By Balaji Ramamurti, Industry Analyst, Frost & Sullivan
To predict the future medical demands that will be made by the population in the U.S., it is necessary to study the past trends of the population and the country-wide medical information on diagnoses and procedures over the same period of time. In this article, the population trends during the past decade (1990-2000) were studied. The main objective was to observe the quantitative changes in the age groups of the U.S. population. For the same time period the trends in selective diagnoses and procedures related to spine surgery were studied. Among the diagnoses, the information on patients diagnosed with disc herniations was analyzed. Among the procedures, the information on the discectomies performed was analyzed.
Based on age group, the U.S. population was divided into four categories, namely, under 15 years, between 15 and 44 years, between 45 and 64 years and the group that is 65 years and over. It should be observed that this grouping is uneven, since the 15-44 age group spans 30 years, while the 45-64 age group spans 20 years only. This grouping was selected so as to make comparisons with data available from the National Hospital Discharge Survey. Although the time frame of interest is from 1990 to 2000, actual data for 1980 and projected data for 2010 were included to clarify the population trend.
It was observed that during this period the age group of 15-44 years peaked during 2000 and was 124 million strong (Fig.1). As a percentage of the population, the 15-44 age group peaked in 1990 when this group constituted 47% of the population (Fig.2). Both the 45-64 and the 65-plus age groups were showing increases both in numbers and as a percentage from 1990 to 2000 and beyond (Figs. 1&2).
The information on in-patients primarily diagnosed with either cervical (neck) or lumbar (low-back) disc herniations was gathered from the National Hospital Discharge survey (Fig.3). During any given year, there were more patients diagnosed with lumbar than cervical disc herniation. Although the number of patients diagnosed with cervical herniations held steady, there was a 36% drop in the number of patients diagnosed with lumbar disc herniation from 1990 to 2000. Among the general population in the U.S., the 15-44 age group was the major contributor to the in-patients with lumbar disc herniations (Fig.4). From 1990 to 2000, an appreciable decrease in the contribution to lumbar disc herniations from the same group was observed (Fig.4).
The details regarding the number of discectomies performed were also gathered from the National Hospital Discharge Survey (Fig.5). During the period 1990 to 2000, the number of discectomies performed peaked in 1993 with 320,000 procedures. Since then the rate of the discectomy procedures has shown a declining trend. During the early 1990s, the 15-44 age group was again the major contributor to the patient population undergoing lumbar discectomy (Fig.6). The contribution from this age group has been steadily decreasing from 1990 to 2000. This reduction in the contribution from this age group was not offset by appropriate increases from other age groups, leading to an overall decrease in the number of discectomies performed (Fig.6)
Similar analyses were performed on spine fusion procedures during the period 1990-2000. The number of spine fusions performed has increased by 87% from about 130,000 procedures in 1990 to about 244,000 procedures in 2000. These analyses also indicated that during the early 1990s, the major contributor was the 15-44 age group. But towards the end of the 1990s, the major contribution came from the 45-64 age group. The number of spine fusions in the 65-plus age group increased by 730% from 1990 to 2000.
From the analyses presented, it was possible to derive important take home messages. The population trends indicated that the crest of the "baby boomer" population wave has passed through the 15-44 age group and was traversing the 45-64 and the 65-plus age groups. The incidence of disc herniation was higher in the 15-44 age group, leading to most discectomies also being performed on the same population group.
In the future, the trend in the population does not seem to favor appreciable increases in the number of discectomy procedures. This may have an effect on the new non-fusion technologies for spine procedures slated to enter the U.S. market from 2005 to 2008 and beyond. These technologies are aimed at the 45-55 age group indicated for discectomies and early degeneration of the disc. Patients older than 60 years may become suitable candidates for spine fusion rather than a non-fusion procedure.
The population older than 60 years undergoing spine fusion could suffer from less than optimal bone vitality requiring fusion enhancers, such as, bone morphogenic proteins (BMP) or electrical stimulation. As the "baby boomers" grow older than 65, there could be an increase in osteoporotic fractures of the spine, driving the demand for vertebroplasty and kypholasty. The spine industry needs to gear up to meet the demands of the aging population in the U.S.
The Frost & Sullivan report A640 titled "U.S. and Asia Markets for Bone Morphogenic Proteins for spine fusion" is already available. Soon, there will be a report on the Non-fusion technologies in spine procedures. This Frost & Sullivan report number is A628.