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Disabilities and Limitations

Why are disabilities and limitations important for people with arthritis?
Arthritis impacts function and mobility that can result in activity and other limitations, and is a leading cause of disability among US adults. 1

Disabilities and Limitations can be Examined in Many Ways

There is no single definition for "disability," and many programs and surveys use different definitions based on program needs and available data. Also, the same underlying cause of a disability can affect different people in different ways. It is important to remember that all people can be healthy and live well with or without a disability. It is also important to estimate the number of people with disabilities or limitations and the types of difficulties that can occur in order to improve planning for programs and accommodations.

The CDC Arthritis Program examines disabilities and limitations in the following ways:

  1. Arthritis-Attributable limitations. Everyone in this group has arthritis and reports that their arthritis is responsible for specific limitations:
    • Arthritis-Attributable Activity Limitations (AAAL).
    • Arthritis-Attributable Work Limitations (AAWL).
    • Arthritis-Attributable Social Participation Restriction (AASPR).
  2. Specific functional limitations. These limitations make up a group of common daily activities that many people with arthritis report are "very difficult" or that they "cannot do" them. The activities are
    • grasp small objects.
    • reach above one's head.
    • sit more than 2 hours.
    • lift or carry 10 pounds.
    • climb a flight of stairs.
    • push a heavy object.
    • walk a 1/4 mile.
    • stand more than 2 hours.
    • stoop, bend, or kneel.
  3. Defining Disability. As mentioned above, disability definitions often vary based on the survey used and other criteria. The CDC Arthritis Program uses data and information from several sources to characterize disability among adults with arthritis.
    • General disability: A typical case-finding question would be: "Because of a physical or mental health condition, [do you] have difficulty doing any of the following by yourself?" followed by a list of various activities.
    • Participation restriction: This is a concept developed by the World Health Organization (WHO) as part of their International Classification of Functioning, Disability, and Health (ICF), a framework that reflects impairments, activity limitations, environment, personal factors, and participation restriction as interconnected components on a continuum of functioning. Participation restriction refers to experiencing difficulties in life situations and is an umbrella term for disability. The concept of participation restriction can be applied to various settings and situations to evaluate capacity to engage (or not) in life situations. For example, participation restriction could be measured in domestic life, work and employment, and community, social, and civic life, among other areas. Social participation restriction reflects limitation in the ability to engage in social activities and situations. Community participation restriction reflects limitation in the ability to engage in community activities and/or the physical community itself. Because ability is influenced by environment, external characteristics of a person's environment are ideally considered when evaluating participation restriction. Furthermore, the ICF framework recognizes that accommodations and adaptations may cancel out limitations—for example, a cane and a ramp may provide access to community events and facilities. More information on the ICF framework is available.

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National Arthritis Prevalence and Arthritis-Attributable Limitations

Based on 2010-2012 data from the National Health Interview Survey (NHIS)2, an estimated

  • 52.5 million (22.7%) of adults ≥18 years have self-reported doctor-diagnosed arthritis.
  • 22.7 million (9.8%) of all adults ≥18 years have arthritis and arthritis-attributable activity limitation.

Based on 2010-2012 data from the National Health Interview Survey (NHIS)3, a projected

  • 78 million (26%) adults aged 18 years or older will have doctor-diagnosed arthritis by the year 2040.
  • Of those with arthritis, an estimated 44% (35 million adults) will report arthritis-attributable activity limitations by the year 2040.

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Arthritis-Attributable Impacts

The impact of arthritis on individuals is significant. Figure 1 a and b show that more than 43.2% (22.7 million) of the 52.5 million adults with doctor-diagnosed arthritis report limitations in their usual activities due to their arthritis.

Figures 1 a and b show that, in addition to activity limitations, 31% (8.3 million) of working age adults with doctor-diagnosed arthritis report being limited in work due to arthritis.

Figures 1 c and d show that 41% (5 million) of adults with arthritis who volunteer are limited in their abilities to do so because of their arthritis; 27% (7 million) of adults with arthritis who do not volunteer report that arthritis is their main barrier to volunteering.4

Figure 3: Arthritis-Attributable Activity Limitation Among Adults with Arthritis

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Figure 1a. Arthritis-Attributable Activity Limitation Among Adults with Arthritis (NHIS 2010-2012) and Arthritis-Attributable Work Limitation Among Adults with Arthritis 18-64 Years Old (NHIS 2002)

A text description is also available.

Figure 3b. Arthritis-Attributable Activity Limitation Among Adults with Arthritis, NHIS 2010-2012 and Arthritis-Attributable Work Limitation Among Adults with Arthritis Ages 18-64 Years, NHIS 2002.

Figure 1b. Arthritis-Attributable Activity Limitation Among Adults with Arthritis, NHIS 2010-2012 and Arthritis-Attributable Work Limitation Among Adults with Arthritis Ages 18-64 Years, NHIS 2002

A text description is also available.

NOTE: Arthritis-Attributable Activity Limitation = responding "yes" to "Are you now limited in any way in any of your usual activities due to arthritis or joint symptoms?"; Arthritis-Attributable Work Limitation = among working age population (18–64 years), responding "yes" to being limited in the type, amount, or whether they work due to arthritis.

image on Arthritis Limits people in their ability to volunteer

Figure 1c. Arthritis-Attributable Volunteer Limitation Among Adults ≥45 years with Arthritis who Volunteer, and Arthritis is the Main Barrier to Volunteering Among Adults Adults ≥45 years with Arthritis with Arthritis who do not Volunteer

A text description of this graph is also available.

Data source: ACHES 2005-2006

NOTE: Arthritis-Attributable Volunteer Limitation = responding "yes" to "Do arthritis or joint symptoms affect the amount or type of volunteer work you do?"; Arthritis is the Main Barrier to Volunteering = responding "yes" to "Is arthritis or joint symptoms the main reason you do not do volunteer work?"

image on Arthritis Limits millions of people in their ability to volunteer

Figure 1d. Arthritis-Attributable Volunteer Limitation Among Adults ≥45 years with Arthritis;  Arthritis is the Main Barrier to Volunteering Among Adults ≥45 years with Arthritis with Arthritis who do not Volunteer

A text description of this graph is also available.

Data source:ACHES 2005-2006

NOTE: Arthritis-Attributable Volunteer Limitation = responding "yes" to "Do arthritis or joint symptoms affect the amount or type of volunteer work you do?"; Arthritis is the Main Barrier to Volunteering = responding "yes" to "Is arthritis or joint symptoms the main reason you do not do volunteer work?"

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Specific Functional Limitations Among Adults with Arthritis

Functional limitations in common daily activities are common among adults with arthritis; 43% report it is "very difficult" or they "cannot do" at least 1 of 9 important daily functional activities. For example, 14 million adults who report an activity limitation due to their arthritis report limitation in their ability to stoop, bend or kneel, and 11 million cannot walk ¼ mile. Figure 2 shows the prevalence of specific functional limitations. Impairment in the ability to perform essential daily living activities may interfere with the ability of people with arthritis to work, function in their community, or care for their family.

Figure 4. Functional limitation is defined as "very difficult" or "cannot do" for the following activities: grasp small objects; reach above one's head; sit more than 2 hours; lift or carry 10 pounds; climb a flight of stairs; push a heavy object; walk a 1/4 mile; stand more than 2 hours; stoop, bend, or kneel, NHIS 2009.

Figure 2. Millions of Adults with Arthritis Report Limitations in Specific Functional Activities

A text description of this graph is also available.

Data Source: 2009 National Health Interview Survey; as reported in: Theis KA, Murphy L, Hootman JM, Wilkie R. Social Participation Restriction among U.S. adults with arthritis: A population-based study using the International Classification of Functioning, Disability, and Health. Arthritis Care & Research 2013; 65(7):1059-1069.

Note: Functional limitation is defined as "very difficult" or "cannot do" for the following activities: grasp small objects; reach above one's head; sit more than 2 hours; lift or carry 10 pounds; climb a flight of stairs; push a heavy object; walk a ¼ mile; stand more than 2 hours; stoop, bend, or kneel.

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State-Specific Prevalence of Arthritis-Attributable Impacts 

Prevalence of Arthritis-Attributable Work Limitations Among All Working Age Adults

In all states, working-age (ages 18-64) US adults face work limitations they attribute to arthritis (Figure 3). The prevalence of arthritis-attributable work limitation varies by state but is generally high, affecting from 4.2% to 11.6% of all working-age adults. For example, a state with a population prevalence of arthritis-attributable work limitation of 7% could be expressed as: approximately 1 out of every 14 working-age adults in the state report doctor-diagnosed arthritis and say that it limits them in their work.

Arthritis-Attributable work limitations affect at least 1 in 25 working-age adults in every state.

 Figure 3. Prevalence of Arthritis- Attributable Work Limitations among Adults with Arthritis, age 18-64 years.

A text description is also available.

Data Source: BRFSS 2013; CDC unpublished data.

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Proportion of Arthritis-Attributable Work Limitation Among Adults With Arthritis

Arthritis-attributable work limitation is very common among working-age (ages 18-64) adults with arthritis (Figure 4). In states with the lowest prevalence of arthritis-attributable work limitations, it is still reported by greater than 1 of every 4 working-age adults with arthritis (25%). In states with the highest prevalence of arthritis-attributable work limitation, that ratio jumps to approximately 1 of every 2 working-age adults with arthritis.

Arthritis-Attributable work limitations affect at least 1 in 4 working-age adults with arthritis in every state

 A text description is also available.

Figure 4. Age- Adjusted Proportion of Arthritis- Attributable Work Limitation among Adults

Data Source: BRFSS 2013; CDC unpublished data

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Prevalence of Arthritis-Attributable Activity Limitations Among All Adults

The prevalence of arthritis-attributable activity limitation among all adults ranges from 6.4% to 17.5% (Figure 5). These high rates of arthritis-attributable activity limitation are projected to increase with the aging of the population, requiring increased intervention measures to reduce this impact. Arthritis-attributable activity limitation can be prevented or reduced in many persons. In fact, both aerobic and strengthening exercises can improve physical function and self-reported arthritis disability. Self-management education classes can also increase confidence in one's ability to manage arthritis.

image on Arthritis-Attributable work limitations affect at least 1 in 14 working-age adults in every state

A text description is also available.

Figure 5. Age- Adjusted Population Prevalence of Arthritis- Attributable Activity  Limitation among adults 18 years or older

Data Source: BRFSS 2013; CDC unpublished data

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Proportion of Arthritis-Attributable Activity Limitations Among Adults with Arthritis

The proportion of adults with arthritis who have arthritis-attributable activity limitations is substantial (Figure 6). In every state at least 1 in 3 adults with arthritis reports arthritis-attributable activity limitations. In some states, more than 1 in 2 adults reports arthritis-attributable activity limitations.

image on Arthritis-Attributable work limitations affect at least 1 in 3 working-age adults in every state

A text description is also available.

Figure 6. Age- adjusted proportion of arthritis- attributable activity limitation among adults with arthritis age 18 years of older

Data Source: BRFSS 2013; CDC unpublished data

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Prevalence of Arthritis-Attributable Social Participation Restriction Among All Adults

Arthritis-attributable social participation restriction is defined here as an answer of “a lot” to a question asking how much arthritis has interfered with “normal social activities, such as going shopping, to the movies, or to religious or social gatherings.” The prevalence of arthritis-attributable social participation restriction ranges from at least one in forty to about 1 in 13 adults across states, with a median of 1 in 25 (4%).

image on Arthritis-Attributable social participation restriction affect at least 1 in 40 working-age adults with arthritis in every state

Figure 7. Prevalence of Arthritis-Attributable Social Participation Restriction Among All Adults

A text description is also available.

Data Source: BRFSS 2013; CDC unpublished data

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Proportion of Arthritis-Attributable Social Participation Restriction Among Adults with Arthritis

The proportion of adults with arthritis-attributable social participation restriction ranges from about 1 in 12 to one in three adults with arthritis across states, indicating that it is a substantial problem caused by arthritis.

image on Arthritis-Attributable work limitations affect at least 1 in 12 working-age adults with arthritis in every state

 A text description is also available.

Figure 8. Proportion of Arthritis-Attributable Social Participation Restriction Among Adults with Arthritis

Data Source: BRFSS 2013; CDC unpublished data

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Racial and Ethnic Disparities in Prevalence of Arthritis-Attributable Impacts

Arthritis is a frequent problem with a large impact on all racial/ethnic groups in the U.S., but the disabling effects of arthritis (arthritis-attributable activity and work limitations) sometimes affect racial/ethnic minorities more frequently and do not affect all racial/ethnic minorities equally.

Arthritis-Attributable Impacts Vary by Racial/Ethnic Group and are Often Higher in Minorities

Arthritis-Attributable impacts vary by racial/ethnic group and are often higher in minorities. Approximate percentage of Arthritis-attributable activity limitations: white=35; Asian/Pacific Islander=38; American Indian/Alaska Native=39; Hispanic=42; Black=43; Multirace/Other=49. Approximate percentage of Arthritis-attributable work limitations: white=28; Asian/Pacific Islander=27; American Indian/Alaska Native=37; Hispanic=39; Black=41; Multirace/Other=47.

Figure 9. Proportion of US adults with arthritis who have arthritis-attributable limitations by racial/ethnic group

A text description is also available.

Data source: National Health Interview Survey, 2002, 2003, 2006, as reported in: Bolen J, Schieb L, Hootman JM, Helmick CG, Theis K, Murphy LB, et al. Differences in the prevalence and impact of arthritis among racial/ethnic groups in the United States, National Health Interview Survey, 2002, 2003, and 2006. Prev Chronic Dis 2010;7(3):1–5.  [PDF-320KB]

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Arthritis-Attributable Impacts Vary Across Hispanic Subgroups

Chart: Arthritis-Attributable impacts vary across Hispanic subgroups. Approximate percentages of Arthritis-Attributable Activity Limitations (see full html link below this chart for exact numbers): Cuban/Cuban American=20; Dominican/Dominican American=22; Central/South American=32; Mexican=42; Mexican American=44; Other/Multiple Hispanic=44; Puerto Rican=47. Percentage of Arthritis-Attributable Work Limitations: Cuban/Cuban American=38; Dominican/Dominican American=37; Central/South American=32; Mexican=38; Mexican American=42; Other/Multiple Hispanic=35; Puerto Rican=38.

Figure 10. Proportion of US adults with arthritis who have arthritis-attributable impacts by Hispanic subgroup

A text description is also available.

Data source: National Health Interview Survey, 2002, 2003, 2006, as reported in: Murphy LB, Bolen J, Schieb L, Hootman, JM, Langmaid GA, Cheng YJ, et al. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Effects Among Hispanic Adults, by Hispanic Subgroup — United States, 2002, 2003, 2006, and 2009. MMWR 2011;60(6):167-171. html [PDF - 332KB]

The Disability and Health Data System (DHDS)

The DHDS is an interactive online data tool that helps users translate state-level, disability-specific data into valuable public health information. With DHDS, users can customize how they view disability and health data throughout the country, making it easy to understand health disparity information, identify trends, and help support the development of fiscally-responsible, evidence-based programs, services and policies that include people with disabilities.

Among its many features, DHDS allows filtering for arthritis-specific information. For more information and to view data through interactive maps and data tables visit the DHDS Web site.

Resources

Many resources are available for people with and without arthritis who have disabilities or limitations:

References

  1. Brault MW, Hootman JM, Helmick CG, Theis KA, Armour BS. Prevalence and Most Common Causes of Disability Among Adults - United States, 2005. MMWR 2009;58(16):421-426.
    html; [PDF-1.30MB]
  2. Barbour KE, Helmick CG, Theis KA, Murphy LB, Hootman JM, Brady TJ, Cheng YJ. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation-United States, 2010-2012. MMWR 2013;62 (44):869-873. html [PDF-542KB]
  3. Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA.  Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040.  Arthritis & Rheumatology. 2016 Mar 25. [Epub ahead of print]. doi: 10.1002/art.39692. PubMed PMID: 27015600. abstract
  4. Theis KA, Murphy L, Hootman JM, Helmick CG, Sacks JJ. Arthritis Restricts Volunteer Participation: Prevalence and Correlates of Volunteer Status Among Adults With Arthritis. Arthritis Care & Research;62(7):907–916. abstract
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