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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Arthritis Prevalence and Activity Limitations -- United States, 1990Arthritis 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 NoteEditorial 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
* 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. 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.
====================================================================================================================================
Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
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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