Disabilities and Limitations
Arthritis affects a person’s overall function and mobility, which can result in activity and other limitations. It is a leading cause of work disability among US adults.1 Learn about the prevalence of arthritis-related limitations in the United States, and how CDC defines disability and limitations.
Prevalence of Arthritis-Attributable Limitations
CDC’s Arthritis Management and Wellbeing Program analyzes data from the National Health Interview Survey (NHIS) to calculate the prevalence of arthritis and arthritis-attributable activity limitations in the United States. CDC considers individuals to have arthritis-attributable activity limitations if they responded “yes” to the question “Are you now limited in any way in any of your usual activities because of your arthritis or joint symptoms?”
CDC analyzed 2013 to 2015 data from the National Health Interview Survey (NHIS)2 and estimated that
- 58.5 million (23.7%) of adults aged 18 years or older have self-reported doctor-diagnosed arthritis.
- 23.7 million (43.5%) of adults aged 18 years or older with arthritis have arthritis-attributable activity limitation.
CDC also analyzed 2010 to 2012 data from the National Health Interview Survey (NHIS)3 and projected that by 2040:
- 78 million (26%) adults aged 18 years or older will have doctor-diagnosed arthritis.
- Among adults with arthritis, 44% (35 million adults) will report arthritis-attributable activity limitations.
Based on analysis of 2011 to 2013 NHIS data, CDC found that 10.4% (20.1 million) working-age adults aged 18 to 64 years reported work disability. Back or neck problems and Arthritis/Rheumatism were consistently among the top three conditions reported to cause work disability. This pattern was observed across all age groups, for both men and women, and across all underlying chronic condition.
Data Source: 2011–2013 National Health Interview Survey.
CDC’s Arthritis Management and Wellbeing Program analyzes data from the Behavioral Risk Factor Surveillance System (BRFSS) to produce state-specific arthritis prevalence estimates. The state-specific prevalence of arthritis-attributable limitations are presented in maps on the State Statistics page. Three of the maps are for:
- Prevalence of Work Limitation Among US Adults with Arthritis.
- Prevalence of Activity Limitations Among US Adults with Arthritis.
- Prevalence of Social Participation Restriction Among US Adults with Arthritis.
Go to the Chronic Disease Indicators (CDI) Interactive Database to view state-specific prevalence estimates for activity limitations and other select arthritis prevalence characteristics.
There is not a single definition for “disability.” In 2001, the US Department of Health and Human Services recommended specific standards for measuring and studying demographic characteristic, including disabilities. As a result, a standardized set of six questions is being asked on national population health and related surveys. Nevertheless, there are still more than 60 federal definitions for disability, and there will always be many definitions because people with disabilities are not all the same. Our understanding of disability, measurement, and use of disability data will continue to evolve over time.
Importantly, the same underlying cause of a disability in one person can affect another person in different ways. It is essential to remember that all people can be healthy and live well with or without a disability.
It is important to estimate the number of people with disabilities or limitations and the types of difficulties that they have to improve planning for programs and accommodations.
CDC’s Arthritis Management and Wellbeing Program studies disabilities and limitations in the following ways:
- Arthritis-attributable limitations.
- Specific functional limitations.
- Data-source and project-specific definitions of disability.
Someone with arthritis has an “arthritis-attributable” limitation if they report that their arthritis is responsible for specific limitations.
- Arthritis-Attributable Activity Limitations (AAAL): “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?”
- Arthritis-Attributable Work Limitations (AAWL): “In this next question we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?”
- Arthritis-Attributable Social Participation Restriction (AASPR): “During the past 30 days, to what extent has your arthritis or joint symptoms interfered with your normal social activities, such as going shopping, to the movies, or to religious or social gatherings?”
Arthritis-attributable limitations can be reported in two ways. The first is the percentage among adults with arthritis which focuses on limitations specifically among adults with arthritis. The second is the percentage among all adults which focuses on the entire adult population.
Specific Functional Limitations
There are nine common daily activities that many people with arthritis report are “very difficult” or that they “cannot do.” The activities are:
- Grasp small objects.
- Reach above one’s head.
- Sit for about 2 hours.
- Lift or carry as much as 10 pounds.
- Climb a flight of stairs without resting.
- Push or pull a heavy object.
- Walk a 1/4 mile.
- Stand for about 2 hours.
- Stoop, bend, or kneel.
One CDC report describing specific functional limitations among adults with arthritis is Theis KA, Murphy L, Hootman JM, Wilkie R. Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability, and Health. Arthritis Care & Research. 2013;65(7):1059–1069. Link.
Data-Source and Project-Specific Definitions of Disability
The definition of “disability” varies across surveys and depends on what is being measured. CDC’s Arthritis Management and Wellbeing Program uses data and information from several sources to describe disability among adults with arthritis.
General disability. A typical question used to identify someone 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. For more information, see the US Census Bureau’s Report—American’s with Disabilities: 2010.
Participation restriction. This refers to experiencing difficulties in life situations and is sometimes used to describe any disability. The World Health Organization (WHO) developed this concept as part of their International Classification of Functioning, Disability, and Health (ICF). The framework reflects the interconnectedness of impairments, activity limitations, environment, personal factors, and participation restriction on a continuum of functioning. This concept of participation restriction can be applied to various settings and situations which permits evaluation of a person’s capacity to engage (or not) in various life situations. Measuring participation restriction in areas such as domestic life, work and employment, and community, social, and civic life provides valuable information for research and practice.
- Social participation restriction is limitation in the ability to do social activities and situations (e.g., visiting friends, going to parties, doing hobbies, volunteering).
- Community participation restriction is limitation in the ability to do community activities (e.g., neighborhood clubs, town hall meetings, visiting community centers or public recreation locations) and the physical community itself. Because environment influences ability, external characteristics of a person’s environment (e.g., building design, stairs, lighting, sound, sidewalks, transportation) are ideally considered when evaluating participation restriction.
Furthermore, the ICF framework recognizes that accommodations and adaptations may cancel out limitations. For example, individuals may be able to participate in a community event or access a facility when they use a cane or a ramp. For more information, see the WHO’s International Classification of Functioning, Disability and Health (ICF) framework.
For more information about disability and participation restriction, see the CDC Disability and Health website’s Disability Overview page.
For CDC publications on topics such as arthritis-attributable volunteer participation restriction, community participation restriction, and social participation restriction, interference with routine life activities, and walking limitations respectively, see the References below.
Arthritis Conditions Health Effects Survey (ACHES)
In 2005–2006, CDC’s Arthritis Management and Wellbeing Program conducted the first national survey of 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. ACHES was designed to generate a more comprehensive picture of the impact of arthritis or joint symptoms on peoples‘ lives.
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 this CDC tool, users can customize how they view disability and health data throughout the country, making it easy to:
- Understand health disparity information.
- Identify trends.
- 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.
Visit the DHDS website for more information and to view data through interactive maps and data tables.
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’s Arthritis Management and Wellbeing Program Evidence-Based Interventions.
- The Job Accommodation Network (JAN)
- Office of Disability Employment Policy (ODEP)
- ODEP Disability Resources
- National Disability Employment Awareness Month—every October it is sponsored by ODEP.
Census Bureau’s Survey of Income Program and Participation (SIPP)
This survey has been repeated several times and can be used to study specific causes of disability in general. For many years, arthritis and back conditions have been by far the most common main causes of disability in the U.S.
See: Theis KA, Steinweg A, Helmick CG, Courtney-Long E, Bolen JA, Lee R. Which one? What kind? How many? Types, Causes, and Prevalence of Disability among U.S. Adults. Disability and Health Journal 2019;12:411-421 DOI: doi.org/10.1016/j.dhjo.2019.03.001.
1. Theis KA, Roblin D, Helmick CG, Luo R. Prevalence and causes of work disability among working-age U.S. adults: 2011-2013, NHIS. Disabil Health J. 2018;11:108–115. doi: 10.1016/j.dhjo.2017.04.010. PMID: 28476583.
2. 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: 10.15585/mmwr.mm6609e1
3. 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. abstrac
4. Theis KA, Brady TJ, Helmick CG, Murphy L, Barbour KE. Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life. ACR Open Rheumatology. 2019;1(7):412-423. DOI 10.1002/acr2.11050
5. Theis KA, Murphy LB, Baker NA, Hootman JM. When you can’t walk a mile: walking limitation prevalence and associations among middle-age and older US adults with arthritis: a cross-sectional, population-based study. ACR Open Rheumatol 2019; 1:350-358.
6. Theis KA, Steinweg A, Helmick CG, Courtney-Long E, Bolen JA, Lee R. Which one? What kind? How many? Types, Causes, and Prevalence of Disability among U.S. Adults. Disability and Health Journal 2019;12:411-421 DOI: doi.org/10.1016/j.dhjo.2019.03.001.