筋骨格系障害の州レベル分析により、診断画像に関連する地理的な不公平が持続していることが判明

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.

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.

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.

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.