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Updated: May 13, 2026
A Novel Application of Musculoskeletal Ultrasound Imaging
Published on: September 17, 2013
A state-level analysis of musculoskeletal disability reveals persistent geographic inequities with implications for
Benjamin R Paul1, Katelyn T Koschmeder2, Jeremiah R Long3
1Mayo Clinic Arizona, Department of Orthopaedic Surgery, Phoenix, AZ, United States; Creighton University School of Medicine, Phoenix, AZ, United States.
Background:
Musculoskeletal (MSK) disorders are among the leading contributors to disability in the United States, and are inherently diagnosis-dependent, relying on radiologic evaluation to define pathology, stratify disease severity, and guide escalation of care. Although substantial interstate variation in MSK disability burden has been reported, it is unclear whether these geographic differences represent transient trends or persistent structural patterns that may reflect inequities in diagnostic access and care delivery. Understanding whether high-burden states are improving, stagnating, or falling further behind is critical for radiology-relevant health policy, imaging workforce planning, and equitable resource allocation.
Methods:
This study used the Global Burden of Disease (GBD) 2010-2023 age-standardized Disability-Adjusted Life Year (DALY) rates for all MSK causes combined. Cross-sectional MSK burden was defined using a 3-year average (2021-2023). States were grouped into tertiles-low, intermediate, and high-burden-based on this average. Long-term temporal changes were assessed using the Compound Annual Growth Rate (CAGR) from 2010 to 2023. Temporal stability was evaluated through a heatmap of annual DALY values.
Results:
High-burden states had an average of 4,230 MSK DALYs per 100,000, compared with 3,609 per 100,000 in low-burden states, representing a 620 DALY (17 %) difference. Although most states showed modest declines in MSK burden, improvement was minimal overall (mean compound annual growth rate (CAGR) -0.16 % per year). High-burden states showed the least improvement in DALYs (-0.05 % per year), compared with faster declines in low-burden states (-0.26 % per year), and seven high-burden states experienced a worsening burden over time. Heatmap visualization demonstrated highly persistent geographic patterns, with states rarely shifting between burden categories over the 14-year period.
Conclusion:
States with the highest MSK disability burden are improving the slowest, resulting in a widening MSK disability gap. Because MSK care is dependent on imaging for diagnosis and treatment escalation, these disparities may suggest potential disparities in access to timely MSK imaging and subspecialty expertise. Radiology can directly contribute to reducing long-term MSK disability by aligning imaging capacity and workforce resources with regions experiencing the highest burden.
Insights
States with the highest musculoskeletal (MSK) disability burden are improving the slowest, widening the gap. This suggests potential disparities in access to timely MSK imaging and subspecialty expertise, impacting care delivery.
Area of Science:
- Public Health
- Radiology
- Health Services Research
Background:
- Musculoskeletal (MSK) disorders are a leading cause of disability in the U.S.
- Radiologic evaluation is crucial for MSK diagnosis, severity assessment, and treatment guidance.
- Interstate variations in MSK disability suggest potential inequities in care access and delivery.
Purpose of the Study:
- To analyze geographic variations and temporal trends in MSK disability burden across U.S. states.
- To investigate whether high-burden states are improving, stagnating, or worsening over time.
- To inform radiology-relevant health policy, workforce planning, and resource allocation.
Main Methods:
- Utilized Global Burden of Disease (GBD) 2010-2023 age-standardized Disability-Adjusted Life Year (DALY) rates for MSK disorders.
- Defined cross-sectional MSK burden using a 3-year average (2021-2023) and categorized states into burden tertiles.
- Assessed long-term temporal changes using Compound Annual Growth Rate (CAGR) and evaluated temporal stability with a heatmap.
Main Results:
- High-burden states averaged 4,230 MSK DALYs per 100,000, 17% higher than low-burden states.
- Overall MSK burden declined minimally (mean CAGR -0.16%), with high-burden states showing the least improvement (-0.05%).
- Seven high-burden states experienced worsening MSK disability, and geographic patterns remained highly persistent over 14 years.
Conclusions:
- States with the highest MSK disability burden are improving at the slowest rate, widening the disability gap.
- Disparities in MSK disability may indicate unequal access to timely imaging and subspecialty expertise.
- Radiology can mitigate MSK disability by aligning imaging capacity and workforce resources with high-burden regions.
