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 Program analyzes data from the National Health Interview Survey (NHIS) to produce national prevalence estimates for arthritis and arthritis-attributable activity limitations. CDC defines arthritis-attributable activity limitations as a response of “yes” to the question “Are you now limited in any way in any of your usual activities because of your arthritis or joint symptoms?”
Based on the analysis of 2013 to 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 aged 18 years or older with arthritis have arthritis-attributable activity limitation.
Based on the analysis of 2010 to 2012 data from the National Health Interview Survey (NHIS)3, it is projected that by 2040:
- 78 million (26%) adults aged 18 years or older will have doctor-diagnosed arthritis.
- Of adults with arthritis, an estimated 44% (35 million adults) will report arthritis-attributable activity limitations.
Based on the analysis of 2011 to 2013 NHIS data, an estimated 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 regardless of age group, sex, or underlying chronic condition.
Data Source: 2011–2013 National Health Interview Survey.
CDC’s 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 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 no single definition for “disability.” In 2001, the Department of Health and Human Services issued a recommendation on data collection standards for demographic characteristic, including disabilities. As a result, a standardized set of six questions is being phased in and 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 a homogenous group. Different definitions, ascertained differently for different purposes, will continue to persist, and 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 also valuable 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.
CDC’s Arthritis Program examines disabilities and limitations in the following ways:
- Arthritis-attributable limitations.
- Specific functional limitations.
- Data-source and project-specific definitions of disability.
Everyone with an “arthritis-attributable” limitation has arthritis and reports 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 as the percentage among adults with arthritis (when focused on adults with arthritis) or the proportion among all adults (when focused 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.
For publications on specific functional limitations see: 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.
Data-Source and Project-Specific Definitions of Disability
Definitions labeled as “disability” often vary based on the survey used and other criteria. CDC’s 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. For more information, see the US Census Bureau’s Report—American’s with Disabilities: 2010External.
Participation restriction. This refers to experiencing difficulties in life situations and is sometimes used as an umbrella term for disability. The World Health Organization (WHO) developed this concept as part of their International Classification of Functioning, Disability, and Health (ICF). The framework reflects impairments, activity limitations, environment, personal factors, and participation restriction as interconnected components on a continuum of functioning. Applying the concept of participation restriction to various settings and situations permits evaluation of a person’s capacity to engage (or not) in life situations. Measurement of participation restriction in domestic life, work and employment, and community, social, and civic life, among other areas provides valuable information for research and practice.
- Social participation restriction reflects limitation in the ability to engage specifically in social activities and situations (e.g., visiting friends, going to parties, doing hobbies, volunteering).
- Community participation restriction reflects limitation in the ability to engage specifically in 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, a cane or a ramp may provide access to community events and facilities. For more information, see the WHO’s International Classification of Functioning, Disability and Health (ICF) frameworkExternal.
For more information about disability and participation restriction, see the CDC Disability and Health website’s Disability Overview page.
Arthritis Conditions Health Effects Survey (ACHES)
In 2005–2006, CDC’s 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, designed to generate a more comprehensive picture of the impact of arthritis or joint symptoms on peoples‘ lives.
- ACHES Data Documentation Cdc-pdf[PDF – 922KB]
- ACHES Questionnaire Specification Cdc-pdf[PDF – 360KB]
- For publications on arthritis-attributable volunteer participation restriction, community participation restriction, and social participation restriction, respectively, see:
- 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
- Theis KA, Furner SE. Shut in? Impact of chronic conditions on community participation in restriction among older adults. Journal of Aging Research. 2011;759158. doi:10.4061/2011/759158.
- 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.
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 Program Evidence-Based Interventions.
- The Job Accommodation Network (JAN)External
- Office of Disability Employment Policy (ODEP)External
- ODEP Disability ResourcesExternal
- National Disability Employment Awareness Month—every October it is sponsored by ODEP.
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. abstract