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Table 1.  

Characteristic

No. of adults with arthritis (unweighted)§

No. of adults with arthritis in population§ (millions)

Distribution among adults with arthritis (%)

Prevalence of doctor-diagnosed arthritis, % (95% CI)

Unadjusted

Age-standardized

       
Overall 23,921 58.5 100 23.7 (23.2–24.2) 21.5 (21.1–21.9)
Sociodemographic characteristic
Age group, yrs
18–44 2,594 8.1 13.8 7.1 (6.7–7.5)
45–64 9,313 25.4 43.5 30.5 (29.7–31.4)
≥65 12,014 25.0 42.7 50.4 (49.4–51.3)
Sex
Male 9,159 23.8 40.7 20.0 (19.4–20.6) 18.5 (18.0–19.0)
Female 14,762 34.7 59.3 27.2 (26.5–27.8) 24.2 (23.6–24.7)
Race/Ethnicity
Hispanic or Latino, any race 1,733 5.4 9.3 13.7 (12.7–14.6) 16.4 (15.5–17.3)
White, NH 18,399 43.4 74.2 27.6 (27.0–28.2) 23.2 (22.7–23.7)
Black, NH 2,548 6.4 10.9 22.0 (20.8–23.2) 21.8 (20.8–22.9)
Asian or Other Pacific Islander, NH 549 1.7 3.0 11.9 (10.6–13.2) 12.2 (11.0–13.5)
American Indian or Alaska Native, NH 211 0.5 0.8 26.3 (20.9–31.6) 26.8 (22.0–32.3)
Other/Multiple races, NH 481 1.1 1.9 23.5 (20.9–26.1) 26.9 (24.6–29.4)
Sexual identity
Lesbian or gay 356 0.8 1.4 21.2 (18.9–23.6) 22.4 (20.0–25.0)
Straight 22,498 55.1 96.5 23.9 (23.3–24.4) 21.4 (21.0–21.9)
Bisexual 197 0.5 0.8 16.9 (14.1–19.8) 25.6 (22.1–29.5)
Something else/Don't know the answer** 336 0.7 1.2 22.2 (19.1–25.5) 22.4 (19.8–25.2)
Education
Less than high school graduate 3,310 7.8 13.4 26.9 (25.7–28.0) 22.0 (21.1–23.0)
High school graduate or equivalent 6,494 16.0 27.4 26.5 (25.5–27.4) 23.0 (22.2–23.7)
Some college 7,631 18.3 31.4 24.3 (23.5–25.1) 23.4 (22.7–24.0)
College degree or greater 6,410 16.2 27.8 20.0 (19.3–20.7) 18.5 (18.0–19.1)
Employment status
Employed/Self-employed 8,849 24.4 41.8 15.7 (15.2–16.2) 18.2 (17.7–18.8)
Unemployed 475 1.3 2.2 14.9 (13.3–16.5) 20.0 (17.9–22.2)
Unable to work/Disabled†† 3,578 8.4 14.4 52.3 (50.6–54.0) 43.1 (41.3–44.9)
Other §§ 11,012 24.3 41.7 36.7 (35.7–37.7) 21.8 (21.1–22.6)
Poor/Near poor (<125%) 4,811 10.1 17.2 24.7 (23.7–25.8) 25.7 (24.8–26.7)
Low income (125% to <200%) 3,554 7.9 13.6 25.1 (24.0–26.1) 22.7 (21.8–23.7)
Middle income (200% to <400%) 6,972 17.1 29.2 24.1 (23.3–24.9) 21.6 (21.0–22.3)
High income (≥400%) 8,583 23.4 40.0 22.6 (22.0–23.3) 19.7 (19.2–20.3)
Health characteristic
BMI (kg/m2)
Under/Healthy weight (<25.0) 6,128 14.6 25.8 17.6 (17.0–18.2) 17.2 (16.7–17.7)
Overweight (25.0 to <30.0) 7,609 18.4 32.6 22.2 (21.6–22.9) 19.1 (18.5–19.6)
Obese (≥30.0) 9,349 23.5 41.6 32.0 (31.1–32.9) 28.8 (28.1–29.5)
Meets recommendations 9,598 24.1 41.9 18.8 (18.3–19.4) 19.1 (18.6–19.6)
Insufficiently active 5,443 13.3 23.1 27.0 (26.1–27.9) 23.4 (22.7–24.2)
Inactive 8,426 20.1 34.9 30.9 (29.9–31.9) 24.3 (23.5–25.1)
Joint symptoms†††
Yes 17,973 43.9 75.1 52.2 (51.4–53.0) 42.0 (41.1–42.8)
No 5,943 14.6 24.9 9.0 (8.6–9.3) 9.6 (9.3–10.0)
ADL disability§§§
Yes 1,493 3.3 5.7 54.8 (52.2–57.5) 41.4 (37.9–44.9)
No 22,426 55.2 94.3 22.9 (22.4–23.4) 21.1 (20.6–21.5)
IADL disability¶¶¶
Yes 3,098 6.5 11.1 55.9 (54.0–57.7) 41.8 (39.5–44.0)
No 20,818 52.0 88.9 22.1 (21.6–22.6) 20.5 (20.1–21.0)
Psychological distress****
None/Mild 16,450 40.2 70.7 21.4 (20.8–21.9) 18.8 (18.4–19.3)
Moderate 5,236 12.8 22.5 29.9 (28.9–30.8) 29.4 (28.6–30.3)
Serious 1,589 3.9 6.8 44.3 (42.0–46.7) 41.1 (39.1–43.2)
Self-rated health
Excellent/Very good 9,198 22.8 38.9 15.2 (14.7–15.7) 15.8 (15.4–16.3)
Good 8,027 19.6 33.5 29.9 (29.0–30.8) 25.0 (24.2–25.8)
Fair/Poor 6,684 16.1 27.6 51.2 (49.8–52.5) 40.7 (39.2–42.2)

Table 1. Unadjusted and age-standardized* annualized prevalence of doctor-diagnosed arthritis among adults aged ≥18 years — National Health Interview Survey, United States, 2016–2018

Abbreviations: ADL = activities of daily Living; BMI = body mass index; CI = confidence interval; IADL = instrumental activities of daily living; NH = non-Hispanic.

* Age-standardized to the 2000 U.S. projected adult population, using three age groups: 18–44, 45–64, and ≥65 years.

Responded “yes” to, “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

§ Might not sum to overall total for some categories because of item-specific missing data.

Might not sum to 100 because of rounding.

** Responded “I don't know the answer” to, “Which of the following best represents how you think of yourself?”

†† This category is a combination of respondents who self-reported their reason for not working as: “temporarily unable to work due to health reasons” or “disabled.”

§§ Students, homemakers, and retirees.

¶¶ Income-to-poverty ratio estimates were derived using NHIS imputed income file. https://www.cdc.gov/nchs/data/nhis/tecdoc18.pdf

*** Respondents were considered to have met recommendations if they reported ≥150 minutes of moderate-intensity leisure-time aerobic physical activity per week, insufficiently active if they reported 1–149 minutes, and inactive if they reported 0 minutes. Reported vigorous-intensity physical activity minutes were counted twice and added to moderate-intensity physical activity minutes.

††† Responded “yes” to, “The next questions refer to your joints. Please do not include the back or neck. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?”

§§§ Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside this home?”

¶¶¶ Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you] need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?”

**** Psychological distress was classified as none/mild, moderate, or severe and measured by the Kessler-6 Scale. https://www.hcp.med.harvard.edu/ncs/k6_scales.php

Table 2.  

Characteristic

Unweighted no. of adults with arthritis

No. of adults with AAAL in population§ (millions)

Distribution among adults with AAAL (%)

Prevalence of AAAL among all US adults, % (95% CI)

Prevalence of AAAL among adults with doctor-diagnosed arthritis, % (95% CI)

Unadjusted

Age-standardized

Unadjusted

Age-standardized

Overall 10,682 25.7 100 10.4 (10.1–10.7) 9.4 (9.1–9.6) 43.9 (42.9–44.8) 40.8 (39.4–42.1)
Sociodemographic characteristic
Age group, yrs
18–44 996 3.0 11.6 2.6 (2.4–2.8) N/A 36.8 (34.6–39.1) N/A
45–64 4,378 11.7 45.6 14.0 (13.5–14.6) N/A 46.0 (44.5–47.5) N/A
≥65 5,308 11.0 42.8 22.2 (21.5–22.9) N/A 44.0 (42.9–45.2) N/A
Sex
Male 3,831 9.6 37.6 8.1 (7.8–8.5) 7.5 (7.2–7.8) 40.6 (39.3–41.9) 37.1 (35.1–39.3)
Female 6,851 16.0 62.4 12.5 (12.1–13.0) 11.1 (10.7–11.5) 46.1 (45.0–47.3) 43.3 (41.5–45.1)
Race/Ethnicity
Hispanic or Latino, any race 875 2.7 10.4 6.7 (6.1–7.4) 8.2 (7.5–8.9) 49.1 (46.0–52.3) 43.4 (39.3–47.6)
White, NH 7,854 18.2 71.0 11.6 (11.2–12.0) 9.6 (9.3–9.9) 41.9 (40.9–43.0) 39.3 (37.7–40.9)
Black, NH 1,300 3.1 12.2 10.8 (9.9–11.7) 10.6 (9.9–11.5) 48.9 (46.2–51.6) 43.2 (39.3–47.1)
API, NH 244 0.8 3.1 5.5 (4.6–6.5) 5.7 (4.8–6.6) 46.2 (40.4–52.1) 42.8 (34.0–52.1)
AI/AN, NH 134 0.3 1.1 15.9 (12.9–19.6) 16.3 (13.5–19.6) 60.7 (50.3–70.2) 58.9 (46.0–70.8)
Other/Multiple races, NH 275 0.6 2.3 13.1 (11.0–15.5) 15.1 (13.0–17.5) 54.5 (48.5–60.3) 54.2 (46.4–61.7)
Sexual identity
Lesbian or gay 163 0.4 1.6 10.2 (8.3–12.1) 10.5 (8.7–12.7) 48.1 (41.3–54.8) 47.8 (39.6–56.1)
Straight 9,960 24.0 96.0 10.4 (10.0–10.7) 9.3 (9.0–9.5) 43.5 (42.5–44.5) 40.1 (38.7–41.6)
Bisexual 103 0.2 1.0 8.7 (6.5–11.0) 13.1 (10.2–16.6) 51.7 (42.8–60.6) 50.8 (42.2–59.4)
Something else/Don't know the answer†† 169 0.3 1.4 10.7 (8.8–13.0) 11.0 (9.2–13.1) 48.4 (41.2–55.8) 51.5 (41.0–61.8)
Education
Less than HS graduate 1,902 4.5 17.5 15.4 (14.5–16.3) 12.4 (11.8–13.2) 57.2 (55.0–59.3) 51.1 (46.9–55.2)
HS graduate or equivalent 2,954 7.1 27.9 11.8 (11.2–12.3) 10.2 (9.7–10.7) 44.6 (43.1–46.1) 42.0 (39.4–44.7)
At least some college 3,427 8.1 31.7 10.7 (10.3–11.2) 10.3 (9.9–10.7) 44.3 (42.9–45.7) 42.6 (40.5–44.7)
College degree or greater 2,350 5.8 22.9 7.2 (6.8–7.6) 6.7 (6.3–7.0) 36.1 (34.5–37.7) 32.7 (30.4–35.1)
Employment status
Employed/Self-employed 2,716 7.5 29.2 4.8 (4.6–5.1) 5.5 (5.2–5.9) 30.7 (29.4–32.1) 29.8 (28.2–31.4)
Unemployed 215 0.6 2.2 6.6 (5.6–7.8) 8.6 (7.1–10.2) 44.4 (38.8–50.2) 42.4 (36.1–49.0)
Unable to work/ Disabled§§ 2,904 6.9 26.9 27.6 (26.8–28.4) 26.7 (25.1–28.3) 54.7 (53.5–55.8) 72.2 (69.5–74.7)
Other ¶¶ 4,840 10.7 41.6 16.1 (15.5–16.7) 9.4 (8.9–9.9) 43.8 (42.6–45.1) 40.7 (36.4–45.1)
Income-to-poverty ratio***
Poor/Near poor (<125%) 3,058 6.4 24.9 15.7 (14.8–16.5) 16.4 (15.6–17.1) 63.3 (61.4–65.2) 59.0 (56.1–61.8)
Low income (125% to <200%) 1,855 4.2 16.5 13.4 (12.6–14.2) 12.2 (11.5–13.0) 53.3 (51.0–55.6) 50.9 (47.2–54.7)
Middle income (200% to <400%) 2,962 7.4 28.8 10.4 (9.9–10.9) 9.3 (8.9–9.8) 43.2 (41.7–44.8) 39.3 (36.8–41.8)
High income (≥400%) 2,806 7.7 29.9 7.4 (7.0–7.8) 6.4 (6.1–6.7) 32.8 (31.4–34.2) 28.7 (26.5–30.9)
Health characteristic
BMI (kg/m2)
Under/Healthy weight (<25.0) 2,455 5.7 23.2 6.9 (6.5–7.3) 6.8 (6.4–7.1) 39.2 (37.6–41.0) 38.1 (35.2–41.0)
Overweight (25.0 to <30.0) 3,060 7.2 29.4 8.8 (8.4–9.2) 7.4 (7.1–7.8) 39.5 (38.0–41.0) 35.7 (33.3–38.1)
Obese (≥30.0) 4,749 11.7 47.5 16.0 (15.4–16.6) 14.2 (13.7–14.7) 49.8 (48.5–51.2) 45.5 (43.6–47.4)
Aerobic physical activity level†††
Meets recommendations 3,073 7.7 30.7 6.0 (5.7–6.4) 6.1 (5.8–6.4) 32.1 (30.9–33.4) 30.8 (29.1–32.5)
Insufficiently active 2,418 5.8 23.1 11.9 (11.2–12.5) 10.2 (9.7–10.8) 43.9 (42.1–45.7) 42.4 (39.5–45.4)
Inactive 4,982 11.6 46.2 17.9 (17.2–18.6) 14.0 (13.4–14.6) 58.0 (56.5–59.4) 54.6 (51.7–57.4)
Joint symptoms§§§
Yes 9,401 22.6 88.2 26.9 (26.2–27.6) 21.1 (20.5–21.8) 51.6 (50.5–52.6) 48.8 (47.2–50.4)
No 1,276 3.0 11.8 1.9 (1.7–2.0) 2.0 (1.9–2.1) 20.7 (19.3–22.1) 19.1 (17.2–21.1)
ADL disability¶¶¶
Yes 1,236 2.8 10.7 45.3 (42.8–47.7) 34.7 (31.7–37.7) 82.6 (80.2–84.8) 82.7 (75.6–88.1)
No 9,444 22.9 89.3 9.5 (9.2–9.8) 8.7 (8.4–9.0) 41.5 (40.6–42.5) 38.9 (37.6–40.3)
IADL disability****
Yes 2,476 5.2 20.4 44.9 (43.1–46.6) 34.6 (32.5–36.6) 80.4 (78.6–82.1) 82.4 (78.1–86.0)
No 8,205 20.4 79.6 8.7 (8.4–9.0) 8.0 (7.8–8.3) 39.3 (38.3–40.3) 37.0 (35.6–38.4)
Psychological distress††††
None/Mild 5,995 14.2 57.4 7.6 (7.3–7.9) 6.6 (6.3–6.8) 35.5 (34.4–36.5) 30.7 (29.0–32.4)
Moderate 3,122 7.6 30.7 17.8 (16.9–18.6) 17.4 (16.7–18.2) 59.5 (57.7–61.2) 54.1 (51.8–56.5)
Serious 1,213 2.9 11.9 33.8 (31.7–36.0) 31.1 (29.3–32.9) 76.3 (73.5–79.0) 72.3 (68.1–76.1)
Self-rated health
Excellent/Very good 2,290 5.6 21.7 3.7 (3.5–4.0) 3.9 (3.6–4.1) 24.4 (23.2–25.7) 23.3 (21.5–25.2)
Good 3,516 8.4 32.7 12.8 (12.3–13.4) 10.5 (10.1–11.0) 42.9 (41.5–44.3) 39.7 (37.6–41.9)
Fair/Poor 4,868 11.7 45.6 37.1 (35.9–38.3) 29.1 (27.8–30.4) 72.6 (71.1–73.9) 70.2 (67.3–72.9)

Table 2. Unadjusted and age-standardized* annualized prevalence of arthritis-attributable activity limitation among adults aged ≥18 years and unadjusted and age-standardized prevalence of arthritis-attributable activity limitation among those with doctor-diagnosed arthritis§ — National Health Interview Survey, United States, 2016–2018

Abbreviations: AAAL = arthritis-attributable activity limitation; ADL = activities of daily living; AI/AN = American Indian/Alaska Native; API = Asian or Other Pacific Islander; BMI = body mass index; CI = confidence interval; HS = high school; IADL = instrumental activities of daily living; N/A = not applicable; NH = non-Hispanic.

* Age-standardized to the 2000 U.S. projected adult population, using three age groups: 18–44, 45–64, and ≥65 years. Subgroup differences were assessed using pairwise t-tests with significance set at α = 0.05. Results exactly correspond to interpretation of non-overlapping CIs; all categories of education were statistically significantly different from each other per t-test results for unadjusted prevalence of AAAL among all U.S. adults.

Responded “yes” to, “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?”

§ Responded “yes” to, “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

Might not sum to overall total for some categories because of item-specific missing data.

** Might not sum to 100 because of rounding.

†† Responded “I don't know the answer” to, “Which of the following best represents how you think of yourself?”

§§ This category is a combination of respondents self-reporting their reason for not working as: “temporarily unable to work due to health reasons” or “disabled.”

¶¶ Students, homemakers, and retirees.

*** Income-to-poverty ratio estimates were derived using NHIS imputed income file. https://www.cdc.gov/nchs/data/nhis/tecdoc18.pdf.

††† Respondents were classified as meets recommendations if they reported ≥150 minutes of moderate intensity leisure time aerobic physical activity per week, insufficiently active if they reported 1–149 minutes, and inactive if they reported 0 minutes. Reported vigorous intensity physical activity minutes were counted twice and added to moderate intensity physical activity minutes.

§§§ Responded “yes” to, “The next questions refer to your joints. Please do NOT include the back or neck. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?”

¶¶¶ Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you/does anyone in the family] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside this home?”

**** Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you/any of these family members] need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?”

†††† Psychological distress was classified as none/mild, moderate, or severe and measured by the Kessler-6 Scale. https://www.hcp.med.harvard.edu/ncs/k6_scales.php

CME / ABIM MOC / CE

Prevalence of Arthritis and Arthritis-Attributable Activity Limitation — United States, 2016–2018

  • Authors: Kristina A. Theis, PhD; Louise B. Murphy, PhD; Dana Guglielmo, MPH; Michael A. Boring, MS; Catherine A. Okoro, PhD; Lindsey M. Duca, PhD; Charles G. Helmick, MD
  • CME / ABIM MOC / CE Released: 2/4/2022
  • Valid for credit through: 2/4/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

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Target Audience and Goal Statement

This activity is intended for public health officials, rheumatologists, internists, family practitioners, orthopedists, nurses, and other clinicians caring for patients with arthritis and arthritis-attributable activity limitations (AAAL).

The goal of this activity is to describe national prevalence estimates, trends, and associated factors for arthritis and AAAL among US adults, according to a CDC analysis of combined National Health Interview Survey data from 2016 to 2018.

Upon completion of this activity, participants will:

  • Describe national prevalence estimates, trends, and associated factors for arthritis among U.S. adults, according to a Centers for Disease Control and Prevention (CDC) analysis of combined National Health Interview Survey (NHIS) data from 2016 to 2018
  • Determine national prevalence estimates, trends, and associated factors for arthritis-attributable activity limitation (AAAL) among U.S. adults, according to a CDC analysis of combined NHIS data from 2016 to 2018
  • Identify clinical and public health implications of national prevalence estimates, trends, and associated factors for arthritis and AAAL among U.S. adults, according to a CDC analysis of combined NHIS data from 2016 to 2018


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Faculty

  • Kristina A. Theis, PhD

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Kristina A. Theis, PhD, has disclosed no relevant financial relationships.

  • Louise B. Murphy, PhD

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

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    Disclosure: Louise B. Murphy, PhD, has disclosed no relevant financial relationships.

  • Dana Guglielmo, MPH

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia
    Oak Ridge Institute for Science and Education
    Oak Ridge, Tennessee

    Disclosures

    Disclosure: Dana Guglielmo, MPH, has disclosed no relevant financial relationships.

  • Michael A. Boring, MS

    ASRT Inc.
    Smyrna, Georgia

    Disclosures

    Disclosure: Michael A. Boring, MS, has disclosed no relevant financial relationships.

  • Catherine A. Okoro, PhD

    Division of Human Development and Disability
    National Center on Birth Defects and Developmental Disabilities
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Catherine A. Okoro, PhD, has disclosed no relevant financial relationships.

  • Lindsey M. Duca, PhD

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Epidemic Intelligence Service
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Lindsey M. Duca, PhD, has disclosed no relevant financial relationships.

  • Charles G. Helmick, MD

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

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    Disclosure: Charles G. Helmick, MD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

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    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

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    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.


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CME / ABIM MOC / CE

Prevalence of Arthritis and Arthritis-Attributable Activity Limitation — United States, 2016–2018

Authors: Kristina A. Theis, PhD; Louise B. Murphy, PhD; Dana Guglielmo, MPH; Michael A. Boring, MS; Catherine A. Okoro, PhD; Lindsey M. Duca, PhD; Charles G. Helmick, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 2/4/2022

Valid for credit through: 2/4/2023

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Introduction

Arthritis has been the most frequently reported main cause of disability among U.S. adults for >15 years,[1] was responsible for >$300 billion in arthritis-attributable direct and indirect annual costs in the U.S. during 2013,[2] is linked to disproportionately high levels of anxiety and depression,[3] and is projected to increase 49% in prevalence from 2010–2012 to 2040.[4] To update national prevalence estimates for arthritis and arthritis-attributable activity limitation (AAAL) among U.S. adults, CDC analyzed combined National Health Interview Survey (NHIS) data from 2016–2018. An estimated 58.5 million adults aged ≥18 years (23.7%) reported arthritis; 25.7 million (10.4% overall; 43.9% among those with arthritis) reported AAAL. Prevalence of both arthritis and AAAL was highest among adults with physical limitations, few economic opportunities, and poor overall health. Arthritis was reported by more than one half of respondents aged ≥65 years (50.4%), adults who were unable to work or disabled* (52.3%), or adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), activities of daily living (ADL) disability (54.8%), or instrumental activities of daily living (IADL)§ disability (55.9%). More widespread dissemination of existing, evidence-based, community-delivered interventions, along with clinical coordination and attention to social determinants of health (e.g., improved social, economic, and mental health opportunities), can help reduce widespread arthritis prevalence and its adverse effects.

NHIS is an ongoing, nationally representative, in-person interview health survey of the noninstitutionalized, U.S. civilian population. Analyses were limited to adults aged ≥18 years. Unweighted sample sizes and final response rates of the Sample Adult component for 2016, 2017, and 2018 were 33,028 (54.3%); 26,742 (53.0%); and 25,417 (53.1%), respectively. Arthritis was ascertained by a response of "yes" to, "Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?" AAAL was ascertained among those with arthritis by a response of "yes" to, "Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?" Annualized unadjusted and age-standardized** prevalence estimates of arthritis and AAAL were generated overall and by selected sociodemographic,†† health,§§ and function characteristics.¶¶ Sampling weights were applied to account for the complex survey design, to generate nationally representative estimates, and to adjust for nonresponse. Subgroup differences were assessed using pairwise t-tests; orthogonal linear contrasts were performed to conduct linear trend tests in ordinal variables. Unadjusted estimates are reported in text unless otherwise noted; all differences are significant at α = 0.05. To examine change over time, a secondary analysis using identical methods was conducted to produce annualized absolute prevalence estimates of arthritis and AAAL for the combined years 2003–2005, 2007–2009, 2010–2012, and 2013–2015. These years were chosen to correspond to previous surveillance reports.*** A linear model trend test was conducted with significance set at α = 0.05.††† Analyses were conducted in SAS (version 9.4; SAS Institute) and SUDAAN (version 11.0; RTI International). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§§§

During 2016–2018, 58.5 million U.S. adults aged ≥18 years (23.7%; 21.5% age-standardized) are estimated to have arthritis; 25.7 million (43.9%; 40.8% age-standardized) of those with arthritis are estimated to have AAAL (Figure), representing 10.4% (9.4% age-standardized) of the total U.S. adult population. Annualized absolute prevalence of both arthritis and AAAL continues nearly two decades of an increasing statistically significant linear trend (Figure). Prevalence of arthritis increased with increasing age, body mass index (BMI), aerobic physical inactivity, and worsening psychological distress and self-rated health, and decreased with increasing educational attainment and income-to-poverty ratio (Table 1). Arthritis prevalence was >50% among adults aged ≥65 years (50.4%), adults who were unable to work or disabled (52.3%), and adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), ADL disability (54.8%), and IADL disability (55.9%).

Enlarge

FIGURE. Weighted number of adults aged ≥18 years with arthritis* and arthritis-attributable activity limitation , § , ,** — National Health Interview Survey, United States, 2003–2018

Among adults with arthritis, unadjusted prevalence of AAAL exceeded 50% in several groups, including adults with joint symptoms in the past 30 days (51.6%), adults who were unable to work or disabled (54.7%), adults of other/multiple races (54.5%) or non-Hispanic American Indian or Alaska Natives (60.7%), adults with low income (53.3%) or poor/near poor income-to-poverty ratios (63.3%), or with moderate psychological distress (59.5%) (Table 2). AAAL was also reported by a high proportion of adults with arthritis who had an ADL disability (82.6%), IADL disability (80.4%), serious psychological distress (76.3%), or fair/poor self-rated health (72.6%).

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* This category is a combination of respondents self-reporting their reason for not working as: “temporarily unable to work because of health reasons” or “disabled.”

† ADL disability was queried in the Person File and matched to respondents in the Sample Adult file, identified by “yes” to, “Because of a physical, mental, or emotional problem, [do you] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside this home?”

§ IADL disability was queried in the Person File and matched to respondents in the Sample Adult file, identified by “yes” to, “Because of a physical, mental, or emotional problem, [do you] need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?”

¶ Survey description documents are available at https://www.cdc.gov/nchs/ nhis/1997-2018.htm.

** Age-standardized to the 2000 projected U.S. population with three age groups (18–44, 45–64, and ≥65 years). https://www.cdc.gov/nchs/data/ statnt/statnt20.pdf

†† Age, sex, race and ethnicity, sexual identity, education, employment status, and income-to-poverty ratio values for the income-to-poverty ratio variable were calculated using NHIS imputed income files https://www.cdc.gov/ nchs/data/nhis/tecdoc18.pdf.

§§ Body mass index [weight (kg)/(height [m])2] reported as: under/healthy weight (<25.0), overweight (25.0–29.9), or obese (≥30); aerobic physical activity level reported as: active (≥150 minutes), insufficiently active (1– 149 minutes), or inactive (0 minutes) moderate-intensity leisure-time aerobic physical activity per 2018 Physical Activity Guidelines for Americans (https:// health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_ edition.pdf ); psychological distress (none/mild, moderate, severe measured by the Kessler-6 Scale https://www.hcp.med.harvard.edu/ncs/k6_scales.php); self-rated health (excellent/very good, good, or fair/poor).

¶¶ Measured by joint symptoms (pain, aching, or stiffness in the past 30 days), ADL disability, and IADL disability.

***https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5540a2.htm?s_ cid = mm5540a2_e; https://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5939a1.htm?s_cid = mm5939a1_w; https://www.cdc.gov/mmwr/ preview/mmwrhtml/mm6244a1.htm; and https://www.cdc.gov/mmwr/ volumes/66/wr/mm6609e1.htm

††† https://surveillance.cancer.gov/help/joinpoint

§§§ 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.