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Prevalence and Impact of Arthritis Among Women -- United States, 1989-1991

Arthritis and other rheumatic conditions are among the most prevalent chronic conditions in the United States, affecting approximately 38 million persons (1). The self-reported prevalence of arthritis is greater among women than among men, and for women aged greater than 45 years, arthritis is the leading cause of activity limitation (1,2). This report uses data from the National Health Interview Survey (NHIS) to provide estimates of the prevalence and impact of arthritis among women aged greater than or equal to 15 years during 1989-1991, compares the prevalence estimates of arthritis to other chronic conditions affecting women during 1989-1991, and projects the prevalence of arthritis among women in 2020. Prevalence and Impact Estimates

The NHIS is an annual national probability sample of the U.S. civilian, noninstitutionalized population (3). Estimates of the prevalence of arthritis were based on a one-sixth random sample of women aged greater than or equal to 15 years during 1989-1991 (n=24,201 of 145,832) who answered questions about the presence of any musculoskeletal condition during the preceding 12 months and details about these conditions. Each condition was assigned a code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). This analysis used the definition of arthritis, which included arthritis and other rheumatic conditions, * developed by the National Arthritis Data Workgroup (1). These data were weighted to provide average annual prevalence estimates.

Arthritis impact, defined as activity limitation caused by arthritis, was estimated using all women aged greater than or equal to 15 years participating in NHIS. Respondents were asked whether they were limited in working, housekeeping, or performing other activities as a result of health condition(s) and the condition(s) they considered to be responsible for these activity limitations. Data from women who attributed their activity limitation to arthritis were weighted to provide average annual prevalence estimates of the impact of arthritis among women aged greater than or equal to 15 years during 1989-1991.

An estimated 22.8 million (22.7%) women self-reported arthritis during 1989-1991 Table_1. The prevalence of self-reported arthritis increased directly with age and was 8.6% for women aged 15-44 years, 33.5% for women aged 45-64 years, and 55.8% for women aged greater than or equal to 65 years. Rates were higher for women who were overweight (body mass index {BMI} greater than or equal to 27.3 {28.9%}), had less than or equal to 11 years of education (30.0%), and resided in households with an annual income less than $20,000 (29.9%).

An estimated 4.6 million (4.6%) women reported arthritis as a major or contributing cause of activity limitation during 1989-1991 Table_1. Activity limitation associated with arthritis increased directly with age and was 1.0% for women aged 15-44 years, 6.4% for women aged 45-64 years, and 14.2% for women aged greater than or equal to 65 years. Age-adjusted rates of activity limitation were higher for blacks (6.5%) and American Indians/Alaskan Natives (6.9%) than for whites (4.2%). Age-adjusted rates of activity limitation for women who were overweight were nearly twofold greater than for those who were not, and nearly threefold greater for women who resided in a household with an annual income less than $10,000 per year than for those who resided in a household with an annual income greater than or equal to $35,000. Comparison With Other Chronic Conditions Affecting Women

Average annual prevalence estimates of other chronic conditions affecting women were based on a one-sixth random sample of women who answered questions, on separate condition lists, regarding the presence of impairments; respiratory conditions; circulatory conditions; and selected conditions of the genitourinary, endocrine, and nervous systems. These data were weighted to provide average annual prevalence estimates of other chronic conditions among women aged greater than or equal to 15 years during 1989-1991. Average annual prevalence estimates of activity limitation caused by these chronic conditions were determined as they were for arthritis.

Arthritis was the most common self-reported chronic condition affecting women Table_2, ranking ahead of self-reported hypertension (8.1 million), ischemic heart disease (3.7 million), and other chronic conditions, including breast cancer and malignancy of the female reproductive tract (e.g., ovarian, endometrial, and cervical cancer). Among the conditions reported responsible for activity limitations, women most frequently mentioned arthritis (4.6 million), followed by orthopedic deformity (3.0 million) and ischemic heart disease (1.3 million). Projections for 2020

Arthritis among women aged greater than or equal to 15 years was projected to 2020 by applying the average annual arthritis prevalence rate for 1989-1991, stratified by age and race to the relevant U.S. population projected by the Bureau of the Census (4).

From 1989-1991 to 2020, the prevalence of self-reported arthritis among women aged greater than or equal to 15 years is projected to increase from 22.8 million (22.7%) to 35.9 million (26.7%). Reported by: 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 during 1989-1991, arthritis was the most common self-reported chronic condition and cause of activity limitation among women aged greater than or equal to 15 years. By 2020, an estimated 36 million women may be affected by arthritis -- primarily reflecting the increasing average age of the U.S. population.

The analysis in this report also documents higher prevalences of self-reported arthritis and related activity limitation among older women, overweight women, and women with lower income and education levels. Older age and overweight are commonly recognized risk factors for arthritis. The cross-sectional analysis in this report precluded determination of whether overweight precedes or results from arthritis; however, overweight has been established as a risk factor for osteoarthritis of the knee (5). In addition, low socioeconomic status, for which income and education may be markers, has been associated with increased prevalence, mortality, and disability among persons with arthritis and other rheumatic conditions (6,7). Although prevalence rates for self-reported arthritis among blacks and American Indians/Alaskan Natives were similar to those among whites, activity limitation was more prevalent among both of these groups. Reasons for the increased activity limitation among blacks and American Indians/Alaskan Natives have not been determined but might reflect sociocultural differences or access to health care.

Diseases considered to have particularly important public health ramifications for women include those that affect only women (e.g., endometrial, ovarian, and cervical cancers); are more prevalent among women (e.g., breast cancer and osteoporosis); are more prevalent overall (e.g., hypertension, diabetes, and cardiovascular disease); have different risk factors for women (e.g., menopause and cardiovascular disease or smoking and pregnancy); or require different interventions for women (e.g., infertility) (8). Although the prevalence of arthritis is approximately 60% greater among women than men (1), the public health importance of arthritis among women has not been emphasized previously.

The NHIS data enables a more accurate estimate of the prevalence and impact of arthritis than alternative data sources (e.g., Medicare, health maintenance organization databases, and hospital discharge data) because many persons with arthritis do not visit physicians for their condition. However, these self-reported conditions and the ICD-9-CM codes assigned to them have not been validated.

In addition to limitations in understanding the epidemiology of self-reported arthritis among women, the relation of arthritis to other chronic conditions among women has not been well characterized. To assist in reducing the public health impact of arthritis among women, priorities in the assessment of this problem include determining frequencies of the different types of arthritis and their natural histories among women, estimating more accurately the economic and societal burden of this condition in women, and evaluating the effectiveness of interventions, including supervised exercise programs, weight loss, and self-education courses (5,9,10). Additional strategies public health agencies and health-care providers can consider to reduce the impact of arthritis among women include 1) promoting primary prevention of arthritis through weight reduction and prevention of sports- or occupational-related joint injury and 2) encouraging early detection and appropriate management of women with arthritis through use of medical and physical therapy, exercise, and established educational programs such as the Arthritis Self-Management Course (9,10).

References

  1. CDC. Arthritis prevalence and activity limitations -- United States, 1990. MMWR 1994;43:433-8.

  2. Verbrugge LM, Patrick DL. Seven chronic conditions: their impact on U.S. adults' activity levels and use of medical services. Am J Public Health 1995;85:173-82.

  3. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-1994. Vital Health Stat 1989;2:1-5.

  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. Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women: the Framingham Study. Ann Intern Med 1992;116:535-9.

  6. Leigh JP, Fries JF. Occupation, income, and education, as independent covariates of arthritis in four national probability samples. Arthritis Rheum 1991;34:984-94.

  7. Badley EM, Ibanez D. Socioeconomic risk factors and musculoskeletal disability. J Rheumatol 1994;21:515-22.

  8. Merritt DH, Kirchstein RL. Women's health: report of the public health task force on women's health issues. Vol II. Washington, DC: US Department of Health and Human Services, Public Health Service, 1987; DHHS publication no. (PHS)88-50506.

  9. Kovar PA, Allegrante JP, MacKenzie CR, Peterson MGE, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 1992;116:529-34.

  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;36:439-45.

    • 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-

+------------------------------------------------------------------- ---+ |             | | Erratum: Vol. 44, No. 17 | | ======================== | | SOURCE: MMWR 44(27);517-518 DATE: Jul 14, 1995 | |             | | In the article, "Prevalence and Impact of Arthritis Among | | Women -- United States, 1989-1991," a programming error led to | | incorrect estimates for nonarthritis conditions listed in Table 2. | | The corrected table follows. | | The error does not change statements in the text on the | | relative ranking of arthritis compared with other chronic | | conditions but does change the following: 1) under the subheading | | "Comparison With Other Chronic Conditions Affecting Women" on page | | 332, the first sentence of the second paragraph should read | | "Arthritis was the most common self-reported chronic condition | | affecting women Table_2E, ranking ahead of self-reported | | hypertension (15.7 million), ischemic heart disease (2.4 million), | | and other chronic conditions ..."; and 2) the second sentence of | | the same paragraph should read "Among the conditions reported | | responsible for activity limitations, women most frequently | | mentioned arthritis (4.6 million), followed by orthopedic deformity | | (3.7 million) and hypertension (1.9 million)." | +------------------------------------------------------------------- ---+




Table_1
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TABLE 1. Estimated average annual prevalence of self-reported arthritis and activity limitation attibuted to arthritis among women
aged >=15 years, by selected characteristics -- National Health Interview Survey (NHIS), United States, 1989-1991
=====================================================================================================================================
                                 Self-reported arthritis                          Self-reported activity limitation
                     -------------------------------------------------   ------------------------------------------------------------
                                              Rate *                                            Rate *
                              ----------------------------------------          -----------------------------------------------------
                                                      Age-                                                  Age-
Characteristic        No. +   Unadjusted  (95% CI&)  adjusted   (95% CI)  No. +   Unadjusted   (95% CI)   adjusted    (95% CI)
-------------------------------------------------------------------------------------------------------------------------------------
Age group (yrs)
  15-24               581       3.3        (+/-0.6)     --        --          62      0.4      (+/-0.1)      --         --
  25-34             1,658       7.7        (+/-0.7)     --        --         163      0.8      (+/-0.3)      --         --
  35-44             2,803      14.7        (+/-1.1)     --        --         342      1.8      (+/-0.4)      --         --
  45-54             3,625      27.8        (+/-1.6)     --        --         572      4.4      (+/-0.8)      --         --
  55-64             4,509      40.2        (+/-1.9)     --        --         989      8.8      (+/-1.4)      --         --
  65-74             5,095      50.9        (+/-2.1)     --        --       1,238     12.4      (+/-1.4)      --         --
  75-84             3,433      60.7        (+/-2.8)     --        --         893     15.5      (+/-2.1)      --         --
   >=85             1,051      62.0        (+/-4.7)     --        --         339     21.3      (+/-4.5)      --         --

Race
  White            19,552      23.7        (+/-0.7)     22.1    (+/-0.5)   3,795      4.6      (+/-0.3)      4.2      (+/-0.1)
  Black             2,459      20.6        (+/-1.4)     23.4    (+/-1.3)     659      5.5      (+/-0.9)      6.5      (+/-0.4)
  American Indian/    180      22.7        (+/-6.6)     24.5    (+/-6.0)      45      5.7      (+/-2.8)      6.9      (+/-1.7)
    Alaska Native
  Asian/Pacific
    Islander          224       8.5        (+/-2.8)     10.8    (+/-2.9)      35      1.3      (+/-0.7)      2.0      (+/-0.5)
  Other @             339      14.6        (+/-3.5)     18.6    (+/-4.0)      63      3.0      (+/-2.4)      3.9      (+/-0.9)

Body mass index **
 >=27.3            11,379      32.7        (+/-1.0)     28.9    (+/-0.8)   2,718      7.8      (+/-0.3)      6.7      (+/-0.2)
  <27.3            11,272      18.7        (+/-0.7)     20.5    (+/-0.6)   1,866      3.1      (+/-0.1)      3.4      (+/-0.1)

Education (yrs)
    <=8             3,965      41.3        (+/-2.3)     24.8    (+/-1.7)   1,216    12.7       (+/-1.6)      6.8      (+/-0.4)
   9-11             3,474      23.0        (+/-1.5)     24.4    (+/-1.4)     866     5.6       (+/-0.8)      5.8      (+/-0.3)
     12             8,406      21.7        (+/-1.1)     20.9    (+/-0.9)   1,489     3.9       (+/-0.5)      3.8      (+/-0.2)
  13-15             3,781      19.3        (+/-1.2)     22.5    (+/-1.1)     595     3.0       (+/-0.5)      3.8      (+/-0.3)
     16             1,635      16.9        (+/-1.5)     19.4    (+/-1.6)     238     2.4       (+/-0.7)      3.1      (+/-0.3)
   >=17             1,276      20.6        (+/-2.1)     22.0    (+/-2.1)     152     2.4       (+/-0.8)      3.0      (+/-0.4)
Unknown               219      19.4        (+/-5.1)     15.7    (+/-4.8)      40     3.9       (+/-2.3)      2.6      (+/-0.8)

Annual household
 income
          <$10,000  3,866      32.8        (+/-2.1)     28.3    (+/-1.7)   1,221    10.3       (+/-1.2)      8.7      (+/-0.4)
   $10,000-$19,999  4,730      27.9        (+/-1.6)     25.0    (+/-1.3)   1,064     6.4       (+/-0.9)      5.3      (+/-0.3)
   $20,000-$34,999  4,224      19.9        (+/-1.1)     21.0    (+/-1.1)     697     3.3       (+/-0.5)      3.6      (+/-0.2)
   $35,000-$49,999  2,445      16.7        (+/-1.4)     19.8    (+/-1.3)     321     2.2       (+/-0.5)      3.1      (+/-0.3)
         >=$50,000  2,931      17.0        (+/-1.2)     20.2    (+/-1.4)     343     1.9       (+/-0.4)      2.7      (+/-0.3)
  Unknown           4,559      25.1        (+/-1.4)     19.1    (+/-1.1)     952     5.3       (+/-0.8)      3.8      (+/-0.2)

Total              22,755      22.7        (+/-0.6)     21.9    (+/-0.5)   4,597     4.6       (+/-0.3)      4.4      (+/-0.1)
-------------------------------------------------------------------------------------------------------------------------------------
 * Average annual rate in percentages in the 1989-1991 U.S. 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 U.S. civilian, noninstitutionalized population for
   age, race, education, and annual household income.
 & Confidence interval.
 @ Includes persons of unknown or multiple races.
** Calculated for women aged >=18 years only.
=====================================================================================================================================

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Table_2
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TABLE 2. Estimated average annual prevalence of self-reported chronic
conditions and activity limitations among women aged >=15 years, by
condition -- National Health Interview Survey (NHIS), United States,
1989-1991.
======================================================================
                                               No. with
Condition               Overall no. *     activity limitation *
----------------------------------------------------------------------
Arthritis                  22,755               4,597
Orthopedic deformity        8,365               3,025
Chronic sinusitis           8,323                  21
Hypertension                8,061                 677
"Hay fever," rhinitis       6,438                  71
Ischemic heart disease      3,694               1,270
Hearing impairment          3,322                 238
Other selected conditions + 4,286               1,220
----------------------------------------------------------------------
* In thousands. To generate national estimates, NHIS rates were
  applied to the U.S. civilian, noninstitutionalized population.
+ Diabetes, thyroid disorder, bladder disorder, cerebrovascular
  disease, breast neoplasm, and female reproductive malignancy.
======================================================================


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Table_2E
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TABLE 2. Estimated average annual prevalence of self-reported chronic conditions
and activity limitations among women aged >=15 years, by condition -- National
Health Interview Survey (NHIS), United States, 1989-1991
===================================================================================

                                                       No. with
Condition                      Overall no. *      activity limitation *
-----------------------------------------------------------------------------------
Arthritis                        22,755                 4,597
Chronic sinusitis                17,511                    80
Hypertension                     15,720                 1,875
Orthopedic deformity             14,536                 3,689
"Hay fever," rhinitis            10,700                   127
Hearing impairment                9,199                   479
Ischemic heart disease            2,421                   874
Other selected conditions +      11,825                 2,356
-----------------------------------------------------------------------------------
* In thousands. To generate national estimates, NHIS rates were applied to the U.S.
  civilian, noninstitutionalized population.
+ Diabetes, thyroid disorder, bladder disorder, cerebrovascular disease, breast
  neoplasm, and female reproductive malignancy.
===================================================================================

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