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Arthritis Prevalence and Activity Limitations -- United States, 1990

Arthritis is a leading cause of work-related disability and the leading cause of disability among persons aged greater than or equal to 65 years in the United States (1). However, there are few national or state-specific estimates and no projections of arthritis prevalence or its impact (2). To develop national and state estimates of arthritis prevalence and physical activity limitation for 1990 and to project these measures through 2020, rates derived from household interview data from the 1989-1991 National Health Interview Survey (NHIS) were applied to the 1990 census population and to census population projections. This report presents the results of that analysis.

The NHIS is a probability sample of the civilian, noninstitutionalized population of the United States (3). Estimates of arthritis prevalence were derived by using a random sample of one sixth (n=59,289) of survey respondents, who were asked about the presence of any of a variety of musculoskeletal conditions during the preceding 12 months and for details of these conditions. Each condition was assigned an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code. Arthritis was classified as a condition that matched ICD-9-CM codes * selected by the National Arthritis Data Workgroup. A total of 8963 (15.1%) persons were classified as having arthritis. Estimates of activity limitation attributable to arthritis were derived by using all 356,592 NHIS respondents, who were asked whether they were limited in or prevented from working, housekeeping, or performing other activities as a result of a health condition(s) and, if so, what specific condition(s) caused the limitation; 10,084 (2.8%) persons reported arthritis as a major or contributing cause of activity limitation.

Synthetic state estimates ** for 1990 were developed by applying respective regional arthritis rates, stratified by age, sex, race, and ethnicity, to the stratum-specific populations of each state as reported by the 1990 census. National projections through 2020 were determined by applying national arthritis prevalence rates, stratified by age, sex, and race, to the total U.S. population projected by the U.S. Bureau of the Census (4).

In 1990, an estimated 15.0% (37.9 million persons) of the U.S. population had arthritis. Estimated prevalence rates were 49.4% for persons aged greater than or equal to 65 years, 5.1% for persons aged less than or equal to 44 years, and 0.5% for children aged less than or equal to 16 years. Arthritis rates age-adjusted to the 1989-1991 population were higher for women (17.1%) than men (12.5%) and for non-Hispanics (15.3%) than Hispanics (11.3%) (Table_1). Rates were similar for blacks and whites. Of persons reporting arthritis, 83.6% had consulted a physician for the problem.

In 1990, an estimated 2.8% (7.0 million persons) of the U.S. population had arthritis as a major or contributing cause of activity limitation. Arthritis limited activities in 11.6% of persons aged greater than or equal to 65 years, 0.5% of persons aged less than or equal to 44 years, and 0.1% of persons aged less than or equal to 16 years. Rates of activity limitation, adjusted for age, were higher for women (3.4%) than men (2.0%) and for blacks (4.0%) than whites (2.6%) (Table_1). Age-adjusted rates of activity limitation were twofold higher for persons with 8 or fewer years of education than for persons with a college degree and were threefold higher for persons earning $10,000 or less per year than for persons earning $35,000 or more.

Based on region-specific rates and state-specific age, sex, race, and ethnicity distributions, estimated synthetic prevalence rates for self-reported arthritis were lowest in Alaska (10.0%) and highest in Florida (19.1%) (Table_2). Similarly derived rates of arthritis-limited activity were lowest in Alaska (1.5%) and highest in Florida and the District of Columbia (3.8% each).

The prevalence rate of self-reported arthritis in the United States is projected to increase from 15.0% of the 1990 population to 18.2% (59.4 million) of the estimated population for 2020. Activity limitation associated with arthritis is projected to increase from 2.8% of the 1990 population to 3.6% (11.6 million) of the 2020 population.

Reported by: National Arthritis Data Workgroup. Statistics Br and Aging Studies Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that both the estimated number of persons with arthritis and the prevalence rate of arthritis have increased since 1985, when 35 million (14.5%) persons had arthritis (5). By 2020, the estimated number of persons with arthritis is projected to increase by 57% and activity limitation associated with arthritis by 66%. These projected increases are largely attributable to the high prevalence of arthritis among older persons and the increasing average age of the U.S. population.

The reasons for higher rates of arthritis among women and higher rates of activity limitation among women and persons with low education and low income are not clear. Race and ethnicity are probably risk markers and not risk factors for arthritis. Risk markers may be useful for identifying groups at greatest risk for arthritis and targeting intervention efforts.

Although arthritis is more prevalent and a more frequent cause of activity limitation than heart disease, cancer, or diabetes (6), epidemiologic data about this condition are limited. To address this limitation, federal and private groups are collaborating to provide better information about the frequency and impact of arthritis. In addition, some states are gathering data through the Behavioral Risk Factor Surveillance System (7) and making diagnostic, treatment, educational, and rehabilitative services more accessible to all persons with arthritis (8).

The findings in this report are subject to at least three limitations. First, the estimates are based on self-reported data that were not validated by a health-care provider. However, because many persons with arthritis do not seek medical care, self-reported data may provide a better indicator of symptomatic arthritis (9). Second, synthetic estimates are not based on direct measurements of state data. Third, synthetic state estimates were not adjusted for income, education, and metropolitan statistical area. In addition, the definition for arthritis used in this report was more comprehensive than that used in the 1985 study and includes additional conditions (e.g., lupus, infectious arthritis, and carpal tunnel syndrome) that persons would identify as arthritis.

Further studies are needed to define the frequency of the specific types of arthritis, determine the characteristics of persons who do not seek medical care, and better assess the financial and societal impact of arthritis. In addition, data are needed to better characterize differences in the prevalence and impact of arthritis in demographic subgroups and to provide more direct measures of arthritis for individual states. These data will assist in efforts to reduce the projected impact of arthritis and to direct interventions and services to groups disproportionately affected by arthritis.

States can use these synthetic estimates to set priorities and target resources until more direct measures of arthritis prevalence and impact are available. To lessen the projected impact of arthritis, health-care providers should 1) promote primary prevention of arthritis through prevention of obesity and sports-associated or occupational-associated joint injury, and 2) encourage early detection and appropriate management of persons with arthritis, including exercise and educational programs (e.g., the Arthritis Self-Help Course, which has been shown to reduce pain and physician visits {10}).

References

  1. Pope AM, Tarlow AR, eds. Disability in America: toward a national agenda for prevention. Washington, DC: National Academy Press, 1991.

  2. CDC. Prevalence of arthritic conditions -- United States, 1987. MMWR 1990;39:99-102.

  3. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-94. Vital Health Stat 1989;2:1-4.

  4. Day JC. Population projections of the United States, by age, sex, race, and Hispanic origin: 1993 to 2050. Washington, DC: US Department of Commerce, Bureau of the Census, 1993. (Current population reports; series P25, no. 1104).

  5. Lawrence RC, Hochberg MC, Kelsey JL, et al. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol 1989;16:427-41.

  6. LaPlante MP. Data on disability from the National Health Interview Survey, 1983-1985. Washington, DC: US Department of Education, National Institute on Disability and Rehabilitation Research, 1988.

  7. CDC. Prevalence of arthritis -- Arizona, Missouri, and Ohio, 1991- 1992. MMWR 1994;43:305-9.

  8. CDC. Arthritis program -- Missouri. MMWR 1988;37:85-7.

  9. Edwards S. Evaluation of the National Health Survey diagnostic reporting. Rockville, Maryland: Westat, Inc., December 21, 1992, (report to NCHS).

  10. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993;36:439-46.

* ICD-9-CM codes 95.6, 95.7, 98.5, 99.3, 136.1, 274, 277.2, 287.0, 344.6, 353.0, 354.0, 355.5, 357.1, 390, 391, 437.4, 443.0, 446, 447.6, 696.0, 710-716, 719.0, 719.2-719.9, 720-721, 725-727, 728.0- 728.3, 728.6-728.9, 729.0-729.1, and 729.4. 

** Synthetic estimation obtains state estimates of characteristics by combining regional estimates of the characteristics specific to demographic subgroups with estimates of the proportional distribution of the local population in those subgroups.


Table_1
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TABLE 1. Estimated average annual prevalence of self-reported arthritis and activity limitation attributable to arthritis, by
selected characteristics, derived from the National Health Interview Survey (NHIS) -- United States, 1989-1991
====================================================================================================================================
                               Self-reported arthritis                          Self-reported activity limitation
                   -----------------------------------------------      --------------------------------------------------
                                            Rate *                                               Rate *
                            --------------------------------------              ------------------------------------------
                                                  Age-                                                 Age-
Characteristic      No. +   (%)     (95% CI &)  adjusted  (95% CI)      No. +   (%)      (95% CI)    adjusted     (95% CI)
--------------------------------------------------------------------------------------------------------------------------
Age (yrs)
   <=24             1,128    1.3     (+/-0.2)       ---        ---        120    0.1     (+/-0.0)       ---         ---
  25-34             2,862    6.6     (+/-0.6)       ---        ---        249    0.6     (+/-0.1)       ---         ---
  35-44             4,778   12.7     (+/-0.8)       ---        ---        568    1.5     (+/-0.1)       ---         ---
  45-54             5,757   22.6     (+/-1.1)       ---        ---        879    3.5     (+/-0.2)       ---         ---
  55-64             7,699   36.5     (+/-1.5)       ---        ---      1,491    7.1     (+/-0.4)       ---         ---
  65-74             8,273   45.4     (+/-1.7)       ---        ---      1,809    9.9     (+/-0.4)       ---         ---
  75-84             5,501   55.2     (+/-2.3)       ---        ---      1,301   13.1     (+/-0.7)       ---         ---
   >=85             1,714   57.1     (+/-4.5)       ---        ---        554   18.5     (+/-1.4)       ---         ---

Sex
  Female           22,992   18.0     (+/-0.5)      17.1      (+/-0.4)   4,635    3.6     (+/-0.1)       3.4       (+/-0.1)
  Male             14,227   11.7     (+/-0.4)      12.5      (+/-0.4)   2,177    1.8     (+/-0.1)       2.0       (+/-0.1)

Race
  White            31,864   16.0     (+/-0.5)      15.2      (+/-0.3)   5,620    2.8     (+/-0.1)       2.6       (+/-0.1)
  Black             3,672   12.3     (+/-0.7)      15.5      (+/-0.8)     899    3.0     (+/-0.2)       4.0       (+/-0.2)
  American Indian/
    Alaskan Native    270   13.4     (+/-3.5)      17.5      (+/-3.4)      61    3.0     (+/-0.8)       4.2       (+/-1.0)
  Asian/Pacific
    Islander          401    5.6     (+/-1.4)       7.3      (+/-1.6)      52    0.7     (+/-0.2)       1.1       (+/-0.3)
  Other               760    7.8     (+/-1.5)      12.7      (+/-2.3)     129    1.3     (+/-0.2)       2.3       (+/-0.4)
Ethnicity
  Hispanic          1,412    6.5     (+/-0.8)      11.3      (+/-1.1)     314    1.4     (+/-0.2)       2.7       (+/-0.3)
  Non-Hispanic     36,000   15.9     (+/-0.4)      15.3      (+/-0.3)   6,524    2.9     (+/-0.1)       2.8       (+/-0.1)

Region @
  Northeast         7,354   14.5     (+/-0.7)      13.0      (+/-0.5)   1,266    2.5     (+/-0.2)       2.3       (+/-0.1)
  Midwest            9506   15.9     (+/-0.7)      15.9      (+/-0.6)   1,730    2.9     (+/-0.2)       2.9       (+/-0.2)
  South            13,491   15.8     (+/-0.6)      15.8      (+/-0.5)   2,616    3.1     (+/-0.2)       3.1       (+/-0.2)
  West              6,901   13.1     (+/-0.9)      14.2      (+/-0.8)   1,214    2.3     (+/-0.1)       2.5       (+/-0.1)

Residence
  Metropolitan
    statistical
    area (MSA) **  27,060   14.1     (+/-0.4)      14.4      (+/-0.3)   4,820    2.5     (+/-0.1)       2.6       (+/-0.1)
  Not MSA           9,805   18.1     (+/-0.8)      16.9      (+/-0.7)   1,930    3.6     (+/-0.2)       3.2       (+/-0.2)

Education (yrs)
    <=8             6,665   12.5     (+/-0.7)      16.4      (+/-1.0)   2,462    3.4     (+/-0.2)       4.2       (+/-0.2)
   9-11             5,346   18.3     (+/-1.1)      17.1      (+/-0.8)   1,461    4.0     (+/-0.2)       3.6       (+/-0.2)
     12            13,014   18.6     (+/-0.8)      15.3      (+/-0.6)   1,714    3.1     (+/-0.1)       2.5       (+/-0.1)
  13-15             6,093   16.7     (+/-0.9)      16.3      (+/-0.8)     916    2.4     (+/-0.2)       2.5       (+/-0.2)
     16             2,956   14.7     (+/-1.1)      13.6      (+/-1.1)     653    1.9     (+/-0.2)       1.9       (+/-0.2)
   >=17             2,404   16.4     (+/-1.4)      14.3      (+/-2.3)     226    2.0     (+/-0.2)       1.8       (+/-0.3)

Income
         <10,000    5,298   21.2     (+/-1.5)      20.3      (+/-1.2)   1,583    6.4     (+/-0.4)       6.0       (+/-0.3)
  10,000-19,999     7,636   19.1     (+/-1.0)      17.5      (+/-0.8)   1,618    4.1     (+/-0.2)       3.5       (+/-0.2)
  20,000-34,999     7,272   13.3     (+/-0.7)      14.5      (+/-0.7)   1,121    2.1     (+/-0.1)       2.3       (+/-0.1)
  35,000-49,999     4,459   11.4     (+/-0.8)      14.1      (+/-0.8)     540    1.4     (+/-0.1)       1.9       (+/-0.2)
       >=50,000     5,228   11.4     (+/-0.7)      13.4      (+/-0.8)     561    1.2     (+/-0.1)       1.6       (+/-0.1)

Total              37,943   15.0     (+/-0.4)      15.0      (+/-0.4)   6,964    2.8     (+/-0.1)       2.8       (+/-0.1)
--------------------------------------------------------------------------------------------------------------------------
 * Average annual rate in percentages in the 1989-1991 civilian, noninstitutionalized population. Age-adjusted rates use the eight
   listed age categories to adjust to the same population.
 + In thousands. To generate national estimates, NHIS rates were applied to the total population for age, sex, race, ethnicity,
   region and education and to the civilian, noninstitutionalaized population for residence and income.
 & Confidence interval.
 @ Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
   Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and
   Wisconsin. South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland,
   Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West=Alaska, Arizona,
   California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
** A county or group of counties containing at least one city having a population of 50,000 or more and adjacent counties that are
   metropolitan in character and are economically and socially integrated with the central city.
====================================================================================================================================


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Table_2
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TABLE 2. Synthetic estimates of state-specific prevalence of self-reported arthritis and
activity limitation attributable to arthritis -- United States, 1990 *.
=============================================================================================
                  Self-reported arthritis    Self-reported Activity limitation
                  ------------------------   ---------------------------------
Area              No. +   (%)   (95% CI &)         No. +  (%)    (95% CI)
------------------------------------------------------------------------------
Alabama            679   16.7    (+/-2.5)           134   3.3    (+/-0.6)
Alaska              54   10.0    (+/-3.0)             8   1.5    (+/-0.5)
Arizona            536   14.6    (+/-4.0)            95   2.6    (+/-0.8)
Arkansas           417   17.5    (+/-2.5)            81   3.4    (+/-0.6)
California        4000   13.4    (+/-4.6)           697   2.3    (+/-0.8)
Colorado           452   13.6    (+/-3.5)            77   2.3    (+/-0.7)
Connecticut        476   14.2    (+/-2.9)            82   2.4    (+/-0.6)
Delaware           108   16.1    (+/-2.4)            21   3.0    (+/-0.6)
District
  of Columbia       99   16.1    (+/-2.6)            23   3.8    (+/-0.9)
Florida           2471   19.1    (+/-3.1)           491   3.8    (+/-0.8)
Georgia            965   14.8    (+/-2.4)           184   2.8    (+/-0.5)
Hawaii             131   12.0    (+/-6.1)            20   1.9    (+/-1.0)
Idaho              143   14.0    (+/-2.9)            25   2.4    (+/-0.6)
Illinois          1822   15.7    (+/-3.4)           347   2.9    (+/-0.7)
Indiana            897   15.9    (+/-2.7)           163   2.8    (+/-0.6)
Iowa               485   17.0    (+/-2.7)            89   3.0    (+/-0.5)
Kansas             406   16.2    (+/-2.9)            75   2.9    (+/-0.6)
Kentucky           617   16.6    (+/-2.2)           115   3.1    (+/-0.5)
Louisiana          638   15.0    (+/-2.5)           126   2.9    (+/-0.6)
Maine              178   14.3    (+/-2.5)            29   2.3    (+/-0.5)
Maryland           745   15.5    (+/-2.6)           141   2.9    (+/-0.6)
Massachusetts      863   14.0    (+/-2.8)           148   2.4    (+/-0.6)
Michigan          1469   15.6    (+/-2.9)           273   2.9    (+/-0.6)
Minnesota          695   15.5    (+/-2.6)           123   2.7    (+/-0.5)
Mississippi        410   15.8    (+/-2.6)            84   3.2    (+/-0.6)
Missouri           870   16.7    (+/-2.9)           164   3.1    (+/-0.6)
Montana            121   14.9    (+/-3.0)            21   2.6    (+/-0.6)
Nebraska           263   16.3    (+/-2.7)            48   2.9    (+/-0.5)
Nevada             173   14.4    (+/-3.7)            29   2.5    (+/-0.7)
New Hampshire      148   13.1    (+/-2.4)            24   2.1    (+/-0.4)
New Jersey        1093   14.0    (+/-3.3)           194   2.5    (+/-0.7)
New Mexico         198   13.0    (+/-4.7)            35   2.3    (+/-0.9)
New York          2488   13.6    (+/-3.5)           458   2.5    (+/-0.8)
North Carolina    1087   16.4    (+/-2.5)           210   3.1    (+/-0.6)
North Dakota       105   16.1    (+/-2.7)            19   2.8    (+/-0.5)
Ohio              1793   16.2    (+/-2.8)           333   3.0    (+/-0.6)
Oklahoma           520   16.3    (+/-2.6)            98   3.1    (+/-0.6)
Oregon             441   15.4    (+/-3.2)            78   2.7    (+/-0.6)
Pennsylvania      1839   15.2    (+/-3.0)           319   2.6    (+/-0.6)
Rhode Island       150   14.7    (+/-2.8)            26   2.5    (+/-0.6)
South Carolina     547   15.7    (+/-2.5)           107   3.1    (+/-0.6)
South Dakota       116   16.2    (+/-2.8)            21   2.9    (+/-0.6)
Tennessee          823   16.7    (+/-2.4)           157   3.2    (+/-0.5)
Texas             2273   13.2    (+/-2.8)           441   2.5    (+/-0.7)
Utah               201   11.6    (+/-2.6)            33   1.9    (+/-0.5)
Vermont             76   13.3    (+/-2.4)            12   2.1    (+/-0.4)
Virginia           956   15.5    (+/-2.5)           181   2.9    (+/-0.6)
Washington         704   14.4    (+/-3.3)           121   2.5    (+/-0.6)
West Virginia      331   18.2    (+/-2.3)            62   3.4    (+/-0.5)
Wisconsin          799   16.0    (+/-2.7)           143   2.8    (+/-0.5)
Wyoming             62   13.5    (+/-2.9)            11   2.3    (+/-0.6)
------------------------------------------------------------------------------
* Numbers and percentages were estimated by applying the average annual 1989-1991
  National Health Interview Survey arthritis rates for the civilian, noninstitutionalized
  population by age group (<=24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and>=85 years),
  sex, race (white, black, and other), ethnicity, and region (Northeast, Midwest, South,
  and West) to the area's total 1990 census population.
+ In thousands.
& Confidence interval.
=============================================================================================



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