About Arthritis Disabilities and Limitations

Why are disabilities and limitations important for people with arthritis?
Because of its impacts on function and mobility, arthritis can result in activity and other limitations and is the most common cause of disability among U.S. adults ¹.

Causes of Disability Among US Adults

A CDC study shows that 47.5 million US adults (21.8%) reported a disability ¹ in 2005, an increase of 3.4 million from 1999. Arthritis or rheumatism continues to be the most common cause of disability, while back or spine problems and heart trouble round out the top three causes (Figure 1). Among adults reporting a disability, the most commonly identified limitations were difficulty climbing a flight of stairs (21.7 million, 10.0%) and walking 3 city blocks (22.5 million, 10.3%). That means that 1 in 10 adults have trouble walking a distance equal to walking from the parking lot to the back of a large store or through a mall.

[Text description is available.]

Figure 1. Data Source: U.S. Census Bureau, 2004 Survey of Income and Program Participation, Wave 5, June-September 2005. as reported in: Hootman JM, Brault MW, 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 [1.3Mb]

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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Arthritis Disabilities and Limitations Analyses

• Causes of Disability Among US Adults
• National Arthritis Prevalence and Arthritis-Attributable Limitations
• Arthritis-Attributable Impacts (6 analyses available)
• Racial and Ethnic Disparities in Prevalence of Arthritis-Attributable Impacts
• The Disability and Health Data System (DHDS)
• Resources

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National Arthritis Prevalence and Arthritis-Attributable Limitations

Based on 2007-2009 data from the National Health Interview Survey (NHIS)², an estimated

• 50 million (22%) of adults have self-reported doctor-diagnosed arthritis.
• 21 million (9% of all adults) have arthritis and arthritis-attributable activity limitation.

Based on 2003 NHIS data ³ a projected

• 67 million (25%) adults aged 18 years or older will have doctor-diagnosed arthritis by the year 2030.
• An estimated 37% (25 million adults) of those with arthritis will report arthritis-attributable activity limitations by the year 2030 (Figure 2).

Arthritis prevalence is projected to grow

Figure 2. Projected prevalence of arthritis-attributable activity limitation in U.S. adults, 2005-2030, by age, data source: National Health Interview Survey, 2003, as reported in: Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;54(1):266–229. abstract

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Arthritis-Attributable Impacts

The impact of arthritis on individuals is significant. More than 42% (21 million) of the 50 million adults with doctor-diagnosed arthritis report limitations in their usual activities due to their arthritis.

Figures 3 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 3 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 3a. Arthritis-Attributable Activity Limitation Among Adults with Arthritis (NHIS 2007-2009) and Arthritis-Attributable Work Limitation Among Adults with Arthritis 18-64 Years Old (NHIS 2002)

Figure 3b. Arthritis-Attributable Activity Limitation Among Adults with Arthritis, NHIS 2007-2009 and Arthritis-Attributable Work Limitation Among Adults with Arthritis Ages 18-64 Years, NHIS 2002.

[A text description of this graph 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.

Figure 3c. Arthritis-Attributable Volunteer Limitation Among Adults with Arthritis who Volunteer, ACHES 2005-2006 and Arthritis is the Main Barrier to Volunteering Among Adults with Arthritis who do not Volunteer, 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?"

Figure 3d. Arthritis-Attributable Volunteer Limitation Among Adults with Arthritis who Volunteer, ACHES 2005-2006 and Arthritis is the Main Barrier to Volunteering Among Adults with Arthritis who do not Volunteer, 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; 40% report it is "very difficult" or they "cannot do" at least 1 of 9 important daily functional activities. For example, almost 8 million adults who report an activity limitation due to their arthritis also report limitation in their ability to stoop, bend or kneel, and 6 million cannot walk ¼ mile. Figure 4 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 2002.

Data Source: 2002 National Health Interview Survey

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State-Specific Prevalence of Arthritis-Attributable

Impacts Prevalence of Arthritis-Attributable Work Limitation among All Working Age Adults

In all states, working-age (ages 18-64) U.S. adults face work limitations they attribute to arthritis (Figure 5). The prevalence of arthritis-attributable work limitation varies by state but is generally high, affecting from 4.0% to 12.6% 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.

[Text description is available.]

Figure 5. CDC unpublished data

Data Source: BRFSS 2009

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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 6). 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.

[Text description is available.]

Figure 6. CDC unpublished data

Data Source: BRFSS 2009

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Arthritis-Attributable Activity Limitations among All Adults

The prevalence of arthritis-attributable activity limitation among all adults ranges from 7.3% to 16.7% (Figure 7). 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.

[Text description is available.]

Figure 7. CDC unpublished data

Data Source: BRFSS 2009

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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 8). In every state at least one in three adults with arthritis reports arthritis-attributable activity limitations. In some states, more than one in two adults reports arthritis-attributable activity limitations.

[Text description is available.]

Figure 8. CDC unpublished data

Data Source: BRFSS 2009

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Proportion of arthritis-attributable social participation restriction among adults with arthritis

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

[Text description is available.]

Figure 9. CDC unpublished data

Data Source: BRFSS 2009

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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

Figure 10. Proportion of U.S. adults with arthritis who have arthritis-attributable impacts by racial/ethnic group, 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. html pdf [320k]

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Arthritis-Attributable impacts vary across Hispanic subgroups

Figure 11. Proportion of U.S. adults with arthritis who have arthritis-attributable impacts by Hispanic subgroup, 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 [1.1MB]

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.