Association of musculoskeletal burden with health outcomes in community-dwelling adults in Singapore: A prospective cohort study

Abstract

Musculoskeletal (MSK) disorders are a leading cause of global disability, yet the cumulative association of multiple MSK conditions—encompassing both pain symptoms and diagnosed disorders—with health outcomes remains underexplored, particularly in Asian populations. This study estimated the prevalence of single and multiple MSK conditions among community-dwelling adults in Singapore and examined their cross-sectional and longitudinal associations with physical function, depressive symptoms, health-related quality of life (HRQoL), and self-rated health. Data from 1,941 adults who participated in the Population Health Index survey in central Singapore were analysed. MSK burden was categorised as no, single, or multiple (≥ 2) MSK conditions. Survey-weighted analyses, including Rao-Scott Chi-square tests and design-based F-tests for group comparisons, were used to compare outcomes across MSK burden groups. Survey-weighted Tobit regression models adjusted for covariates were used to examine associations between MSK burden and health outcomes. The weighted prevalence of single and multiple MSK conditions was 23.3% and 12.2%, respectively. A clear graded association emerged: increasing number of MSK conditions was associated with poorer outcomes at both Waves 1 and 2, after adjusting for Wave 1 covariates. In models adjusting for Wave 1 outcome levels, associations persisted at one year for HRQoL and self-rated health, but were attenuated for physical function (p-trend=0.687) and limited to the multiple MSK group for depressive symptoms (p=0.007). The findings highlight the need for integrated care models and policies supporting early intervention, with implications for healthcare planning in Singapore and other rapidly ageing Asian societies.