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Impact of Arthritis and Other Rheumatic Conditions on the Health-Care System -- United States, 1997

Arthritis and other rheumatic conditions are the leading cause of disability in the United States (1), affecting approximately 43 million persons (2) and costing $65 billion in 1992 (3). By 2020, these numbers will increase as the population ages (4). This report examines several measures of the impact of arthritis on the U.S. health-care system; the findings indicate that arthritis and other rheumatic conditions have a large impact on hospitalizations, ambulatory-care visits, and home health care, with women accounting for most of this impact and all persons aged less than 65 years accounting for a substantial portion.

The impact on the health-care system was measured using the most recent data on inpatient care, ambulatory care, and home health care. The 1997 National Hospital Discharge Survey was used to measure the number of discharges (by first-listed discharge diagnosis), days of care, and average length of stay at short-stay, nonfederal hospitals. The 1997 National Ambulatory Medical Care Survey and the 1997 National Hospital Ambulatory Medical Care Survey were used to measure the number and percentage (recorded by principal diagnosis and setting) of ambulatory-care visits. The 1996 National Home and Hospice Care Survey was used to measure the number and percentage (recorded by first diagnosis at admission) of home health-care discharges and the average length of service. Arthritis and other rheumatic conditions (e.g., lupus, bursitis, and fibromyalgia) were defined using the National Arthritis Data Workgroup definition (4)*. When appropriate, data were examined by age group (less than 15, 15-44, 45-64, and greater than or equal to 65 years) and sex. Data were analyzed using SUDAAN (5), and the results were weighted to account for the complex sample design.

Persons with arthritis and other rheumatic conditions accounted for 2.4% (approximately 744,000) of all hospital discharges and 2.4% (approximately 4 million) of days of care in 1997, with an average length of stay similar to that for all conditions (approximately 5 days) (Table 1). Of these discharges, women accounted for 60.7% and persons aged less than 65 years for 44.2%. Persons with arthritis and other rheumatic conditions accounted for 4.6% (approximately 44 million) of all ambulatory-care visits, including 38.9 million visits to physicians' offices, 2.9 million visits to outpatient departments, and 2.2 million visits to emergency departments (Table 2). Of these visits, women accounted for 63% and persons aged less than 65 years accounted for 68%. Arthritis and other rheumatic conditions accounted for 4.8% (approximately 372,000) of all discharges from home health care, with an average length of service of 88.7 days. Most (60%) home health-care discharges were attributable to osteoarthritis. Of these discharges, women accounted for approximately 70% and persons aged less than 65 years for approximately 26%.

Reported by: Div of Health Care Statistics, National Center for Health Statistics; Health Care and Aging Studies Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

The findings in this report indicate that arthritis and other rheumatic conditions cause large numbers of persons to receive care in hospital, ambulatory, and home health settings. Women and all persons aged less than 65 years accounted for much of this impact. The impact of arthritis has been underrecognized, and key interventions that reduce arthritis pain and health-care costs have been underused (6). Primary (e.g., weight control and injury prevention), secondary (e.g., early diagnosis and appropriate management), and tertiary (e.g., self-management and rehabilitation services) prevention measures can help reduce this impact (7).

These findings are subject to at least one limitation. These data sources do not measure health care in other settings important to persons with arthritis, such as rehabilitation services, chiropractors' offices, physical and occupational therapy services, and mental health services.

Recognition of arthritis and other rheumatic conditions as a large public health problem is increasing; the problem has been addressed in the National Arthritis Action Plan: A Public Health Strategy (7) and the first-ever draft objectives for arthritis in the national health objectives for 2010 (8). Future research will expand analyses of health-care system data to explore arthritis trends, the interaction of arthritis and other chronic conditions, and other settings of care. In 1999, CDC is initiating funding to increase public health activities targeting arthritis prevention at the national and state levels. State-level arthritis programs should consider collaboration with components of the health-care system because of the large impact of arthritis.

References

  1. CDC. Prevalence of disabilities and associated health conditions--United States, 1991-1992. MMWR 1994;43:730-1,737-9.
  2. CDC. Prevalence and impact of chronic joint symptoms--seven states, 1996. MMWR 1998; 47:345-51.
  3. Yelin E, Callahan LF. The economic cost and social and psychological impact of musculoskeletal conditions. Arthritis Rheum 1995;38:1351-62.
  4. CDC. Arthritis prevalence and activity limitations--United States, 1990. MMWR 1994;43:433-8.
  5. Shah BV. SUDAAN user's manual, release 6.0. Research Triangle Park, North Carolina: Research Triangle Institute, 1992.
  6. Kruger JM, Helmick CG, Callahan LF, Haddix AC. Cost-effectiveness of the Arthritis Self-help Course. Arch Intern Med 1998;158:1245-9.
  7. CDC. National Arthritis Action Plan: a public health strategy. Atlanta, Georgia: Arthritis Foundation, Association of State and Territorial Health Officials, and CDC, 1999.
  8. Office of Disease Prevention and Health Promotion. Healthy people 2010 objectives: draft for public comment. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 1998.

* International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes 095.6, 095.7, 098.5, 099.3, 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.



Table 1
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TABLE 1. Number and percentage distribution of discharges from short-stay hospitals, number and percentage distribution of days of care, and average length of stay for all conditions
and for first-listed diagnosis of arthritis and other rheumatic conditions, by age and sex of patients -- National Hospital Discharge Survey, United States, 1997
=============================================================================================================================================================================================

                                                                Discharges                                               Days of care
                                                                (thousands)                                               (thousands)
                                                         --------------------------     % of all arthritis         --------------------------     % of all arthritis        Average length
Characteristic                                             No.            (95% CI*)         discharges               No.            (95% CI)         days of care           of stay (days)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All conditions                                            30,914         (+/-1,740)             --                 157,458        (+/-10,523)             --                    5.1
Arthritis and other rheumatic conditions                     744         (+/-   88)           100.0                  3,835        (+/-   714)           100.0                   5.2
  Age (yrs)
    <15                                                       21         (+/-    8)             2.8                     63        (+/-    23)             1.6                   3.0
  15-44                                                       90         (+/-   14)            12.1                    481        (+/-   257)            12.6                   5.3
  45-64                                                      218         (+/-   27)            29.3                  1,023        (+/-   189)            26.7                   4.7
   >=65                                                      414         (+/-   58)            55.7                  2,269        (+/-   586)            59.2                   5.5
  Sex
   Male                                                      292         (+/-   19)            39.3                  1,307        (+/-   196)            34.1                   4.5
   Female                                                    451         (+/-   57)            60.7                  2,529        (+/-   603)            65.9                   5.6
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Confidence interval.
=============================================================================================================================================================================================


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Table 2
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TABLE 2. Number and percentage distribution of ambulatory-care visits by setting for all visits and for principal diagnosis of arthritis and other rheumatic conditions, by age and sex of patients -- National
Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 1997
================================================================================================================================================================================================================================

                                Physician's office                                   Outpatient department                               Emergency department                               Combined settings
                      ------------------------------------------      -------------------------------------------------   -----------------------------------------------    ---------------------------------------------------
                                Visits                 % of all                Visits                                              Visits                                             Visits
                      -------------------------        arthritis      ----------------------------       % of all         ---------------------------       % of all         ---------------------------             % of all
                      No. (millions)   (95% CI*)        visits        No. (millions)      (95% CI)    arthritis visits    No. (millions)     (95% CI)    arthritis visits    No. (millions)     (95% CI)      arthritis visits
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All visits                  787         (+/-56)           --                77           (+/-14)            --                 95           (+/- 8)            --                959           (+/-59)                     --
Arthritis and other         39          (+/- 7)          100                 3           (+/- 0.8)         100                  2           (+/- 0.3)         100                 44           (+/- 7)                    100
rheumatic conditions
  Age (yrs)
    <15                                    --                                                --                                 0.2         (+/- 0.1)           8                   1           (+/- 0.4)                   2
  15-44                     10          (+/- 2)           27                 1           (+/- 0.3)          35                  1           (+/- 0.2)          50                  12           (+/- 2)                    28
  45-64                     15          (+/- 3)           39                 1           (+/- 0.4)          38                  0.6         (+/- 0.1)          25                  17           (+/- 3)                    38
   >=65                     13          (+/- 3)           33                 0.6         (+/- 0.1)          19                  0.4         (+/- 0.1)          17                  14           (+/- 3)                    31
  Sex
   Male                     14          (+/- 2)           37                 1           (+/- 0.3)          36                  0.9         (+/- 0.2)          43                  16           (+/- 2)                    37
   Female                   24          (+/- 5)           63                 2           (+/- 0.5)          64                  1           (+/- 0.2)          57                  28           (+/- 6)                    63
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Confidence interval.
+ Data do not meet standards of reliability or precision (sample size is <30) and therefore are not reported.
================================================================================================================================================================================================================================


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