 000) ranged from 93.3 to 481 (95%CI: 407-564) in wo men and from 31.9 to 154 (95%CI: 106-218) in men. The prevalence of osteoporosis in women ranged from 11.0% to 15.4% (95%CI: 13.4-17.6) and in men from 1.1% to 16.8% (95%CI: 12.2-22.3). The prevalence of
ring the increasing number of old people through-out the world and the observed trends in lifestyles, which promote the occurrence of musculoskeletal disorders, the burden of these conditions on pu blic health tends to rise4,6.
Individual and population impact of rheuma tic diseases is certainly high in Portugal according to estimates obtained in other developed societies. However, it is important to systematically collect indicators of the current burden of musculoskeletal conditions in our population, in order to mo -nitor trends and guide health policies7. Although in Portugal, narrative reviews on the frequency of rheumatic diseases, individually or as a group, have been published5,8-10, we believe that the knowledge about these conditions will benefit from a systema -tic approach.
We were interested in original studies estima ting the prevalence and/or incidence of rheumatic di -seases targeted by the National Program against Rheumatic Diseases because of their predicted im-pact at population level, either related to their high frequency or to their strong association with ad-verse health outcomes2,11. These conditions are os-teoarthritis, back pain, periarticular rheumatic disea ses, including work-related musculoskeletal disorders, osteoporosis and osteoporotic fracture, fibromyalgia, microcrystal-related arthropathies, rheumatoid arthritis, spondyloarthritis, other sys-temic rheumatic diseases and pediatric rheuma tic diseases.
Objectives
We aimed to systematically review published scien tific literature on the frequency of rheumatic di seases in Portugal, to critically appraise the avai -la ble information and to identify the gaps in data collection.
Methods
Following the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines12, data on the occurrence of rheumatic diseases in Portugal were obtained through MED-LINE and Índex das Revistas Médicas Portuguesas (Index RMP) searches using the expressions pre-sented in Table I (Date of last search: 30thAugust 2011). We also reviewed PhD theses in the Index
RMP bibliographic database, periodic general health surveys such as the 4th National Health Sur-vey and publications including information on rheumatic diseases. In addition to this strategy, we also performed a cross references search and a full manual search in the journals Acta Reumatológica Portuguesa, Acta Médica Portuguesa, Revista Por-tuguesa de Saúde Pública, Revista PorPor-tuguesa de Clínica Geral and Arquivos de Medicina. Since a re-view on the studies before 2000 estimating the prevalence of rheumatic diseases in Portugal was published in 20025and to optimize the relation be-tween the sensitivity desired and the resources available, original articles in English or Portuguese published between 1 January 2000 and 31 Decem-ber 2010 were included.
For rheumatic diseases, 1 049 articles were re-trieved by MEDLINE and Index RMP bibliogra phic databases. We identified 170 articles for osteoar -thritis, 261 articles for back pain, 86 articles for pe-riarticular rheumatic diseases, 260 articles for work-related musculoskeletal disorders, 345 arti-cles for osteoporosis and osteoporotic fracture, 32 articles for fibromyalgia, 66 articles for microcrys-tal-related arthropathies, 200 articles for rheuma-toid arthritis, 158 articles for spondyloarthritis, 853 articles for other systemic rheumatic diseases and 52 articles for pediatric rheumatic diseases.
Two reviewers (TM and RL) screened all the refe -rences. After reviewing the titles and abstracts and/or the full articles, we excluded those that were clearly unrelated to the study subject, (e.g. stu dies not estimating prevalence or incidence of the condition of interest) or that had a sampling strategy which did not include a random or con-secutive sample of Portuguese subjects).
For rheumatic diseases that almost inevitably lead to hospitalization or medical appointments, such as osteoporotic fracture and juvenile idio-pathic arthritis, studies estimating prevalence and/or incidence based on hospital records were also included.
Through the MEDLINE and Index RMP sear -ches, and after exclusions were made, two studies were included for rheumatic diseases13,14, one study for osteoarthritis13, five studies for back pain13,15-18, two studies for workrelated musculoskeletal di -sor ders19,20, seven studies for osteoporosis and os-teoporotic fracture13,21-26, one study for fibromyal-gia27, two studies for rheumatoid arthritis13,28, two studies for spondyloarthritis13,29, three studies for other systemic rheumatic diseases13,28,30and one
T a b le I . S e a r c h e x p r e s s io n s a n d s y s te m a ti c r e v ie w r e s u lt s a b o u t r h e u m a ti c d is e a s e s o c c u r r e n c e N u m b e r o f re su lt s a ft e r N u m b e r o f B ib li o g ra p h ic d u p li c a te s E x c lu d e d a rt ic le s in c lu d e d a rt ic le s D is e a se s d a ta b a se S e a rc h e x p re ss io n re m o ve d b y t it le a n d a b st ra c t a n d r e fe re n c e s Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (m us cu lo sk el et al d is ea se O R m us cu lo sk el et al d is or de r O R r he um at ic d is ea se s O R s ki n an d co nn ec tiv e tis su e di se as es O R c al ci um m et ab ol is m d is or de r) A N D (P or tu ga l O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: do en ça A N D r eu m át ic a A N D p re va lê nc ia do en ça A N D r eu m át ic a A N D in ci dê nc ia pa to lo gi a A N D r eu m át ic a A N D p re va lê nc ia pa to lo gi a A N D r eu m át ic a A N D in ci dê nc ia pa to lo gi a A N D m us cu lo A N D p re va lê nc ia pa to lo gi a A N D m us cu lo A N D in ci dê nc ia pa to lo gi a A N D o st eo ar tic ul ar A N D p re va lê nc ia pa to lo gi a A N D o st eo ar tic ul ar A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (a rt hr iti s O R o st eo ar th ri tis O R a rt hr os is O R os te oa rt hr os is ) A N D ( Po rt ug al O R P or tu gu es e) A N D (p re va le nc e O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: os te oa rt ro se A N D p re va lê nc ia os te oa rt ro se A N D in ci dê nc ia ar tr os e A N D p re va lê nc ia ar tr os e A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (b ac k pa in O R b ac k ac he ) A N D ( Po rt ug al O R Po rt ug ue se ) A N D ( pr ev al en ce O R in ci de nc e O R oc cu rr en ce O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: ra qu ia lg ia A N D p re va lê nc ia co nt in ue s on t he n ex t p ag e R he um at ic di se as es O st eo ar th ri tis N ot in ci de nc e/ pr ev al en ce st ud ie s of o st eo ar th ri tis : n= 16 7 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 2 N ot in ci de nc e/ pr ev al en ce st ud ie s of b ac k pa in : n = 25 1 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 5 Ba ck p ai n M ed lin e M ed lin e M ed lin e In de x R M P In de x R M P In de x R M P 1 04 9 17 0 26 1 N ot in ci de nc e/ pr ev al en ce st ud ie s of r he um at ic di se as es : n = 1 04 1 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 6 2 13 ,1 4 1 13 13,15 5-18
T a b le I . (c o n ti n u a ti o n ) N u m b e r o f re su lt s a ft e r N u m b e r o f B ib li o g ra p h ic d u p li c a te s E x c lu d e d a rt ic le s in c lu d e d a rt ic le s D is e a se s d a ta b a se S e a rc h e x p re ss io n re m o ve d b y t it le a n d a b st ra c t a n d r e fe re n c e s ra qu ia lg ia A N D in ci dê nc ia ce rv ic al gi a A N D p re va lê nc ia ce rv ic al gi a A N D in ci dê nc ia do r A N D c er vi ca l A N D p re va lê nc ia do r A N D c er vi ca l A N D in ci dê nc ia lo m ba lg ia A N D p re va lê nc ia lo m ba lg ia A N D in ci dê nc ia do r A N D lo m ba r A N D p re va lê nc ia do r A N D lo m ba r A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (s of t tis su e in ju ry O R b ur si tis O R t en di ni tis O R te no sy no vi tis O R e nt he so pa th y O R c ap su lit is ) A N D (P or tu ga l O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: pa to lo gi a A N D p er ia rt ic ul ar A N D p re va lê nc ia pa to lo gi a A N D p er ia rt ic ul ar A N D in ci dê nc ia te nd in ite A N D p re va lê nc ia te nd in ite A N D in ci dê nc ia te no ss in ov ite A N D p re va lê nc ia te no ss in ov ite A N D in ci dê nc ia en te si te A N D p re va lê nc ia en te si te A N D in ci dê nc ia bu rs ite A N D p re va lê nc ia bu rs ite A N D in ci dê nc ia ca ps ul ite A N D p re va lê nc ia ca ps ul ite A N D in ci dê nc ia lig am en tit e A N D p re va lê nc ia lig am en tit e A N D in ci dê nc ia co nt in ue s on t he n ex t p ag e Pe ri ar tic ul ar rh eu m at ic di se as es N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 1 M ed lin e In de x R M P 86 N ot in ci de nc e/ pr ev al en ce st ud ie s of p er ia rt ic ul ar rh eu m at ic d is ea se s: n= 85 0
T a b le I . (c o n ti n u a ti o n ) N u m b e r o f re su lt s a ft e r N u m b e r o f B ib li o g ra p h ic d u p li c a te s E x c lu d e d a rt ic le s in c lu d e d a rt ic le s D is e a se s d a ta b a se S e a rc h e x p re ss io n re m o ve d b y t it le a n d a b st ra c t a n d r e fe re n c e s Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (o cc up at io na l O R w or k) A N D m us cu lo sk el et al d is ea se ) A N D ( Po rt ug al O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: re um at ol og ia A N D o cu pa ci on al A N D p re va lê nc ia re um at ol og ia A N D o cu pa ci on al A N D in ci dê nc ia le s* A N D m us cu lo A N D p re va lê nc ia le s* A N D m us cu lo A N D in ci dê nc ia LM ER T A N D p re va lê nc ia LM ER T A N D in ci dê nc ia LM EL T A N D p re va lê nc ia LM EL T A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (o st eo po ro si s O R o st eo po ro tic fr ac tu re ) A N D ( Po rt ug al O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R oc cu rr en ce O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: os te op or os e A N D p re va lê nc ia os te op or os e A N D in ci dê nc ia fr ac tu ra A N D p re va lê nc ia fr ac tu ra A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (fi br om ya lg ia O R fi br om yo si tis O R c hr on ic fa tig ue sy nd ro m e) A N D ( Po rt ug al O R P or tu gu es e) A N D (p re va le nc e O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: fib ro m ia lg ia A N D p re va lê nc ia fib ro m ia lg ia A N D in ci dê nc ia si nd ro m e fib ro m iá lg ic o A N D p re va lê nc ia si nd ro m e fib ro m iá lg ic o A N D in ci dê nc ia «f ad ig a cr ón ic a» A N D p re va lê nc ia «f ad ig a cr ón ic a» A N D in ci dê nc ia co nt in ue s on t he n ex t p ag e W or k-re la te d m us cu lo sk el et al di so rd er s O st eo po ro si s an d os te op or ot ic fr ac tu re Fi br om ya lg ia M ed lin e M ed lin e M ed lin e In de x R M P In de x R M P In de x R M P 26 0 34 5 32 N ot in ci de nc e/ pr ev al en ce st ud ie s of w or k-re la te d m us cu lo sk el et al d is or de rs : n= 24 8 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 10 N ot in ci de nc e/ pr ev al en ce st ud ie s of o st eo po ro si s an d os te op or ot ic fr ac tu re : n = 33 0 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 8 N ot in ci de nc e/ pr ev al en ce st ud ie s of fi br om ya lg ia : n = 30 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 1 2 19 ,2 0 7 13 ,2 1-26 1 27
T a b le I . (c o n ti n u a ti o n ) N u m b e r o f re su lt s a ft e r N u m b e r o f B ib li o g ra p h ic d u p li c a te s E x c lu d e d a rt ic le s in c lu d e d a rt ic le s D is e a se s d a ta b a se S e a rc h e x p re ss io n re m o ve d b y t it le a n d a b st ra c t a n d r e fe re n c e s Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (g ou t O R c ho nd ro ca lc in os is O R c ry st al a rt hr op at h* ) A N D ( Po rt ug al O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: ar tr op at ia A N D p re va lê nc ia ar tr op at ia A N D in ci dê nc ia go ta A N D p re va lê nc ia go ta A N D in ci dê nc ia pi ro fo sf at o A N D c ál ci o A N D p re va lê nc ia pi ro fo sf at o A N D c ál ci o A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : rh eu m at oi d ar th ri tis A N D ( Po rt ug al O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: ar tr ite A N D p re va lê nc ia ar tr ite A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (s po nd yl oa rt hr op at hi es O R s po nd yl ar th ro pa th * O R ps or ia tic a rt hr iti s O R a rt hr iti c ps or ia si s O R a nk yl os in g sp on dy lit is O R b ec ht er ew d is ea se O R r ei te r O R r ea ct iv e ar th ri tis O R p os tin fe ct io us a rt hr iti s) A N D ( Po rt ug al O R Po rt ug ue se ) A N D ( pr ev al en ce O R in ci de nc e O R oc cu rr en ce O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: es po nd il* A N D p re va lê nc ia es po nd il* A N D in ci dê nc ia ps or ia * A N D p re va lê nc ia ps or ia * A N D in ci dê nc ia si nd ro m * A N D R ei te r A N D p re va lê nc ia si nd ro m * A N D R ei te r A N D in ci dê nc ia SA PH O A N D p re va lê nc ia SA PH O A N D in ci dê nc ia C on tin ue s on t he n ex t p ag e M ic ro cr ys ta l--r el at ed ar th ro pa th ie s R he um at oi d ar th ri tis Sp on dy lo -ar th ri tis M ed lin e M ed lin e M ed lin e In de x R M P In de x R M P In de x R M P 0 20 0 15 8 N ot in ci de nc e/ pr ev al en ce st ud ie s of m ic ro cr ys ta l-r el at ed ar th ro pa th ie s: n= 66 N ot in ci de nc e/ pr ev al en ce st ud ie s of r he um at oi d ar th ri tis : n= 19 8 N ot in ci de nc e/ pr ev al en ce st ud ie s of s po nd yl oa rt hr iti s: n= 15 5 N ot P or tu gu es e ge ne ra l po pu la tio n ba se d st ud ie s: n= 1 66 13,22 8 2 13 ,2 9
T a b le I . (c o n ti n u a ti o n ) N u m b e r o f re su lt s a ft e r N u m b e r o f B ib li o g ra p h ic d u p li c a te s E x c lu d e d a rt ic le s in c lu d e d a rt ic le s D is e a se s d a ta b a se S e a rc h e x p re ss io n re m o ve d b y t it le a n d a b st ra c t a n d r e fe re n c e s Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (s ys te m ic r he um at ic d is ea se O R c on ne ct iv e tis su e di se as es O R a ut oi m m un e di se as es O R m yo si tis O R va sc ul iti s O R s ki n di se as es , v as cu la r) A N D ( Po rt ug al O R Po rt ug ue se ) A N D ( pr ev al en ce O R in ci de nc e O R oc cu rr en ce O R fr eq ue nc y) A rt ic le s an d Ph D t he se s fr om 2 00 0 to 2 01 0: do en ça A N D r eu m át ic a A N D s is té m ic a A N D p re va lê nc ia do en ça A N D r eu m át ic a A N D s is té m ic a A N D in ci dê nc ia do en ça A N D t ec id o A N D c on ju nt iv o A N D p re va lê nc ia do en ça A N D t ec id o A N D c on ju nt iv o A N D in ci dê nc ia co ne ct iv ite A N D p re va lê nc ia co ne ct iv ite A N D in ci dê nc ia do en ça A N D a ut oi m un e A N D p re va lê nc ia do en ça A N D a ut oi m un e A N D in ci dê nc ia es cl er os e A N D s is té m ic a A N D p re va lê nc ia es cl er os e A N D s is té m ic a A N D in ci dê nc ia po lim io si te A N D p re va lê nc ia po lim io si te A N D in ci dê nc ia de rm at om io si te A N D p re va lê nc ia de rm at om io si te A N D in ci dê nc ia va sc ul ite A N D p re va lê nc ia va sc ul ite A N D in ci dê nc ia lú pu s A N D e ri te m at os o A N D s is té m ic o A N D p re va lê nc ia lú pu s A N D e ri te m at os o A N D s is té m ic o A N D in ci dê nc ia Sj og re n A N D p re va lê nc ia Sj og re n A N D in ci dê nc ia Pu bl ic at io n D at e - fr om 2 00 0/ 1/ 01 t o 20 10 /1 2/ 31 : (p ed ia tr ic r he um at ic d is ea se s O R ju ve ni le a rt hr iti s) A N D ( Po rt ug al O R P or tu gu es e) A N D ( pr ev al en ce O R in ci de nc e O R o cc ur re nc e O R fr eq ue nc y) C on tin ue s on t he n ex t p ag e O th er sy st em ic rh eu m at ic di se as es Pe di at ri c rh eu m at ic di se as es M ed lin e In de x R M P 85 3 N ot in ci de nc e/ pr ev al en ce st ud ie s of o th er s ys te m ic rh eu m at ic d is ea se s: n= 85 0 3 13 ,2 8, 30 52 N ot in ci de nc e/ pr ev al en ce st ud ie s of p ed ia tr ic r he um at ic di se as es : n = 51 1 31
study for pediatric rheumatic diseases31.
For their relevance in population-based mea-sures and indicators we obtained also data from the 4th National Health Survey, carried out by the Na-tional Health Institute Doutor Ricardo Jorge (INSA, IP) and Statistics Portugal (INE, IP)32, from the ECOS project (Em Casa Observamos Saúde), an observa-tion tool created by INSA, IP14,33, and from the Net-work of Sentinel Doctors, a primary care surveillance system from the National Institute of Health based on a network of general practitio ners18,34,35.
Through the cross references search and full manual search we additionally identified two stu -dies for back pain36,37and seven studies for work-related musculoskeletal disorders38-44.
For each study, we extracted information on first author, year of publication, period of data collec-tion, data collection method, case definition used, study population addressed, characteristics of the subjects evaluated (gender and age of the partici-pants), sample size, participation/response rate and a summary of the estimates. Researchers were contact directly when studies did not present re-sults in a format that could be used in the inci-dence and prevalence tables. A summary of the characteristics of the studies included in this sys-tematic review and results on the frequency of rheumatic diseases are presented in Tables II to XI. We conducted a thorough assessment of the methodological quality of the included studies using the checklist for incidence and prevalence studies of chronic diseases (Methodological Eva -luation of Observational Research)45. For each study, the report firstly lists flaws and issues not reported related to external validity followed by flaws and is-sues not reported related to internal validity. The authors of this checklist did not propose numerical rating of quality, quantitative values for criteria or numerical weighting of flaws. We did not appraise the methodological quality of two articles estimat-ing the frequency of acute low back pain18,35since it is not a chronic disease and of one article providing prevalence of several rheumatic diseases28, since it was based on secondary data combining informa-tion from patients followed by specialists and the prevalence of these diseases in other countries.
Results
We identified 32 studies reporting the incidence or the prevalence of rheumatic diseases in the
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T a b le I I. F r e q u e n c y o f r h e u m a ti c d is e a s e s ( s tu d ie s c h a r a c te r is ti c s a n d r e s u lt s ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s IN SA , I P/ IN E, 20 05 -2 00 6 Fa ce t o To h av e or h av e ha d an y R es id en ts in 48 .4 % 41 1 93 76 % A ge g ro up s Li fe tim e pr ev al en ce : IP , 2 00 9 32 fa ce rh eu m at ic d is ea se /P re vi ou s Po rt ug al fa m ili ar in di vi du al s (y ea rs ): Bo th s ex es : 1 6. 0% in te rv ie w m ed ic al o r nu rs in g dw el lin gs (1 5 23 9 < 15 : 1 5. 6% M : 1 1. 1% ; F : 2 0. 5% di ag no si s of a r he um at ic dw el lin gs ) 15 -2 4: 1 2. 4% Li fe tim e pr ev al en ce ( m ed ic al di se as e/ To h av e or h av e 25 -3 4: 1 5. 6% or n ur si ng d ia gn os is ): ha d an y rh eu m at ic d is ea se 35 -4 4: 1 4. 8% Bo th s ex es : 1 4. 6% in t he p re vi ou s ye ar ( al l 45 -5 4: 1 3. 3% Pr ev al en ce in t he p re vi ou s se lf-re po rt ed ) 55 -6 4: 1 1. 2% ye ar : B ot h se xe s: 14 .5 % 65 -7 4: 9 .6 % 75 -8 4: 5 .9 % ≥ 85 : 1 .5 % Br an co M , 20 04 Te le ph on e To h av e a rh eu m at ic R es id en ts in 47 .4 % 2 82 0 82 .1 % A ge g ro up s Po in t pr ev al en ce : 20 05 14 in te rv ie w di se as e (s el f-r ep or te d) Po rt ug al (y ea rs ) Bo th s ex es : 2 4. 0% m ai nl an d fa m ili ar 0-4: 2 .8 % (9 5% C I:2 2. 4-25 .7 ) dw el lin gs w ith 5-9: 4 .3 % M : 1 8. 3% ( 95 % C I:1 6. 2-20 .6 ) la nd lin e 10 -1 4: 4 .8 % F: 2 9. 1% ( 95 % C I:2 6. 7-31 .7 ) (P or tu ga l 15 -2 4: 1 2. 6% Te le co m ) 25 -3 4: 1 2. 6% 35 -4 4: 12 .8 % 45 -5 4: 14 .4 % 55 -6 4: 1 4. 8% 65 -7 4: 1 2. 6% > 75 : 8 .2 % C os ta L , 19 99 -2 00 3 Fa ce t o H is to ry o f m ed ic al A du lt 36 .4 % 1 23 8 70 .0 % A ge g ro up s Li fe tim e pr ev al en ce : 20 04 13 fa ce di ag no se d of , a t le as t, on e po pu la tio n (y ea rs ): Bo th s ex es : 2 3. 0% in te rv ie w of t he se d is ea se s: rh eu m at oi d of t he c ity o f ≤ 40 : 3 3. 9% M : 1 3. 1% ( 95 % C I:1 0. 2-16 .6 ) ar th ri tis , s ys te m ic lu pu s Po rt o 41 -5 9: 3 6. 2% F: 2 8. 7% ( 95 % C I:2 5. 6-32 .0 ) er yt he m at os us , a nk yl os in g > 59 : 2 9. 9% sp on dy lit is , p so ri at ic a rt hr iti s, hi p os te oa rt hr iti s, kn ee os te oa rt hr iti s an d ch ro ni c lo w b ac k pa in ( se lf-re po rt ed ) IN SA , I P/ IN E, IP – N at io na l I ns tit ut e of H ea lth /S ta tis tic s-Po rt ug al ; M – m al es ; F – fe m al es ; 9 5% C I 9 5% c on fid en ce in te rv al s.
tuguese population and published during the last decade.
Rheumatic diseases
Two studies meeting our inclusion criteria des cribing the overall prevalence of rheumatic disea ses were identified from the bibliographic database search13,14. Additionally we identified the 4th National Health Survey from which we calculated the lifetime preva-lence of rheumatic diseases32(Table II).
The number of subjects evaluated ranged from 1 238, 36.4% males, in Costa et al (2004)13to 41 193, 48.4% males, in the 4th National Health Survey32. Branco et al (2005)14and the 4th National Health Survey described samples with wide age ranges (from childhood to over 75) while Costa et al (2004) enrolled participants over 18 years. In these three studies the cases of rheumatic disease were de-fined according the participant’s self-reported history of any medicallydiagnosed rheumatic disea se. Overall, the prevalence of selfreported rheu -matic disease ranged from 16.0%32to 24.0%14. In women estimates ranged from 20.5% 32to 29.1% (95% confidence intervals (95%CI): 26.7-31.7)14and in men these ranged from 11.1% 32to 18.3% (95%CI: 16.2-20.6)14.
Osteoarthritis
The prevalence of osteoarthritis was obtained from the aforementioned study by Costa et al (2004)13 (Table III). Cases were defined according to self-re-ported history of clinically diagnosed hip and/or knee osteoarthritis. Overall the prevalence of self-reported osteoarthritis was higher in the knee [11.1% (95%CI: 9.4-13.1)] than in the hip [5.5% (95%CI: 4.3-7.0)].
Back pain
We identified two studies estimating the inci-dence18,35and seven studies estimating the preva-lence of back pain13,15-17,33,36,37(Table IV). Both stu -dies estimating incidence were performed by the Network of Sentinel Doctors through registration of new episodes of acute low back pain in 200318 and in 200435. In 2004, in 124 709 patients (47.8% males), the global yearly incidence was 1 817.8 per 100 000 population, higher in women (2 157.4) than in men (1 446.7)35. Prevalence studies des -cribed samples that ranged from 215 [Vital et al (2006)37] to 4 817 participants [Matos et al (2006)36] and a male proportion varying from 35.4% [Ra biais et al (2003)33] to 55.8% [Vital et al (2006)]. These T a b le I II . F r e q u e n c y o f o s te o a r th r it is ( s tu d ie s c h a r a c te r is ti c s a n d r e s u lt s ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s C os ta L , 19 99 -2 00 3 Fa ce t o H is to ry o f m ed ic al d ia gn os ed A du lt 36 .4 % 1 23 8 70 .0 % A ge g ro up s Li fe tim e pr ev al en ce ( hi p 20 04 13 fa ce hi p os te oa rt hr iti s or k ne e po pu la tio n of (y ea rs ): os te oa rt hr iti s) : B ot h se xe s: in te rv ie w os te oa rt hr iti s (s el f-r ep or te d) th e ci ty o f P or to ≤ 40 : 3 3. 9% 5. 5% ( 95 % C I:4 .3 -7 .0 ) 41 -5 9: 3 6. 2% M : 2 .2 % ( 95 % C I:1 .1 -4 .2 ) >5 9: 2 9. 9% F: 7. 4% ( 95 % C I:5 .7 -9 .5 ) Li fe tim e pr ev al en ce ( kn ee os te oa rt hr iti s) : B ot h se xe s: 11 .1 % ( 95 % C I:9 .4 -1 3. 1) M : 5 .9 % ( 95 % C I:3 .9 -8 .6 ) F: 14 .2 % ( 95 % C I:1 1. 8-16 .9 ) M – m al es ; F – fe m al es ; 9 5% C I 9 5% c on fid en ce in te rv al s.
T a b le I V . F r e q u e n c y o f b a c k p a in ( s tu d ie s c h a r a c te r is ti c s a n d r e s u lt s ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e p a rt ic ip a ti o n d is tr ib u ti o n E st im a te s N et w or k of 20 04 N ew c as es C lin ic al c ri te ri a fo r C lie nt s of 47 .8 % 12 4 70 9 2. 3% o f g en er al A ge g ro up s Ye ar ly in ci de nc e ra te : Se nt in el of d is ea se th e di ag no si s of m ai nl an d pa tie nt s pr ac tic tio ne rs (y ea rs ): Bo th s ex es : 1 8 17 .8 p er D oc to rs , no tif ie d ac ut e lo w b ac k pa in Po rt ug al h ea lth (1 29 in P or tu ga l 0-4: 5 .8 % 10 0 00 0 20 06 35 by t he ca re c en te rs ge ne ra l 5-9: 5 .2 % M : 1 4 46 .7 p er 1 00 0 00 ph ys ic ia ns pr ac tic -10 -1 4: 5 .4 % F: 2 1 57 .4 p er 1 00 0 00 ne tw or k tio ne rs ) 15 -2 4: 1 2. 9% 25 -3 4: 1 5. 9% 35 -4 4: 1 4. 6% 45 -5 4: 1 2. 5% 55 -6 4: 1 0. 2% 65 -7 4: 9 .9 % ≥ 75 : 7 .6 % R ab ia is S , 20 02 Te le ph on e Lo w b ac k pa in A du lt re si de nt s 35 .4 % 1 41 4 84 .6 % A ge g ro up s Pr ev al en ce in t he p re vi ou s 20 03 33 in te rv ie w in t he p re vi ou s w ee k in P or tu ga l (y ea rs ): w ee k: B ot h se xe s: 51 .3 % (a t le as t on e da y) m ai nl an d fa m ili ar 18 -2 4: 5 .8 % (9 5% C I:4 8. 6-53 .9 ) dw el lin gs w ith 25 -3 4: 8 .3 % M : 3 6. 5% ( 95 % C I:3 2. 2-40 .9 ) la nd lin e (P or tu ga l 35 -4 4: 1 8. 0% F: 5 9. 4% ( 95 % C I:5 6. 2-62 .6 ) Te le co m ) 45 -5 4: 1 9. 9% 55 -6 4: 2 0. 8% 65 -7 4: 1 7. 4% ≥ 75 : 9 .7 % N ot s pe ci fie d: 1. 3% C os ta L , 19 99 -2 00 3 Fa ce t o H is to ry o f m ed ic al A du lt 36 .4 % 1 23 8 70 .0 % A ge g ro up s Li fe tim e pr ev al en ce : 20 04 13 fa ce di ag no se d ch ro ni c lo w po pu la tio n (y ea rs ): Bo th s ex es : 1 2. 3% in te rv ie w ba ck p ai n (la st in g of t he c ity o f ≤ 40 : 3 3. 9% (9 5% C I:1 0. 5-14 .3 ) m or e th an 3 m on th s) Po rt o 41 -5 9: 3 6. 2% M : 6 .4 % ( 95 % C I:4 .4 -9 .2 ) (s el f-r ep or te d) > 59 : 2 9. 9% F: 1 5. 6% ( 95 % C I:1 3. 2-18 .4 ) Po nt e C , 20 04 Te le ph on e Lo w b ac k pa in A du lt us er s of 52 .0 % 29 6 98 .6 % A ge g ro up s Pr ev al en ce in t he p re vi ou s 20 05 15 in te rv ie w in t he p re vi ou s a he al th c en te r (y ea rs ): 6 m on th s: Bo th s ex es : 4 9. 0% 6 m on th s of P or to 18 -2 9: 1 9. 6% (9 5% C I: 43 .3 -5 4. 7) 30 -3 9: 2 4. 3% M : 4 4. 2% ( 95 % C I:3 6. 2-52 .4 ) 40 -4 9: 2 2. 0% F: 5 4. 2% ( 95 % C I:4 5. 7-62 .6 ) 50 -6 5: 3 4. 1% C on tin ue s on t he n ex t p ag e
T a b le I V . (c o n ti n u a ti o n ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e p a rt ic ip a ti o n d is tr ib u ti o n E st im a te s M at os M , 20 06 Se lf ad m i-Ba ck p ai n in t he 6t h, 8 th a nd 49 .6 % 4 81 7 1, 6% o f t he M ea n ag e: Pr ev al en ce in t he p re vi ou s 20 06 36 ni st ra te d pr ev io us 6 m on th s 10 th g ra de s po pu la tio n of 14 y ea rs 6 m on th s: qu es tio n-(a lm os t ev er y da y Po rt ug ue se st ud en ts e nr ol le d Bo th s ex es : 1 2. 9% na ir e pa in o r m or e st ud en ts in a ca de m ic y ea r M : 9 .5 % th an o nc e a w ee k) 20 05 /2 00 6 F: 1 6. 2% C os ta M , 19 99 -2 00 0 Fa ce t o Ba ck p ai n in t he Pu bl ic s ch oo l 45 .6 % 76 7 n/ av M ea n ag e Pr ev al en ce in t he p re vi ou s 20 02 16 fa ce pr ev io us 3 m on th s st ud en ts fr om (s ta nd ar d 3 m on th s: in te rv ie w th e m et ro po lit an de vi at io n) ; Bo th s ex es : 8 .0 % by a r he u-re gi on o f L is bo n [r an ge ]: 10 .6 (9 5% C I: 6. 1-10 .1 ) m at ol og is t (2 .4 ) ye ar s; M : 4 .3 % ( 95 % C I:2 .4 -7 .0 ) [6 -1 7] F: 1 1. 0% ( 95 % C I:8 .2 -1 4. 4) C oe lh o L, 20 05 -2 00 6 Se lf ad m i-A ll an d an y ki nd o f Yo un g pe op le 47 .6 % 43 9 n/ av M ea n ag e A nn ua l p re va le nc e: 20 09 17 ni st ra te d pa in fu l c om pl ai nt in re si de nt in t he (s ta nd ar d Bo th s ex es 2 0. 5% qu es tio n th e lu m ba r re gi on G re at er L is bo n de vi at io n) ; (9 5% C I:1 6. 8-24 .6 ) -n ai re w hi ch h as la st ed a t ar ea a nd [r an ge ]: 13 .0 M : 1 1. 0% ( 95 % C I:7 .1 -1 6. 0) le as t 24 h ou rs at te nd in g (1 .1 ) ye ar s; F: 2 9. 2% ( 95 % C I:2 3. 3-35 .5 ) ed uc at io na l [1 1-15 ] Po in t p re va le nc e: es ta bl is hm en ts Bo th s ex es : 1 6. 3% th er e (b ot h (9 5% C I:5 .2 -1 0. 4) st at e-ru n an d Li fe tim e pr ev al en ce : pr iv at e) Bo th s ex es : 2 5. 5% (9 5% C I:2 1. 5-29 .9 ) V ita l E , 2 00 6 37 20 03 -2 00 4 Se lf ad m i-Ba ck p ai n in t he 5t h gr ad e 55 .8 % 21 5 97 .3 % A ge ( ye ar s) : Pr ev al en ce in t he p re vi ou s ni st ra te d pr ev io us 6 m on th s st ud en ts fr om 10 : 5 3. 0% 6 m on th s: qu es tio n-(a lm os t ev er y da y tw o Po rt ug al 11 : 3 1. 2% 29 .5 % ( 95 % C I:2 3. 4-36 .2 ) I -n ai re pa in o r m or e th an C en te r re gi on 12 : 1 2. 6% Pr ev al en ce in t he p re vi ou s on ce a w ee k) m un ic ip al iti es 13 : 3 .3 % 6 m on th s (fi rs t ep is od es ): Bo th s ex es : 1 6. 3 (9 5% C I:1 1. 6-22 .1 ) II n/ av – N ot a va ila bl e; M – m al es ; F – fe m al es ; 9 5% C I – 9 5% c on fid en ce in te rv al s; I, II – Es tim at es c al cu la te d fr om t he r es ul ts p re se nt ed in t he s tu dy
T a b le V . F r e q u e n c y o f w o r k -r e la te d m u s c u lo s k e le ta l d is o r d e r s ( s tu d ie s c h a r a c te r is ti c s a n d r e s u lt s ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s C un ha -20 06 Q ue st io n-C lin ic al ly r el ev an t La rg e di m en si on 48 .4 % 41 0 49 6 62 .3 % M ea n ag e Po in t pr ev al en ce : -M ir an da L , na ir e se nt W R M D s co m pa ni es in w or ke rs (s ta nd ar d 5. 9% ( to ta l W R M D s cl in ic al ly 20 10 19 to t he Po rt ug al ( ov er (5 15 de vi at io n) : re le va nt ) oc cu pa tio na l 25 0 em pl oy ee s) co m pa -M : 3 9. 5 (5 .7 ) Ba ck p ai n: 4 .2 % ph ys ic ia n ni es ) ye ar s C er vi ca l p ai n: 1 .1 % F: 3 7. 9 (5 .1 ) D or sa l p ai n: 0 .8 % ye ar s Lo w b ac k pa in : 2 .3 % U pp er li m b: 1 .6 % Sh ou ld er t en do ni tis : 0 .6 % C ar pa l t un ne l s yn dr om e: 0 .3 % El bo w t en do ni tis : 0 .3 % H an d te nd on iti s: 0. 4% Lo w er li m b te nd on iti s: 0. 1% Pa re nt -20 05 Fa ce t o fa ce Ba ck ac he o r m us cu la r R es id en ts in n/ av 1 00 0 67 % n/ av Po in t pr ev al en ce o f b ac ka ch e: -T hi ri on A , in te rv ie w pa in s in s ho ul de rs , Po rt ug al in p ai d 30 .7 % 20 07 38 ne ck a nd /o r up pe r/ em pl oy m en t Po in t pr ev al en ce o f m us cu la r lo w er li m bs r el at ed t o (e m pl oy ee s an d pa in s in s ho ul de rs , n ec k an d/ or oc cu pa tio na l a ct iv ity se lf-em pl oy ed ), up pe r/ lo w er li m bs : 2 8. 8% du ri ng t he fi el d-w or k pe ri od (o ve r 15 y ea rs o ld ) C ar ni de F , 20 04 In te rv ie w W R M Ss ( pr es en ce o f A ut om ob ile n/ av 29 n/ av M ea n ag e Po in t pr ev al en ce : 20 06 20 an d a cl in ic al pa in o r pa ra es th es ia in du st ry w or ke rs (s ta nd ar d N ec k: W R M Ss : 1 0. 3% ex am du ri ng t he la st y ea r, (p ai nt a re a de vi at io n) : 3 7. 7 (9 5C I% :2 .2 -2 7. 4) co nd uc te d w ith e pi so de s la st in g pr od uc tio n) (8 .2 ) ye ar s W R M D s: 58 .6 % by a n oc cu -fo r at le as t 1 w ee k or (9 5% C I:3 8. 9-76 .5 ) pa tio na l oc cu rr in g at le as t on ce R ig ht s ho ul de r: W R M Ss : 2 4. 1% m ed ic al a m on th , w ith n o pr e-(9 5% C I:1 0. 3-43 .5 ) do ct or vi ou s ac ut e tr au m a) / W R M D s: 20 .7 % /W R M D s ev al ua te d (9 5% C I:8 .0 -3 9. 7) by a n oc cu pa tio na l Le ft s ho ul de r: W R M Ss : 6 .9 % m ed ic al d oc to r (9 5% C I:0 .8 -2 2. 8) C on tin ue s on t he n ex t p ag e
T a b le V . ( c o n ti n u a ti o n ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s W R M D s: 10 .3 % (9 5% C I:2 .2 -2 7. 4) R ig ht e lb ow : W R M Ss : 1 7. 2% (9 5% C I:5 .8 -3 5. 8) W R M D s: 24 .1 % ( 95 % C I:1 0. 3-43 .5 ) Le ft e lb ow : W R M Ss : 0 .0 % (9 5% C I:0 .0 -1 2. 0) W R M D s: 3. 4% ( 95 % C I:0 .1 -1 7. 8) R ig ht w ri st : W R M Ss : 2 7. 6% (9 5% C I:1 2. 7-47 .2 ) W R M D s: 24 .1 % ( 95 % C I:1 0. 3-43 .5 ) Le ft w ri st : W R M Ss : 6 .9 % (9 5% C I:0 .8 -2 2. 8) W R M D s: 17 .2 % ( 95 % C I:5 .8 -3 5. 8) R ig ht h an d: W R M Ss : 1 0. 3% (9 5% C I:2 .2 -2 7. 4) W R M D s: 17 .2 % ( 95 % C I:5 .8 -3 5. 8) Le ft h an d: W R M Ss : 0 .0 % (9 5% C I:0 .0 -1 2. 0) W R M D s: 10 .3 % ( 95 % C I:2 .2 -2 7. 4) Se rr an he ir a F, 20 01 Se lf-ad m in is -W R M Ss in t he A ut om ob ile 16 .1 % 57 4 63 .2 % M od al c la ss Pr ev al en ce in t he p re vi ou s ye ar : 20 03 39 te re d qu es pr ev io us y ea r/ w ee k co m po ne nt s [r an ge ]: 26 -3 3 C er vi ca l r eg io n: 8 3. 0% tio nn ai re (a da pt at io n of t he in du st ry w or ke rs ye ar s [1 8-65 ] Sh ou ld er s: 57 .5 % St an da rd is ed N or di c (in du st ry in El bo w s: 21 .4 % qu es tio nn ai re fo r th e Se tu ba l p en in su la ) W ri st s/ ha nd s: 66 .7 % an al ys is o f m us cu lo s-U pp er b ac k re gi on : 5 0. 3% ke le ta l s ym pt om s) Lo w b ac k re gi on : 5 5. 4% H ip s/ th ig h: 3 1. 1% Le gs /k ne es : 7 1. 2% A nk le s/ fe et : 6 3. 7% Pr ev al en ce in t he p re vi ou s w ee k: C er vi ca l r eg io n: 2 9. 1% C on tin ue s on t he n ex t p ag e
T a b le V . ( c o n ti n u a ti o n ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s Sh ou ld er s: 24 .2 % El bo w s: 8. 3% W ri st s/ ha nd s: 32 .1 % U pp er b ac k re gi on : 2 1. 4% Lo w b ac k re gi on : 2 3. 5% H ip s/ th ig h: 1 4. 5% Le gs /k ne es : 3 5. 3% A nk le s/ fe et : 3 0. 2% U va A , 2 00 5 40 20 02 Se lf-ad m in is -Ba ck p ai n re la te d to M in is tr y of 25 % 1 75 4 41 % A ge g ro up s Po in t pr ev al en ce : tr at ed q ue s-oc cu pa tio na l a ct iv ity H ea lth w or ke rs (y ea rs ): Bo th s ex es : 4 7% tio nn ai re (p hy sic ia ns , n ur se s, < 20 : 1 .1 % he al th c ar e al lie d 20 -2 9: 2 0. 9% pr of es si on al s an d 30 -3 9: 3 0. 7% cl er ks w or ki ng in 40 -4 9: 2 5. 7% he al th fa ci lit ie s, in 50 -5 9: 1 8. 6% go ve rn m en t ag en -≥ 60 : 2 .3 % ci es a nd in o th er N ot s pe ci fie d: se ct or s no t di re c-0. 7% tly r el at ed t o th e pr ov is io n of c ar e) C ar ne ir o P, 20 03 Se lf-ad m in is -Pa in o r di sc om fo rt Po rt ug ue se 44 % 69 7 16 .6 % M ea n ag e Pr ev al en ce in t he p re vi ou s ye ar : 20 05 41 te re d qu es -re la te d to de nt is ts (s ta nd ar d M : 7 5. 5% ( 95 % C I:6 9. 8-80 .5 ) tio nn ai re oc cu pa tio na l a ct iv ity de vi at io n) : F: 8 3. 3% ( 95 % C I:7 9. 0-87 .0 ) M : 3 6. 1 (8 .3 ) ye ar s F: 32 .1 (6 .2 ) y ea rs V ilã o S, 20 00 Se lf-ad m in is -H av e su ffe re d at le as t Ph ys io th er ap is ts 13 % 41 n/ av A ge g ro up s Li fe tim e pr ev al en ce : 20 05 42 te re d qu es - on e W R M D s w or ki ng in (y ea rs ): Bo th s ex es : 5 8. 5% tio nn ai re (s el f-r ep or te d) Po rt ug al C en te r 21 -3 0: 5 0% (9 5% C I:4 2. 1-73 .7 ) re gi on h os pi ta ls 31 -4 0: 4 2% 41 -6 0: 8 % Fo ns ec a R , 20 04 Se lf-ad m in is -W R M Ss N ur se s w or ki ng 16 % 50 7 56 % M ed ia n [r an ge ]: Pr ev al en ce in t he p re vi ou s ye ar : 20 06 43 te re d qu es - (S ta nd ar di se d N or di c in P or to 31 y ea rs Bo th s ex es : 8 4. 2% tio nn ai re qu es tio nn ai re fo r th e ho sp ita ls [2 2-63 ] (9 5% C I: 80 .8 -8 7. 3) C on tin ue s on t he n ex t p ag e
studies used distinct definitions of back pain and different prevalence estimates (point prevalence17, period prevalence in previous specified days/ /months/years15-17,33,36or life-time prevalence13,17). In four studies samples of children and adolescents (6 to 17 years) were evaluated16,17,36,37and three stu dies en-rolled adults13,15,33. Among children and ado-lescents, the prevalence of back pain ranged from 8.0% (95%CI: 6.1-10.1), if classified as pain in the previous three months16, to 29.5% (95%CI: 23.4-36.2), if classified as pain in the previous six months37. In adults, low back pain prevalence ranged from 12.3% (95%CI: 10.5-14.3), when eva luated as life-time low back pain las ting more than three months13, to 51.3% (95%CI: 48.6-53.9), when classified as at least one day of pain in the pre vious seven days33.
Work-related musculoskeletal disorders
We identified nine studies estimating the prevalence of work-related musculoskeletal disorders (WRMDs)19,20,38-44(Table V). To define cases of WRMDs Cunha-Miranda et al (2010)19 and Carnide et al (2006)20considered only cli -ni cally relevant di sorders, with medical diag-nosis, while other stu dies considered work-related musculoskeletal symptoms (WRMSs) as reported by workers38-44. The sample sizes ranged from 29 [Carnide et al (2006)] to 1 000 (Parent-Thirion et al 200738) when workers were inquired directly while, in the study by Cunha-Miranda et al (2010) addressing 515 occupational health doctors, a coverage of 410 496 workers was achieved19. The proportion of males ranged from 13.0% [Vilão et al (2005)42 to 48.4% (Cunha-Miranda et al (2010)], (the gender distribution was not available for two studies20,38), and Parent-Thirion et al (2007) in-cluded workers from the age of 15. Cunha-Mi-randa et al (2010), Pa rent-Thirion et al (2007) and Uva et al (2005)40presented data on the prevalence on WRMDs for seve ral profes-sional categories whereas other studies fo-cused on particular occupational activities (e.g. industrial workers20,39, health care providers41-44). The prevalence of WRMDs ranged from 5.9%, considering cli nically rele-vant disorders in seve ral occupational activi-ties19, to 84.2% (95%CI: 80.8-87.3) regarding symptoms reported by hospital nurses43.
T a b le V . ( c o n ti n u a ti o n ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s an al ys is o f m us cu lo -Pr ev al en ce in t he p re vi ou s w ee k: sk el et al s ym pt om s) C er vi ca l r eg io n: 5 3% Sh ou ld er s: 61 % El bo w s: 33 % W ri st s/ ha nd s: 45 % D or sa l r eg io n: 6 2% Lo w b ac k re gi on : 5 8% T hi gh s: 54 % K ne es : 5 6% A nk le s/ fe et : 7 1% M ar tin s J, 20 07 Se lf-ad m in is -W R M Ss N ur se s w or ki ng 18 .2 % 17 6 80 % M ea n ag e Pr ev al en ce in t he p re vi ou s ye ar : 20 08 44 te re d qu es -(S ta nd ar di se d N or di c in o ne h os pi ta l (s ta nd ar d de vi a-Bo th s ex es : 8 1. 3% tio nn ai re qu es tio nn ai re fo r th e (m ed ic in e, s ur ge ry tio n) ; [ ra ng e] : (9 5% C I:7 4. 7-86 .7 ) an al ys is o f m us cu lo -an d or th op ed ic s 33 .4 ( 7. 5) M : 7 1. 9% ( 95 % C I:5 3. 2-86 .2 ) sk el et al s ym pt om s) se rv ic es ) ye ar s; [2 3-66 ] F: 8 3. 3% ( 95 % C I:7 6. 2-89 .0 ) n/ av – N ot a va ila bl e; W R M D s – w or k-re la te d m us cu lo sk el et al d is or de rs ; W R M Ss – w or k-re la te d m us cu lo sk el et al s ym pt om s; M – m al es ; F – fe m al es ; 9 5% C I – 9 5% c on fid en ce in te rv al s
T a b le V I. F r e q u e n c y o f o s te o p o r o s is o r o s te o p o r o ti c f r a c tu r e ( s tu d ie s c h a r a c te r is ti c s a n d r e s u lt s ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s Pi na M , 20 00 -2 00 2 Se le ct io n of H ip fr ac tu re d ia gn os is R es id en ts in n/ ap n/ ap n/ ap n/ ap Ye ar ly in ci de nc e ra te : 20 08 23 ad m is si on s ac co rd in g th e Po rt ug al m ai nl an d M : 1 29 .4 p er 1 00 0 00 fr om t he IC D 9-C M c la ss ifi ca tio n (o ve r 50 y ea rs F: 3 51 .9 p er 1 00 0 00 N at io na l (c od es IC D 9-C M ol d) H os pi ta l 82 0. x) c au se d by a lo w D is ch ar ge or m od er at e fa ll R eg is te r, (H ea lth In fo rm at ic s an d Fi na nc ia l M an ag em en t In st itu te ) N et w or k of 20 07 N ew c as es M ed ic al d ia gn os is o f C lie nt s of m ai n-47 .9 % 11 1 12 9 2. 3% o f A ge g ro up s Ye ar ly in ci de nc e ra te : Se nt in el of fr ac tu re hi p fr ac tu re la nd P or tu ga l pa tie nt s ge ne ra l (y ea rs ): Bo th s ex es : 6 3. 9 pe r 10 0 00 0 D oc to rs , re po rt ed t o he al th c ar e (1 41 g e-pr ac tic tio - 0-4: 5 .3 % M : 3 1. 9 pe r 10 0 00 0 20 09 34 th e ph ys ici an s ce nt er s ne ra l p ra -ne rs in 5-9: 5. 3% F: 9 3. 3 pe r 10 0 00 0 ne tw or k ct io ne rs ) Po rt ug al 10 -1 4: 5 .1 % 15 -2 4: 1 1. 7% 25 -3 4: 1 5. 7% 35 -4 4: 14 .8 % 45 -5 4: 13 .2 % 55 -6 4: 10 .8 % 65 -7 4: 9. 6% ≥ 75 : 8 .4 % C os ta J, 20 07 C lin ic al H ip fr ac tu re o cc ur ri ng R es id en ts in V ia na n/ ap n/ ap n/ ap n/ ap Ye ar ly in ci de nc e ra te : 20 09 25 re po rt sp on ta ne ou sl y or fr om do C as te lo Bo th s ex es : 3 51 p er 1 00 0 00 co ns ul ta tio n a fa ll no g re at er t ha n di st ri ct ( ov er 6 5 (9 5% C I:3 02 -4 06 ) of p at ie nt s st an di ng h ei gh t ye ar s ol d) M : 1 54 p er 1 00 0 00 ho sp ita liz ed (9 5% C I:1 06 -2 18 ) F: 4 81 p er 1 00 0 00 (9 5% C I:4 07 -5 64 ) C ru z M , 20 04 -2 00 6 C lin ic al Pr ox im al fe m ur R es id en ts in t he n/ ap n/ ap n/ ap n/ ap Ye ar ly in ci de nc e ra te : 20 09 21 re po rt fr ac tu re a ft er a lo w ca tc hm en t ar ea 20 04 : 8 0 pe r 10 0 00 0 co ns ul ta tio n im pa ct fa ll of C al da s da 20 05 : 1 00 p er 1 00 0 00 of p at ie nt s R ai nh a H os pi ta l 20 06 : 8 0 pe r 10 0 00 0 ho sp ita liz ed (o ve r 50 y ea rs o ld ) C on tin ue s on t he n ex t p ag e
T a b le V I. (c o n ti n u a ti o n ) F ir st a u th o r, p u b li c a ti o n P e ri o d C o ll e c ti n g ye a r, o f d a ta d a ta S tu d y % S a m p le % p a rt i-A g e re fe re n c e c o ll e c ti o n m e th o d C a se d e fi n it io n p o p u la ti o n m a le s si z e c ip a ti o n d is tr ib u ti o n E st im a te s IN SA , I P/ IN E, 20 05 -2 00 6 Fa ce t o fa ce T o ha ve o r ha ve h ad R es id en ts in 48 .4 % 41 1 93 76 % A ge g ro up s Li fe tim e pr ev al en ce : IP , 2 00 9 32 in te rv ie w os te op or os is /P re vi ou s Po rt ug al fa m ili ar in di vi du al s (y ea rs ): Bo th s ex es : 6 .2 % m ed ic al o r nu rs in g dw el lin gs (1 5 23 9 < 15 : 1 5. 6% M : 1 .1 % di ag no si s of o st eo po -dw el lin gs ) 15 -2 4: 1 2. 4% F: 1 1. 0% ro si s/ To h av e or h av e 25 -3 4: 1 5. 6% Li fe tim e pr ev al en ce ( m ed ic al ha d os te op or os is in 35 -4 4: 1 4. 8% or n ur si ng d ia gn os is ): th e pr ev io us y ea r 45 -5 4: 1 3. 3% Bo th s ex es : 6 .1 % (a ll se lf-re po rt ed ) 55 -6 4: 1 1. 2% Pr ev al en ce in t he p re vi ou s ye ar : 65 -7 4: 9 .6 % Bo th s ex es : 5 .6 % 75 -8 4: 5 .9 % ≥ 85 : 1 .5 % M ar an te s I, 20 01 -2 00 2 Te le ph on e Se lf-re po rt ed A du lt w om en 0% 1 80 0 n/ av A ge g ro up s Po in t pr ev al en ce : 20 04 26 in te rv ie w os te op or os is re si de nt s in (y ea rs ): 15 .4 % ( 95 % C I:1 3. 4-17 .6 ) of Po rt ug al 18 -2 9: 1 3. 8% w hi ch 9 6. 8% ( 95 % C I:9 3. 1-98 .8 ) m ai nl an d 30 -3 9: 1 6. 0% ha d di ag no st ic e xa m s th at 40 -4 9: 1 9. 6% co nf ir m t he d is ea se 50 -5 9: 1 6. 3% 60 -6 9: 1 7. 6% 70 -7 9: 1 2. 9% ≥ 80 : 3 .8 % Be rn ar do A , 20 01 -2 00 2 Bo ne d en sit y W H O o pe ra tio na l M al es c lie nt s of 10 0% 22 6 n/ av M ea n ag e Po in t pr ev al en ce ( os te op or os is ): 20 03 24 m ea su re m en t de fin iti on o f o st eo po -on e he al th c ar e (s ta nd ar d 16 .8 % ( 95 % C I:1 2. 2-22 .3 ) ro si s ba se d on t he ce nt er o f t he c ity de vi at io n) ; Po in t pr ev al en ce ( os te op en ia ): BM D v al ue s m ea su re d of P or to ( ov er [r an ge ]: 57 .2 50 .9 % ( 95 % C I:4 4. 2-57 .6 ) by D X A ( lo w er s pi ne 20 y ea rs o ld ) (1 6. 0) y ea rs ; an d hi p) [2 1-87 ] Lu ca s R , 19 94 -1 99 5 Bo ne d en sit y W H O o pe ra tio na l C au ca si an a du lt 10 0% 73 9 n/ av A ge g ro up s Po in t pr ev al en ce : 20 08 22 m ea su re m en t de fin iti on o f o st eo po -m al es r es id en ts (y ea rs ): > 39 y ea rs : 4 .3 % ( 95 % C I:2 .9 -6 .2 ) ro si s ba se d on t he in P or tu ga l 20 -3 9: 1 2. 2% 40 -4 9 ye ar s: 1. 9% BM D v al ue s m ea su re d m ai nl an d 40 -4 9: 2 8. 3% (9 5% C I:0 .5 -4 .8 ) by D X A ( no n-do m in an t 50 -5 9: 3 3. 7% ≥ 70 y ea rs : 1 8. 6% di st al fo re ar m ) 60 -6 9: 1 7. 9% (9 5% C I:9 .7 -3 0. 9) ≥ 70 : 8 .0 % n/ ap – N ot a pp lic ab le ; M – m al es ; F – fe m al es ; 9 5% C I – 95 % c on fid en ce in te rv al s; IN SA , I P/ IN E, IP – N at io na l I ns tit ut e of H ea lth /S ta tis tic s-Po rt ug al ; n /a v – N ot a va ila bl e; W H O – W or ld H ea lth O rg an iz at io n; BM D – b on e m in er al d en si ty ; D X A – d ua l e ne rg y X -r ay a bs or pt io m et ry .
