UNLABELLED: Musculoskeletal diseases (MSDs) are the leading cause of disability and facing them demands updated reports on their burden for efficient policymaking. We showed Iran had the highest female-to-male ratio and highest increase in the burden of musculoskeletal diseases, in the past three decades, worldwide. We further confirmed the role of population aging as the main cause. PURPOSE: MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017. METHODS: We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990-2017, for population aged ≥ 5 years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes. RESULTS: In Iran, MSDs were responsible for 1.82 million (95%uncertainty interval [UI] 1.3-2.4) DALYs, in 2017. During the past 28 years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors. CONCLUSION: Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females.

1st Faculty of Medicine Charles University Prague Czech Republic

Center for Non Communicable Pediatric Diseases Health Research Institute School of Nursing and Midwifery Babol University of Medical Sciences Babol Iran

Clinical Research Development Center Taleghani and Imam Ali Hospitals Kermanshah University of Medical Sciences Kermanshah Iran

Clinical Research Development Unit Rafsanjan University of Medical Sciences Rafsanjan Iran

Department of Anesthesiology Hamedan University of Medical Sciences Hamadan Iran

Department of Epidemiology and Biostatistics Shahrekord University of Medical Sciences Shahrekord Iran

Department of Epidemiology and Biostatistics Tehran University of Medical Sciences Tehran Iran

Department of Epidemiology Arak University of Medical Sciences Arak Iran

Department of Epidemiology Shahroud University of Medical Sciences Shahroud Iran

Department of Epidemiology Shiraz University of Medical Sciences Shiraz Iran

Department of Health Economics Iran University of Medical Sciences Tehran Iran

Department of Health Services Management Arak University of Medical Sciences Arak Iran

Department of Immunology Mazandaran University of Medical Sciences Sari Iran

Department of Internal Medicine AJA University of Medical Sciences Tehran Iran

Department of Internal Medicine Rafsanjan University of Medical Sciences Rafsanjan Iran

Department of Occupational Health Engineering Kermanshah University of Medical Sciences Kermanshah Iran

Department of Ophthalmology Iran University of Medical Sciences Tehran Iran

Department of Orthopedic Surgery AJA University of Medical Sciences Tehran Iran

Department of Parasitology and Mycology Shiraz University of Medical Sciences Shiraz Iran

Department of Plastic Surgery Iran University of Medical Sciences Tehran Iran

Faculty of Nursing and Midwifery Kurdistan University of Medical Sciences Sanandaj Iran

Health Management and Economics Research Center Iran University of Medical Sciences Tehran Iran

Health Policy Research Center Shiraz University of Medical Sciences Shiraz Iran

Max Rady College of Medicine University of Manitoba Winnipeg MB Canada

Molecular and Cell Biology Research Center Mazandaran University of Medical Sciences Sari Iran

Multiple Sclerosis Research Center Neuroscience Institute Tehran University of Medical Sciences Tehran Iran

Network of Immunity in Infection Malignancy and Autoimmunity Tehran Iran

Non Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran

Nursing Care Research Center Semnan University of Medical Sciences Semnan Iran

Pediatric Neurorehabilitation Research Center University of Social Welfare and Rehabilitation Sciences Tehran Iran

Preventive Medicine and Public Health Research Center Iran University of Medical Sciences Tehran Iran

Research Center for Immunodeficiencies Tehran University of Medical Sciences Tehran Iran

Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran

School of Behavioral Sciences and Mental Health Iran University of Medical Sciences Tehran Iran

School of Nursing and Midwifery Tehran University of Medical Sciences Tehran Iran

School of Rehabilitation Sciences Kermanshah University of Medical Sciences Kermanshah Iran

Social Determinants of Health Research Center Babol University of Medical Sciences Babol Iran

Student Research Committee Babol University of Medical Sciences Babol Iran

Student Research Committee Iran University of Medical Sciences Tehran Iran

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