Disabilities and Limitations
Why are disabilities and limitations important for people with arthritis?
Arthritis impacts function and mobility that can result in activity and other limitations, and is a major cause of work disability among US adults.1
There is no single definition for “disability,” and many programs and surveys use different definitions based on program needs and available data. Also, the same underlying cause of a disability can affect different people in different ways. It is important to remember that all people can be healthy and live well with or without a disability. It is also important to estimate the number of people with disabilities or limitations and the types of difficulties that can occur in order to improve planning for programs and accommodations.
The CDC Arthritis Program examines disabilities and limitations in the following ways:
Arthritis-Attributable limitations. Everyone in this group has arthritis and reports that their arthritis is responsible for specific limitations:
- Arthritis-Attributable Activity Limitations (AAAL).
- Arthritis-Attributable Work Limitations (AAWL).
- Arthritis-Attributable Social Participation Restriction (AASPR).
Specific functional limitations. These limitations make up a group of common daily activities that many people with arthritis report are “very difficult” or that they “cannot do” them. The activities are
- Grasp small objects.
- Reach above one’s head.
- Sit more than 2 hours.
- Lift or carry 10 pounds.
- Climb a flight of stairs.
- Push a heavy object.
- Walk a 1/4 mile.
- Stand more than 2 hours.
- Stoop, bend, or kneel.
Defining Disability. As mentioned above, disability definitions often vary based on the survey used and other criteria. The CDC Arthritis Program uses data and information from several sources to characterize disability among adults with arthritis.
- General disability: A typical case-finding question would be: “Because of a physical or mental health condition, [do you] have difficulty doing any of the following by yourself?” followed by a list of various activities.
- Participation restriction: Participation restriction refers to experiencing difficulties in life situations and is an umbrella term for disability. This is a concept developed by the World Health Organization (WHO) as part of their International Classification of Functioning, Disability, and Health (ICF), a framework that reflects impairments, activity limitations, environment, personal factors, and participation restriction as interconnected components on a continuum of functioning. The concept of participation restriction can be applied to various settings and situations to evaluate capacity to engage (or not) in life situations. For example, participation restriction could be measured in domestic life, work and employment, and community, social, and civic life, among other areas. Social participation restriction reflects limitation in the ability to engage in social activities and situations. Community participation restriction reflects limitation in the ability to engage in community activities and the physical community itself. Because ability is influenced by environment, external characteristics of a person’s environment are ideally considered when evaluating participation restriction. Furthermore, the ICF framework recognizes that accommodations and adaptations may cancel out limitations; for example, a cane and a ramp may provide access to community events and facilities. More information on the ICF framework is availableExternal.
Based on 2013–2015 data from the National Health Interview Survey (NHIS),2 an estimated
- 54.4 million (22.7%) of adults aged 18 years or older have self-reported doctor-diagnosed arthritis.
- 23.7 million (43.5%) of adults with arthritis 18 years or older have arthritis-attributable activity limitation.
Based on 2010–2012 data from the National Health Interview Survey (NHIS),3 a projected
- 78 million (26%) adults aged 18 years or older will have doctor-diagnosed arthritis by the year 2040.
- Of those with arthritis, an estimated 44% (35 million adults) will report arthritis-attributable activity limitations by the year 2040.
The CDC Arthritis Program analyzes data from the Behavioral Risk Factor Surveillance System (BRFSS) to produce state-specific arthritis prevalence estimates. State-specific prevalence maps of arthritis-attributable limitations are available on the State Statistics page, including:
- Prevalence of Work Limitation Among US Adults.
- Prevalence of Work Limitation Among US Adults with Arthritis.
- Prevalence of Activity Limitations Among US Adults.
- Prevalence of Activity Limitations Among US Adults with Arthritis.
- Prevalence of Social Participation Restriction Among US Adults with Arthritis.
State-specific arthritis data from the 2011, 2013, and 2015 BRFSS is available on the Chronic Disease Indicators (CDI) Interactive Database.
Arthritis Conditions Health Effects Survey (ACHES)
In 2005–2006, the CDC Arthritis Program conducted the first national survey dedicated to arthritis, the Arthritis Conditions Health Effects Survey (ACHES). ACHES is a national random-digit-dialed telephone survey of noninstitutionalized US adults aged 45 years or older, to generate a more comprehensive picture of the impact of arthritis on peoples‘ lives.
- ACHES Data Documentation Cdc-pdf[PDF – 922KB]
- ACHES Questionnaire Specification Cdc-pdf[PDF – 360KB]
- Related publications:
- Theis KA, Murphy L, Hootman JM, Helmick CG, Sacks JJ. Arthritis restricts volunteer participation: prevalence and correlates of volunteer status among adults with arthritis. Arthritis Care & Research. 2010;62(7):907–916. abstractExternal
The Disability and Health Data System (DHDS)
The DHDS is an interactive online data tool that helps users translate state-level, disability-specific data into valuable public health information. With DHDS, users can customize how they view disability and health data throughout the country, making it easy to understand health disparity information, identify trends, and help support the development of fiscally-responsible, evidence-based programs, services, and policies that include people with disabilities. These data are available for analysts.
Among its many features, DHDS allows filtering for arthritis-specific information. For more information and to view data through interactive maps and data tables visit the DHDS website.
Many resources are available for people with and without arthritis who have disabilities or limitations:
- CDC Disability and Health program information for people with disabilities.
- CDC-Funded Disability State Programs.
- CDC Arthritis Program Evidence-Based Interventions.
- JAN-The Job Accommodation Network.External
- National Disability Employment Awareness Month-Every October, sponsored by the Office of Disability Employment Policy (ODEP)External.
- Theis KA, Roblin D, Helmick CG, Luo R. Prevalence and causes of work disability among working-age US adults: 2011-2013. Disabil Health J. 2018;11(1):108-115. doi: 10.1016/j.dhjo.2017.04.010. PMID: 28476583.
- Barbour KE, Helmick CG, Boring M, Brady TJ. Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013–2015. Morb Mortal Wkly Rep. 2017;66:246–253. DOI: http://dx.doi.org/10.15585/mmwr.mm6609e1External
- Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis & Rheumatology. 2016;68(7):1582–1687. doi: 10.1002/art.39692. PubMed PMID: 27015600. abstractExternal