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Comorbidities

What does “comorbidity” mean? 

More than one disease or condition is present in the same person at the same time. 

Conditions described as comorbidities are often chronic or long-term conditions. Other names to describe comorbid conditions are coexisting or co-occurring conditions and sometimes also “multimorbidity” or “multiple chronic conditions.”

The CDC Arthritis Program examines comorbidities in two ways:

  • Comorbidities among people with arthritis. Everyone in this group has arthritis and at least one other chronic condition.
  • Arthritis among people with other chronic conditions. People with other chronic conditions, such as heart disease or diabetes, who also have arthritis.

Comorbidities among people with arthritis

In one study, CDC examined the presence of four specific chronic conditions among people with arthritis: chronic respiratory conditions, diabetes, heart disease, and stroke.  About half (47%) of US adults with arthritis also have at least one of these comorbid conditions (2007 National Health Interview Survey).

 As shown in Figure 1 below, of US adults with arthritis,

  • 24% (11.2 million) also had heart disease. That’s nearly 1 in 4.
    • Heart disease was the most common comorbidity among people with arthritis.
  • 19% (9.0 million) also had chronic respiratory conditions.
  • 16% (7.3 million) also had diabetes.
  • 6.9% (3.2 million) also suffered stroke.
    • Stroke was the least common comorbidity studied among people with arthritis.

Figure 1— Four of the Most Common Comorbidities among Adults with Arthritis

Arthritis is very common, affecting 50 million Americans.1 According to the graph, in 2007, 11.2 million, or nearly one in four adults with arthritis (24%), also had heart disease. The most common comorbidity among adults with arthritis was heart disease. Among people with arthritis 19% (9.0 million) also had chronic respiratory conditions and 16% (7.3 million) also had diabetes. Of the four conditions studied, stroke was the least common condition and affected 3.2 million people with arthritis.

Data source: National Health Interview Survey, 2007; as printed in: Murphy L, Bolen J, Helmick CG, Brady TJ. Comorbidities Are Very Common Among People With Arthritis. Poster 43. 20th National Conference on Chronic Disease Prevention and Control, CDC February 2009.


Why do people with arthritis have so many comorbidities?

No one knows exactly why people with arthritis have so many comorbidities. It might because arthritis and other chronic conditions share some of the same non-modifiable risk factors (e.g., age) and modifiable risk factors (e.g., obesity, smoking). Arthritis also may directly relate to physical inactivity, which can lead to obesity and other chronic conditions.

Figure 2 below shows
 

  • High blood pressure is reported by more than half (53%) of US adults with arthritis. High blood pressure is also associated with heart disease, the most common comorbidity among adults with arthritis (shown in Figure 1).
  • About 1 in 5 (about 19%) of US adults with arthritis are current smokers. Smoking can cause chronic respiratory conditions, the second most common comorbidity among adults with arthritis (shown in Figure 1).  Smoking is also a risk factor for rheumatoid arthritis.

Figure 2— Chronic Disease Risk Factors are Common among Adults with Arthritis 

Graph 2 shows that high blood pressure is reported by more than half of (about 53%) US adults with arthritis. High blood pressure is associated with heart disease, the most common comorbidity among adults with arthritis (shown in Graph 1). Graph 2 also shows that about 1 in 5 (~19%) of US adults with arthritis is also a current smoker. Smoking is associated with chronic respiratory conditions, the second most common comorbidity among adults with arthritis (shown in Graph 1).

Data source: National Health Interview Survey, 2007; as printed in: Murphy L, Bolen J, Helmick CG, Brady TJ. Comorbidities Are Very Common Among People With Arthritis. Poster 43. 20th National Conference on Chronic Disease Prevention and Control, CDC February 2009.

What can people who have arthritis and comorbidities do?

The CDC Arthritis Program recommends self-management education programs and physical activity programs for all people with arthritis. These programs teach people skills to take charge of their conditions and engage in effective, joint-friendly physical activity. These programs also have proven benefits for other chronic conditions.

Public Health Chronic Disease Management Strategies

Self-management education programs are a proven approach

Comorbidities can complicate disease management and treatment.  Fortunately, there are evidence-based public health strategies that address the effects of arthritis and other chronic diseases.  These strategies help individuals and health professionals with comprehensive disease management.

Health care providers can also help people improve their quality-of-life by referring them to chronic disease self-management education programs that address the effects of arthritis and other chronic conditions.

Learn about CDC recommended intervention programs that are proven to improve the quality of life of people with arthritis.

Keeping people with arthritis and comorbidities physically active

Being physically active is an essential part of preventing and managing many chronic conditions, including arthritis, heart disease, diabetes, and obesity. However, most adults face the following common barriers to physical activity:

  • Lack of time.
  • Competing responsibilities.
  • Lack of motivation.
  • Difficulty finding an enjoyable activity.

Adults with arthritis may face the following additional, disease-specific barriers:

  • Concerns about aggravating arthritis pain.
  • Fear about causing further joint damage.
  • Uncertainty about which types and amounts of activity are safe for their joints.

Health care providers can help people overcome arthritis-specific barriers to physical inactivity by providing appropriate advice and referrals to evidence-based physical activity programs that are designed for adults with arthritis. Learn more about the importance of physical activity for people with arthritis.

Learn about intervention programs, such as self-management education programs and physical activity programs, that are designed to teach people the skills they need to take charge of their conditions and engage in effective, joint-friendly physical activity.

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Arthritis among people with other chronic conditions

In the total US population, 22.7% of adults have arthritis.1 Arthritis is even more common among people with other chronic conditions.  For example

  • 49% of adults with heart disease also have arthritis.  
  • 47% of adults with diabetes also have arthritis.
  • 31% of adults who are obese also have arthritis.

Data source:  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. Morb Mort Wkly Rep. 2013;62(44):869-873.

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Arthritis and Heart Disease

Arthritis may be a barrier to increased physical activity among adults with heart disease.2

Being physically active is an important component of heart disease management, but people with heart disease are less likely to comply with physical activity recommendations than those without heart disease. Increasing physical activity (for example, through aerobic exercise or strength training) can benefit people with heart disease and arthritis.

What are the benefits of increased physical activity for people with heart disease and arthritis?

People with heart disease who are inactive and become more active benefit from the following:

  • Improved physical function.
  • Lowering blood pressure.
  • Lowering low-density lipoprotein cholesterol levels.3,4

Despite these benefits, 1 in 5 people with heart disease (21%) are physically inactive. Being physically inactive is an even bigger problem for people with heart disease who also have arthritis (Figure 1). Physical inactivity is more common in adults who have both arthritis and heart disease compared with people who only have one or neither condition. Almost one-third of adults, or 1 in 3, with both conditions are physically inactive. Physical inactivity puts people at greater risk for complications from chronic conditions.

For more information on heart disease, visit CDC’s Heart Disease website.

Figure 1. Physical inactivity is most common among adults who have both heart disease and arthritis

Physical inactivity is the most common among adults who have both heart disease and arthritis. Numbers shown on chart: arthritis and heart disease: 29. Heart disease only: 21. Arthritis only: 18. Neither condition: 11.

Physical inactivity among adults age ≥18 years, by arthritis and heart disease status

Data Source: Behavioral Risk Factor Surveillance System, United States, 2005 and 2007; as printed in: Bolen J, Murphy L, Greenlund K, , Helmick CG, Hootman J, Brady TJ, Langmaid G, Keenan N. Arthritis as a potential barrier to physical activity among adults with heart disease — United States, 2005 and 2007. MMWR 2009;58(7):165-169. html; pdf [1.25MB]

Arthritis and Diabetes

Arthritis may be a barrier to physical activity among adults with diabetes.5

Being physically active, for example, through aerobic exercise or strength training, can benefit people with arthritis or diabetes and especially those with both conditions.5

What are the benefits of increased physical activity for people with diabetes and arthritis?

When they become more physically active, people with diabetes who are inactive benefit from the following:

  • Improved physical function.
  • Improved glucose tolerance.6

Despite these benefits, 1 in 5 people with diabetes (21%) are physically inactive. Being physically inactive is an even bigger problem for people with diabetes who also have arthritis. Physical inactivity is most common in adults who have both arthritis and diabetes compared with people who only have one or neither condition. Almost one third of adults, or one-in-three, with both conditions are physically inactive. Physical inactivity puts people at greater risk for complications from chronic conditions.

The bar chart in the figure below shows that physical inactivity was highest among U.S. adults with both diabetes and arthritis, lower among adults with diabetes or arthritis alone, and lowest among adults without either condition.

Adults with both arthritis and diabetes were 30% more likely to be physically inactive than those with diabetes only, even after adjustment for age, sex, and body mass index (BMI). This means that simply having diabetes and arthritis together increases your likelihood of physical inactivity, regardless of your age, sex, or BMI.

For more information on diabetes, visit CDC’s Diabetes website.

 

Chart: arthritis and diabetes=30. diabetes only=21. arthritis only=17. Neither condition=11.

Physical inactivity among adults age ≥18 years, by arthritis and diabetes status

Data Source: Behavioral Risk Factor Surveillance System, United States, 2005 and 2007; as printed in: Bolen J, Hootman J, Helmick CG, Murphy L, Langmaid G, Caspersen CJ. Arthritis as a Potential Barrier to Physical Activity Among Adults with Diabetes — United States, 2005 and 2007. MMWR 2008;57(18):486–489. html; pdf [1.25MB].

What can people with arthritis and other chronic conditions do to overcome the challenges of both conditions?

People with arthritis and other chronic conditions can participate in interventions programs, such as self-management education programs and physical activity programs, that are designed to teach them the skills they need to take charge of their conditions and engage in effective, joint-friendly physical activity. For information on about these programs, visit  the CDC Arthritis Program's Intervention Programs page

Related Links

References

1. 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 - 198KB

2. Bolen J, Murphy L, Greenlund K, Helmick CG, Hootman J, Brady TJ, etal. Arthritis as a potential barrier to physical activity among adults with heart disease — United States, 2005 and 2007. MMWR 2009;58(7):165–169. html; pdf [1.25MB].

3. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. Hyattsville, MD: U.S. Department of Health and Human Services; 2008. Available at http://www.health.gov/paguidelines.

4. Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation 2006;113:23:63–72. Free access html pdf [611KB]

5. Bolen J, Hootman J, Helmick CG, Murphy L, Langmaid G, Caspersen CJ. Arthritis as a Potential Barrier to Physical Activity Among Adults with Diabetes — United States, 2005 and 2007. MMWR 2008;57(18):486–489. html; pdf [1.25MB]

6. CDC. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2005. 

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