Health inequality and the burden of musculoskeletal disease

Manchester icon Greater Manchester

Our researchers are using data to understand more accurately how often Musculoskeletal diseases occur.

Researchers involved Dr. Jennifer Humphreys, Prof. Will Dixon, Prof Kimme Hyrich and Dr. Suzanne Verstappen
Key partners Salford Royal Foundation Trust, Pennine MSK

Project Overview

Musculoskeletal diseases include a wide range of chronic diseases affecting bones and joints. They significantly impact people’s everyday lives by affecting their ability to move and function. There are estimates of how many people are affected by MSk diseases from GP records, which suggest that 20% of people in the UK see their GP each year with an MSk condition, at a cost of £5 billion to the NHS. However, these data may be inaccurate, as many MSk diseases are difficult for the non-specialist to diagnose and are managed in specialist centres or hospitals. Accurate estimates of how many people are affected (the burden of disease) are essential in assessing health needs and inequalities within a population. The aim of this study is to look at health records from GPs and hospitals to understand more accurately how often MSk diseases occur.


1. What data are you using?

The study will use routinely collected data from two specialist sites in Greater Manchester. These sites reflect the high level of diversity within the city as well as encompassing some rural localities. Data will include adults treated from 2012 onwards.

2. What methods are you using to conduct this work (how are you using the data?)

We will use epidemiological methods to investigate whether rates of MSk disease differ among different parts of society, grouped by poverty, ethnicity, and how rural or urban their environment is. We will also look at changes in these rates over time, before and after the devolution of health and social care to the Greater Manchester Health and Social Care partnership in 2016.

3. Who will/ could benefit (what will we know that we don’t already?)

Current estimates of MSk disease burden rely on case definitions that have often not been externally validated and are not standardised between different studies of the same disease. In clinical practice, autoimmune inflammatory MSk diseases are challenging to diagnose and are managed by specialists. Therefore the use of routinely collected data from GPs is always limited in its ability to produce precise case definitions. The availability of electronic health records (eHRs) from specialist healthcare providers offers an innovative solution to these problems. In the region, two specialist rheumatology services currently keep eHRs: Salford Royal Foundation Trust (SRFT) and Pennine MSK Partnership (PMSKP), which covers Oldham. Using these routinely collected data, we can accurately estimate MSk disease occurrence based on specialist diagnoses. In addition, Greater Manchester has recently become the first city region with a devolved health and social care budget in the country (“DevoManc”). Notably, one of its key strategies is to use greater integration of health and social care to improve outcomes across its population, and these data could help to validate GP estimates against estimates from specialist eHRs.

4. What will be the intended outcome of your research project?

We hope to show the burden and health inequality of MSk disease in Greater Manchester, and to feed this directly back to Greater Manchester Health and Social Care Partnership (GM-HSCP) to enact change and improve the lives of patients.