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Falls and Fall Injuries Among Adults with Arthritis — United States, 2012

Kamil E. Barbour, PhD1, Judy A. Stevens, PhD2, Charles G. Helmick, MD1, Yao-Hua Luo, PhD1, Louise B. Murphy, PhD1, Jennifer M. Hootman, PhD1, Kristina Theis, MPH1, Lynda A. Anderson, PhD1, Nancy A. Baker, ScD3, David E. Sugerman, MD2 (Author affiliations at end of text)

Falls are the leading cause of injury-related morbidity and mortality among older adults, with more than one in three older adults falling each year,* resulting in direct medical costs of nearly $30 billion (1). Some of the major consequences of falls among older adults are hip fractures, brain injuries, decline in functional abilities, and reductions in social and physical activities (2). Although the burden of falls among older adults is well-documented (1,2), research suggests that falls and fall injuries are also common among middle-aged adults (3). One risk factor for falling is poor neuromuscular function (i.e., gait speed and balance), which is common among persons with arthritis (2). In the United States, the prevalence of arthritis is highest among middle-aged adults (aged 45–64 years) (30.2%) and older adults (aged ≥65 years) (49.7%), and these populations account for 52% of U.S. adults (4). Moreover, arthritis is the most common cause of disability (5). To examine the prevalence of falls among middle-aged and older adults with arthritis in different states/territories, CDC analyzed data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) to assess the state-specific prevalence of having fallen and having experienced a fall injury in the past 12 months among adults aged ≥45 years with and without doctor-diagnosed arthritis. This report summarizes the results of that analysis, which found that for all 50 states and the District of Columbia (DC), the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. The prevalence of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fall prevention programs in clinical and community practice.

BRFSS is an annual, random-digit–dialed landline and cellphone survey representative of the noninstitutionalized adult population aged ≥18 years of the 50 states, DC, and the U.S. territories. In 2012, a total of 338,734 interviews with persons aged ≥45 years were completed, and data from 50 states, DC, Puerto Rico, and Guam are included in this report (the U.S. Virgin Islands did not collect BRFSS data). Response rates ranged from 27.7% to 60.4%, with a median of 45.2%.

Respondents were defined as having arthritis if they answered "yes" to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?" The BRFSS survey asks about falls in the past year, explaining to the respondent that, "By a fall, we mean when a person unintentionally comes to rest on the ground or another lower level." Respondents were considered to have fallen if they answered the question, "In the past 12 months, how many times have you fallen?" with a number of one or more. The number of falls was analyzed as a categorical variable (zero, one, or two or more) and as a dichotomous variable (yes or no). Those who reported one or more falls were also asked, "How many of these falls caused an injury? By an injury, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor?" Injury from any fall was categorized as a dichotomous variable (yes or no).

All analyses used sampling weights to account for the complex sample design, nonresponse, noncoverage, and cellphone-only households. Since 2011, iterative proportional weighting (raking) has been used and shown to reduce nonresponse bias and error within estimates compared with post-stratification weighting.§ Thus, 2012 estimates should not be compared with estimates made before 2011. The unadjusted prevalence of any fall (one or more in the past 12 months) with 95% confidence intervals (CIs) for combined state/territory data was used to assess the similarity of prevalence for two age groups (45–64 and ≥65 years). State-specific unadjusted prevalence of fall outcomes among adults aged ≥45 years with and without arthritis are available at http://www.cdc.gov/arthritis/data_statistics/prevalence-injuries-falls-by-state.htm. Age-adjusted estimates were standardized to the year 2000 U.S. standard population using five age-groups (45–54, 55–64, 65–74, 75–84, and ≥85 years). Age-adjusted estimates were presented and used to compare the prevalence of one fall, any fall, two or more falls, and fall injuries by arthritis status across states/territories. In addition, medians and ranges for all states and DC were determined for each fall outcome. For all comparisons, differences were considered statistically significant if the CIs of the age-adjusted estimates did not overlap.

The unadjusted prevalence of having experienced any fall in the past 12 months was similar for adults aged 45–64 years (25.5%) and ≥65 years (27.0%); therefore, state-specific findings for the combined ≥45 years age group are reported. Overall the unadjusted median state prevalence of arthritis among adults aged ≥45 years was 40.1% (range = 31.0%–51.9%), and the median prevalence of one fall, two or more falls, and fall injuries in the preceding year was 13.8% (range = 8.8%–16.7%), 13.3% (range = 6.1%–21.0%), and 9.9% (range = 4.5%–13.3%), respectively.

In analyses of adults with arthritis, the age-adjusted median prevalence for one fall was 15.5% (range = 10.7% in Wisconsin to 20.1% in Washington), for two or more falls was 21.3% (range = 7.7% in Wisconsin to 30.6% in Alaska), and for fall injuries was 16.2% (range = 8.5% in Wisconsin to 22.1% in Oklahoma) (Table). Among adults without arthritis, the age-adjusted median prevalence of one fall, two or more falls, and fall injuries was 12.1% (range = 7.7% in Wisconsin to 15.1% in Wyoming), 9.0% (range = 4.1% in Wisconsin to 14.6% in Alaska), and 6.5% (range = 2.7% in Wisconsin to 9.0% in Alaska), respectively. Within every state and territory except Guam, the prevalence of two or more falls and fall injuries was significantly higher for those with arthritis compared with those without arthritis (Table). The age-adjusted median prevalence of one fall, any fall, two or more falls, and fall injuries was 28%, 79%, 137%, and 149% higher (relative differences), respectively, among adults with arthritis compared with adults without arthritis.

In 2012, 46 states and DC had an age-adjusted prevalence of any fall in the past 12 months of ≥30% among adults with arthritis, and 16 states had an age-adjusted prevalence of any fall of ≥40% (Figure). Among adults without arthritis, no state/territory had an age-adjusted prevalence of falls ≥30% or had a significantly higher age-adjusted prevalence of falls compared with adults with arthritis.

Discussion

In all 50 states and DC, the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults aged ≥45 years with arthritis compared with those without arthritis. Among persons with arthritis, about half of all states had a prevalence of multiple falls (two or more) ranging from 21% to 31% and a prevalence of fall injuries ranging from 16% to 22%. In 45 states and DC, the age-adjusted prevalence of any fall among adults with arthritis was ≥30%; in contrast, the prevalence of any fall in adults without arthritis did not reach 30% in any state. Finally, the age-adjusted median prevalence of two or more falls and fall injuries among adults with arthritis was approximately 2.4 and 2.5 times higher, respectively, than those without arthritis.

The 2010 U.S. Census reported 81.5 million adults (26.4% of the population) aged 45–64 and 40.3 million persons (13.0%) aged ≥65 years. The projected rapid growth in the population aged ≥65 years and the increase in adults with arthritis (an estimated 67 million by 2030) (6) demonstrate the need for increasing fall prevention efforts.

Public health approaches to prevent falls among older adults have focused on modifying fall risk factors (e.g., muscle weakness in the legs, gait and balance problems, psychoactive medication use, poor vision, and environmental hazards such as slippery surfaces or tripping hazards), in addition to identifying and treating the symptoms of chronic conditions that increase fall risk, such as arthritis.** Public health approaches to preventing poor outcomes among adults with arthritis have focused on evidence-based self-management education and physical activity interventions†† that have been proven to reduce pain and improve function by correcting muscle weakness and balance dysfunction. Combining arthritis exercise programs with proven fall prevention intervention might reduce the risk for falls in this at-risk population.

Effective fall prevention interventions can be multifaceted, but the most effective single strategy involves exercise or physical therapy to improve gait, balance, and lower body strength, which have been shown to reduce fall risk by 14%–37% (7). For an exercise program to be effective in reducing falls it must 1) focus on improving balance, 2) become progressively more challenging, and 3) involve at least 50 hours of practice (e.g., a 1-hour Tai Chi class taken twice a week for 25 weeks) (8). As a form of exercise, Tai Chi is an effective fall prevention intervention§§ that has also been shown to improve neuromuscular function (9). However, the effects of Tai Chi intervention programs on arthritis-specific outcomes are still being evaluated; therefore, Tai Chi is not currently endorsed for use by the 12 CDC-funded state arthritis programs that disseminate arthritis-appropriate, evidence-based intervention programs for use in local communities. Existing arthritis physical activity interventions, especially EnhanceFitness and Fit and Strong¶¶ might reduce the risk for falls and fall injuries but have not yet been evaluated for these outcomes.

The findings in this report are subject to at least four limitations. First, data in BRFSS are based on self-report; therefore, arthritis status, falls, and a fall injury might be misclassified. The case-finding question used in BRFSS to assess arthritis status has been judged to be sufficiently sensitive and specific for public health surveillance purposes among those aged ≥65 years, but it is less sensitive for those aged <65 years than is desirable (10); however, recall bias might contribute to an underestimate of self-reported falls. Conversely, the broad definition of a fall injury might have led participants to report minor falls as injurious, resulting in an overestimate. Second, because BRFSS is a cross-sectional survey, the temporal sequence of arthritis and falls could not be established. Nonetheless, a meta-analysis of seven longitudinal studies showed that persons with arthritis have more than a two-fold increased risk for falls (2). Third, no BRFSS questions assess the severity, location, or type of arthritis, which might affect falls and fall injuries differently. Finally, the 2012 median survey response rate for all states and DC was 45.2% and ranged from 27.7% to 60.4%; lower response rates can result in nonresponse bias, although the application of sampling weights is expected to reduce nonresponse bias.

The number of adults with arthritis is expected to increase steadily through at least 2030 (6), putting more adults at higher risk for falls and fall injuries. Efforts to address this growing public health problem require raising awareness about the link between arthritis and falls, evaluating evidence-based arthritis interventions for their effects on falls, and implementing fall prevention programs more widely through changes in clinical and community practice.

1Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Division of Unintentional Injury Prevention; National Center for Injury Prevention and Control, CDC; 3Department of Occupational Therapy, University of Pittsburgh (Corresponding author: Kamil E. Barbour, kbarbour@cdc.gov, 770-488-5145)

References

  1. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev 2006;12:290–5.
  2. Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am 2006;90:807–24.
  3. Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health 2005;5:86.
  4. CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010–2012. MMWR 2013;62:869–73.
  5. CDC. Prevalence and most common causes of disability among adults—United States, 2005. MMWR 2009;58:421–6.
  6. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;54:226–9.
  7. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009;2(CD007146).
  8. Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 2011;22:78–83.
  9. Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot 2010;24:e1–25.
  10. Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA. Validation of a surveillance case definition for arthritis. J Rheumatol 2005;32:340–7.

* Information available at http://www.cdc.gov/injury/wisqars.

The response rate was the number of respondents who completed the survey as a proportion of all eligible and likely eligible persons. Response rates for BRFSS were calculated using standards set by the American Association of Public Opinion Research response rate formula no. 4. Additional information available at http://www.cdc.gov/brfss/annual_data/2012/pdf/summarydataqualityreport2012_20130712.pdf.

§ Additional information available at http://www.cdc.gov/brfss/annual_data/2012/pdf/overview_2012.pdf.

Additional information available at https://www.census.gov/prod/2010pubs/p25-1138.pdf.

** Additional information available at http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010.

†† Additional information available at http://www.cdc.gov/arthritis/interventions/marketing-support/compendium/docs/pdf/compendium-2012.pdf.

§§ Additional information available at http://www.cdc.gov/homeandrecreationalsafety/falls/preventfalls.html#compendium.

¶¶ Additional information available at http://www.cdc.gov/arthritis/interventions/marketing-support/compendium/docs/pdf/compendium-2012.pdf.


What is already known on this topic?

In the United States, arthritis, falls, and fall injuries are highly prevalent conditions among middle-aged (aged 45–64 years) and older (aged ≥65 years) adults. Falls are the leading cause of injury-related morbidity and mortality among older adults; meanwhile, arthritis remains the most common cause of disability.

What is added by this report?

During 2012, for all 50 states and the District of Columbia, the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. Moreover, among adults with arthritis, the age-adjusted median prevalences of one fall, any fall, two or more falls, and fall injuries were 28% , 79%, 137%, and 149% higher, respectively, compared with adults without arthritis.

What are the implications for public health practice?

The burden of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fall prevention programs in clinical and community practice.


TABLE. Weighted age-adjusted prevalence of falls* and fall injuries in the past 12 months,among adults aged ≥45 years with and without arthritis,§ by state/territory — Behavioral Risk Factor Surveillance System, United States, 2012

State/Area

One fall

Two or more falls

Fall injury

Sample size**

Popu-
lation**

Arthritis

No arthritis

Sample size**

Popu-
lation**

Arthritis

No arthritis

Sample size**

Popu-
lation**

Arthritis

No arthritis

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

980

256,858

16.0

(14.2–18.0)

11.3

(10.0–12.9)

1,101

324,718

26.0

(23.7–28.4)

9.3

(7.9–11.0)

835

228,719

18.7

(16.6–20.9)

5.4

(4.5–6.4)

Alaska

409

36,579

15.0

(12.3–18.1)

14.3

(11.9–17.0)

534

53,317

30.6

(26.5–35.0)

14.6

(12.4–17.1)

350

35,369

20.8

(17.4–24.7)

9.0

(7.1–11.5)

Arizona

813

328,358

16.3

(13.3–19.7)

12.1

(10.4–14.0)

732

299,524

21.9

(18.6–25.7)

8.2

(6.8–9.9)

606

262,168

18.1

(15.1–21.5)

7.0

(5.8–8.5)

Arkansas

548

146,006

14.4

(12.3–16.7)

11.0

(9.4–12.8)

678

209,133

27.8

(24.8–30.9)

11.5

(9.8–13.5)

488

144,016

20.9

(18.2–23.8)

6.0

(4.9–7.4)

California

1,309

1,712,404

15.6

(13.9–17.5)

13.3

(12.0–14.8)

1,182

1,563,446

19.4

(17.4–21.6)

9.7

(8.6–10.8)

1,027

1,334,678

15.6

(13.9–17.5)

6.5

(5.6–7.4)

Colorado

1,287

288,047

18.2

(16.4–20.2)

14.2

(13.0–15.5)

1,122

243,734

19.8

(17.8–22.0)

9.5

(8.5–10.6)

909

211,557

17.8

(15.9–19.9)

7.1

(6.2–8.0)

Connecticut

845

186,356

14.0

(12.1–16.1)

11.1

(9.8–12.5)

732

177,566

19.9

(17.3–22.8)

7.9

(6.8–9.0)

641

148,629

17.1

(14.8–19.8)

6.0

(5.1–7.1)

Delaware

473

46,888

15.4

(12.7–18.5)

10.3

(8.8–12.1)

422

44,498

19.4

(16.4–22.7)

7.2

(5.9–8.8)

365

35,880

14.0

(11.5–16.8)

6.6

(5.4–8.0)

DC

396

31,436

13.9

(10.6–17.9)

15.1

(12.4–18.2)

315

27,168

24.2

(19.3–29.8)

7.5

(6.0–9.3)

291

26,465

20.0

(15.6–25.1)

8.0

(5.9–10.7)

Florida

749

968,371

14.3

(11.8–17.2)

10.4

(9.0–12.1)

721

971,220

20.8

(18.0–23.9)

7.2

(6.1–8.6)

669

862,502

17.4

(14.7–20.4)

6.3

(5.2–7.5)

Georgia

597

479,332

16.6

(14.0–19.5)

12.0

(10.4–13.8)

602

476,094

22.4

(19.6–25.5)

8.4

(7.1–10.0)

511

390,040

18.4

(15.9–21.3)

6.5

(5.4–7.9)

Hawaii

613

67,584

15.2

(12.4–18.6)

10.4

(8.9–12.2)

451

45,385

13.5

(11.0–16.5)

6.2

(5.0–7.6)

418

41,177

13.3

(10.6–16.7)

5.0

(4.2–6.0)

Idaho

707

86,883

15.0

(12.4–18.0)

14.4

(12.3–16.9)

761

93,282

25.2

(21.3–29.5)

11.2

(9.5–13.2)

570

67,320

18.9

(15.6–22.8)

7.6

(6.2–9.3)

Illinois

593

678,156

15.5

(13.3–18.0)

12.3

(10.6–14.2)

476

567,290

16.6

(14.0–19.4)

8.0

(6.6–9.7)

408

464,542

15.2

(12.8–18.0)

5.1

(4.1–6.3)

Indiana

888

374,522

16.9

(15.0–18.9)

13.7

(12.3–15.3)

926

381,394

23.8

(21.6–26.2)

10.0

(8.7–11.4)

663

275,651

16.8

(14.9–18.9)

6.9

(5.9–8.1)

Iowa

789

186,009

15.2

(13.3–17.4)

15.0

(13.5–16.5)

674

175,584

22.8

(20.2–25.5)

9.9

(8.7–11.4)

500

125,108

15.9

(13.7–18.3)

6.7

(5.7–7.8)

Kansas

1,295

159,978

16.5

(14.9–18.3)

12.9

(11.8–14.0)

1,205

156,339

22.4

(20.3–24.6)

9.8

(8.8–10.9)

824

103,103

15.3

(13.5–17.2)

5.8

(5.1–6.7)

Kentucky

1,144

229,858

15.4

(13.8–17.2)

11.7

(10.3–13.2)

1,319

298,532

26.0

(23.6–28.6)

10.3

(8.9–11.9)

1,008

213,288

18.4

(16.5–20.6)

6.2

(5.2–7.4)

Louisiana

769

181,584

12.2

(10.4–14.4)

9.1

(7.9–10.5)

910

222,659

21.3

(18.7–24.2)

6.7

(5.5–8.1)

607

151,012

12.4

(10.6–14.6)

5.9

(4.9–7.2)

Maine

1,138

92,883

16.8

(15.1–18.6)

13.8

(12.6–15.1)

1,136

96,548

24.3

(22.2–26.6)

10.7

(9.6–11.8)

840

69,631

18.4

(16.5–20.4)

6.8

(5.9–7.7)

Maryland

1,217

278,273

15.6

(13.5–18.0)

10.9

(9.7–12.1)

991

219,260

15.1

(13.3–17.0)

6.7

(5.8–7.8)

864

187,961

12.9

(11.3–14.8)

5.6

(4.8–6.6)

Massachusetts

2,079

352,749

16.4

(14.7–18.2)

11.8

(10.8–12.8)

1,762

293,545

18.6

(16.8–20.5)

7.6

(6.8–8.4)

1,653

267,905

16.2

(14.6–18.0)

6.4

(5.7–7.1)

Michigan

815

407,924

12.2

(10.8–13.9)

8.1

(7.1–9.2)

514

305,661

12.0

(10.2–14.1)

4.3

(3.6–5.3)

472

249,957

10.1

(8.5–12.0)

3.0

(2.4–3.8)

Minnesota

1,218

291,368

16.4

(14.5–18.6)

12.8

(11.7–13.9)

985

254,660

21.1

(18.6–23.7)

8.2

(7.3–9.2)

802

194,999

16.2

(14.1–18.7)

5.7

(5.0–6.5)

Mississippi

787

139,653

15.4

(13.5–17.5)

10.0

(8.7–11.5)

889

179,522

24.9

(22.5–27.5)

9.2

(7.8–10.7)

680

124,024

17.1

(15.1–19.3)

5.6

(4.7–6.8)

Missouri

764

360,504

18.1

(15.9–20.6)

12.6

(11.0–14.4)

756

379,648

24.1

(21.4–27.1)

10.0

(8.4–11.8)

605

284,659

18.6

(16.2–21.3)

6.9

(5.7–8.3)

Montana

922

63,860

16.8

(14.8–19.1)

13.3

(11.9–14.8)

1,111

78,636

25.5

(23.1–28.1)

14.0

(12.5–15.5)

742

49,480

17.0

(14.9–19.2)

7.9

(6.8–9.1)

Nebraska

2,218

114,065

18.5

(16.8–20.3)

14.5

(13.5–15.6)

1,886

91,793

19.0

(17.2–21.0)

9.4

(8.5–10.3)

1,445

70,856

15.8

(14.2–17.5)

6.5

(5.8–7.2)

Nevada

451

123,607

14.5

(11.5–18.2)

11.1

(9.2–13.4)

451

117,912

20.0

(16.5–23.9)

7.9

(6.5–9.6)

351

91,292

13.9

(11.1–17.2)

6.5

(5.0–8.3)

New Hampshire

853

81,481

16.3

(14.4–18.5)

12.9

(11.5–14.5)

859

83,990

19.8

(17.5–22.3)

11.0

(9.7–12.5)

661

63,234

15.5

(13.5–17.6)

7.8

(6.7–9.1)

New Jersey

1,273

392,045

14.2

(12.6–16.0)

9.9

(8.8–11.0)

974

311,829

15.8

(14.1–17.8)

5.9

(5.1–6.8)

964

295,364

14.1

(12.4–16.0)

5.5

(4.8–6.4)

New Mexico

871

115,409

16.5

(14.5–18.7)

13.4

(12.0–14.8)

912

123,436

26.0

(23.4–28.7)

11.0

(9.8–12.3)

743

98,863

19.6

(17.5–21.9)

7.7

(6.7–8.8)

New York

609

1,160,253

17.7

(14.9–20.9)

13.8

(11.9–15.9)

489

972,909

20.2

(16.9–23.8)

8.7

(7.2–10.5)

460

829,218

15.3

(12.9–18.2)

7.8

(6.4–9.5)

North Carolina

1,102

502,240

14.8

(13.1–16.6)

12.5

(11.2–13.8)

1,100

513,843

21.9

(19.9–24.1)

8.8

(7.8–10.1)

822

358,263

14.8

(13.1–16.6)

6.1

(5.3–6.9)

North Dakota

517

40,120

16.4

(13.8–19.4)

12.5

(10.9–14.4)

447

36,715

18.3

(15.3–21.7)

10.6

(8.9–12.6)

348

27,347

15.7

(12.8–19.1)

6.6

(5.4–8.2)

Ohio

1,242

619,185

14.8

(13.3–16.4)

11.8

(10.6–13.1)

1,300

616,621

20.8

(18.9–22.7)

8.4

(7.4–9.5)

1,034

492,055

16.1

(14.5–17.8)

6.3

(5.5–7.4)

Oklahoma

801

202,036

15.5

(13.7–17.5)

12.0

(10.7–13.5)

1,031

266,556

29.7

(27.1–32.4)

10.6

(9.3–12.0)

742

186,433

22.1

(19.8–24.6)

5.8

(4.9–6.9)

Oregon

427

170,229

13.8

(11.4–16.8)

8.6

(7.3–10.1)

280

109,037

10.6

(8.5–13.1)

4.9

(3.9–6.2)

263

100,791

9.4

(7.5–11.7)

4.1

(3.2–5.2)

Pennsylvania

2,056

775,966

16.9

(15.4–18.5)

12.8

(11.6–14.0)

1,838

651,072

19.2

(17.6–20.9)

7.6

(6.8–8.5)

1,534

538,263

14.6

(13.3–16.1)

6.6

(5.8–7.5)

Rhode Island

502

52,092

15.3

(13.0–17.8)

10.1

(8.6–11.7)

461

50,039

17.5

(15.0–20.3)

8.1

(6.7–9.8)

420

43,397

14.9

(12.7–17.4)

6.5

(5.4–7.7)

South Carolina

1,238

244,630

16.2

(14.3–18.2)

11.3

(10.1–12.7)

1,258

263,224

24.1

(21.9–26.5)

8.1

(7.1–9.3)

1,011

207,080

18.8

(16.8–21.0)

6.1

(5.2–7.2)

South Dakota

900

54,348

19.6

(16.4–23.2)

14.7

(12.7–17.0)

751

40,861

20.3

(17.2–23.8)

9.0

(7.5–10.8)

617

34,616

18.9

(15.7–22.5)

7.0

(5.7–8.7)

Tennessee

605

305,920

14.2

(12.2–16.5)

11

(9.4–12.7)

749

372,174

23.7

(21.3–26.3)

8.1

(6.8–9.6)

439

225,958

12.5

(10.6–14.6)

5.9

(4.8–7.2)

Texas

844

1,106,235

14.3

(12.3–16.7)

11.9

(10.4–13.6)

834

1,196,235

21.9

(19.3–24.8)

9.0

(7.8–10.3)

679

904,705

16.8

(14.4–19.5)

6.6

(5.6–7.7)

Utah

1,126

116,915

17.9

(16.0–20.0)

12.9

(11.7–14.2)

1,038

106,471

19.2

(17.3–21.3)

10.0

(8.9–11.2)

759

78,484

15.3

(13.5–17.2)

6.5

(5.7–7.5)

Vermont

691

42,124

15.7

(13.6–18.1)

14.4

(12.7–16.2)

766

48,216

26.3

(23.5–29.3)

12.4

(10.9–14.1)

514

30,740

17.1

(14.8–19.8)

7.2

(6.1–8.5)

Virginia

642

370,673

14.8

(12.8–17.0)

10.1

(8.8–11.5)

598

390,276

21.2

(18.5–24.1)

7.6

(6.5–8.8)

436

273,548

14.1

(12.0–16.3)

5.2

(4.3–6.2)

Washington

1,922

449,370

20.1

(18.3–22.0)

15.0

(14.0–16.1)

1,704

412,140

22.0

(20.3–24.0)

11.9

(10.9–13.0)

1346

326,695

18.4

(16.7–20.2)

8.5

(7.6–9.4)

West Virginia

479

97,758

12.9

(11.2–14.7)

10.3

(8.8–11.9)

598

131,714

23.3

(20.8–25.9)

9.8

(8.3–11.6)

380

79,390

13.8

(11.9–16.0)

5.5

(4.4–6.8)

Wisconsin

333

197,943

10.7

(8.5–13.5)

7.7

(6.2–9.6)

235

138,625

10.0

(7.7–12.8)

4.1

(3.1–5.5)

182

109,173

8.5

(6.3–11.5)

2.7

(1.9–3.9)

Wyoming

744

33,459

16.6

(13.8–19.7)

15.1

(13.2–17.3)

807

38,643

29.5

(25.8–33.6)

11.5

(9.8–13.5)

559

27,191

20.2

(17.0–23.8)

7.5

(6.2–9.1)

Median††

15.5

12.1

21.3

9.0

16.2

6.5

Range††

10.7–20.1

7.7–15.1

10.0–30.6

4.1–14.6

8.5–22.1

2.7–9.0

Puerto Rico

504

160,786

12.6

(10.9–14.6)

10.2

(8.8–11.7)

459

175,156

16.9

(14.5–19.5)

7.4

(5.3–10.3)

463

170,429

16.6

(14.4–19.2)

8.9

(7.5–10.6)

Guam

107

5,278

16.3

(11.5–22.6)

12.1

(8.7–16.6)

98

4,703

18.6

(12.3–27.0)

9.8

(8.3–11.7)

81

3,790

15.7

(9.9–23.9)

6.6

(4.4–9.9)

Abbreviations: CI = confidence interval; DC = District of Columbia.

* Falls were defined as self-reported number of falls in past 12 months.

Injury from a fall was defined as self-reported injury caused by a fall in past 12 months that caused respondent to limit their regular activities for ≥1 days or to go see a doctor.

§ Doctor-diagnosed arthritis was defined based on a "yes" response to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

Includes all 50 states, DC, Puerto Rico, and Guam.

** Sample size represents the actual number with the outcome, whereas population is the weighted number of adults with the outcome.

†† Does not include Puerto Rico or Guam.


FIGURE. Age-standardized prevalence of having one or more falls in the past 12 months among adults aged ≥45 years with arthritis — Behavioral Risk Factor Surveillance System, United States, 2012


The figure above shows age-standardized prevalence of having one or more falls in the past 12 months among adults aged ≥45 years with arthritis in the United States during 2012. In 2012, 46 states and DC had an age-adjusted prevalence of any fall in the past 12 months of ≥30% among adults with arthritis, and 16 states had an age-adjusted prevalence of any fall of ≥40%.

Alternate Text: The figure above shows age-standardized prevalence of having one or more falls in the past 12 months among adults aged ≥45 years with arthritis in the United States during 2012. In 2012, 46 states and DC had an age-adjusted prevalence of any fall in the past 12 months of ≥30% among adults with arthritis, and 16 states had an age-adjusted prevalence of any fall of ≥40%.



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