State-Specific Severe Joint Pain and Physical Inactivity Among Adults with Arthritis — United States, 2017

Dana Guglielmo, MPH1,2; Louise B. Murphy, PhD1; Michael A. Boring, MS1; Kristina A. Theis, PhD1; Charles G. Helmick, MD1; Jennifer M. Hootman, PhD1; Erica L. Odom, DrPH1; Susan A. Carlson, PhD3; Yong Liu, MD1; Hua Lu, MS1; Janet B. Croft, PhD1 (View author affiliations)

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Summary

What is already known about this topic?

Approximately one in four U.S. adults has arthritis. Severe joint pain and physical inactivity are common among adults with arthritis and are linked to poor mental and physical health outcomes.

What is added by this report?

In 2017, marked state-specific variations in prevalences of arthritis, severe joint pain, and physical inactivity were observed. Physical inactivity was more prevalent among persons with severe joint pain than among those with less pain.

What are the implications for public health practice?

State-specific data support efforts to promote participation in arthritis-appropriate, evidence-based self-management education and physical activity programs, which can reduce pain, increase physical activity and function, and improve mood and quality of life.

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An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis (arthritis) (1). Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations (2,3). CDC analyzed 2017 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate current state-specific prevalence of arthritis and, among adults with arthritis, the prevalences of severe joint pain and physical inactivity. In 2017, the median age-standardized state prevalence of arthritis among adults aged ≥18 years was 22.8% (range = 15.7% [District of Columbia] to 34.6% [West Virginia]) and was generally highest in Appalachia and Lower Mississippi Valley regions.* Among adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3%; range = 20.8% [Colorado] to 45.2% [Mississippi]) and physical inactivity (median = 33.7%; range = 23.2% [Colorado] to 44.4% [Kentucky]) were highest in southeastern states. Physical inactivity prevalence among those with severe joint pain (47.0%) was higher than that among those with moderate (31.8%) or no/mild joint pain (22.6%). Self-management strategies such as maintaining a healthy weight or being physically active can reduce arthritis pain and prevent or delay arthritis-related disability. Evidence-based physical activity and self-management education programs are available that can improve quality of life among adults with arthritis.

BRFSS is an ongoing state-based, landline and cellular telephone survey of noninstitutionalized adults in the United States aged ≥18 years that is conducted by state and territorial health departments in 50 U.S. states, the District of Columbia (DC), and U.S. territories. The combined (telephone and cellular) median response rate in 2017 among states was 45.9% (range = 30.6%–64.1%); 435,331 adults reported information about arthritis status and age, and among them, 144,099 reported having arthritis.§ Having arthritis was defined as a response of “yes” to the question “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” No/mild, moderate, and severe joint pain were defined by responses of 0–3, 4–6, and 7–10, respectively, to the question “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. On a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be, during the past 30 days, how bad was your joint pain on average?” Physical inactivity was defined as a response of “no” to the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”

All analyses, which accounted for BRFSS’s complex sampling design, were conducted using SAS (version 9.4; SAS Institute) and SUDAAN (version 11.0; RTI International). Sampling weights, using iterative proportional fitting (raking), were applied to make estimates representative of each state. Age-standardized,** state-specific prevalences of arthritis among adults aged ≥18 years, and of severe joint pain and physical inactivity among adults with arthritis, were calculated by selected characteristics. Differences across subgroups were tested using t-tests, and orthogonal linear contrasts were conducted for tests of trends to detect linear patterns in ordinal variables (4); all differences and trends reported in the text are significant (α = 0.05).

In 2017, age-specific arthritis prevalence was higher with increasing age, ranging from 8.1% among those aged 18–44 years to 50.4% among those aged ≥65 years (Table 1). Age-standardized arthritis prevalence was significantly higher among women (25.4%) than among men (19.1%); non-Hispanic American Indian/Alaska Natives (29.7%) than among other racial/ethnic groups (range = 12.8%–25.5%); and those unable to work/disabled (51.3%), compared with retired (34.3%), unemployed (26.0%), or employed/self-employed (17.7%). Arthritis prevalence was higher with increasing body mass index, ranging from 17.9% among those with healthy weight or underweight to 30.4% among those with obesity. Arthritis prevalence was lower among Hispanics and non-Hispanic Asians than among other racial/ethnic groups, was inversely related to education and federal poverty level, and was higher among those living in more rural areas compared with urban dwellers.

Among adults with arthritis, no/mild, moderate, and severe joint pain was reported by 36.2% (95% confidence interval [CI] = 35.7%–36.8%), 33.0% (CI = 32.4%–33.5%), and 30.8% (CI = 30.3%–31.4%) of respondents, respectively (unadjusted prevalences). Age-specific percentages for severe joint pain declined with increasing age, ranging from 33.0% among those aged 18–44 years to 25.1% among those aged ≥65 years. Age-standardized severe joint pain prevalence was ≥40% among the following groups: those unable to work/disabled (66.9%); those with less than a high school diploma (54.1%); those living at ≤125% federal poverty level (51.6%); non-Hispanic blacks (50.9%); retired persons (45.8%); Hispanics (42.0%); non-Hispanic American Indians/Alaska Natives (42.0%); and lesbian/gay/bisexual/queer/questioning (40.7%; reported by 27 states). Severe joint pain prevalence was similar across urban/rural geographic areas, ranging from 32.7%–35.7% in all areas, except for a lower prevalence (28.6%) in large fringe metro areas (Table 1).

Among adults with arthritis, age-specific physical inactivity prevalence was higher with increasing age (ranging from 31.0% among those aged 18–44 years to 37.0% among those aged ≥65 years). Age-standardized physical inactivity prevalence was ≥40% among the following groups: those unable to work/disabled (51.2%); those with less than a high school diploma (46.4%); those living at ≤125% federal poverty level (42.6%); and non-Hispanic blacks (40.4%). Physical inactivity prevalence increased with increasing rurality and with increasing joint pain levels (ranging from 22.6% among those with no/mild joint pain to 47.0% among those with severe joint pain).

Median age-standardized state prevalence of arthritis among adults aged ≥18 years was 22.8% (range = 15.7% [DC] to 34.6% [West Virginia]) (Table 2) and was highest in Appalachia and Lower Mississippi Valley regions. Among 144,099 adults with arthritis, median age-standardized state prevalences of severe joint pain and physical inactivity were 30.3% (range = 20.8% [Colorado] to 45.2% [Mississippi]) and 33.7% (range = 23.2% [Colorado] to 44.4% [Kentucky]), respectively. Age-standardized severe joint pain (Figure) and physical inactivity prevalences were highest in southeastern states.

Discussion

The 2017 age-standardized prevalence of arthritis was highest in Appalachia and the Lower Mississippi Valley; prevalences of severe joint pain and physical inactivity among adults with arthritis were highest in southeastern states. Estimates for all three outcomes in 2017 were similar to those in 2015 (5). Except for age, urban-rural status, and sexual orientation, sociodemographic patterns for prevalences of severe joint pain and physical inactivity were similar and offer potential targets for interventions designed to reduce arthritis pain.

Joint pain is often managed with medications, which are associated with various adverse effects. The 2016 National Pain Strategy advises that pain-management strategies be multifaceted and individualized and include nonpharmacologic strategies,†† and the American College of Rheumatology recommends regular physical activity as a nonpharmacologic pain reliever for arthritis.§§ Although persons with arthritis report that pain, or fear of causing or worsening it, is a substantial barrier to exercising (6), physical activity is an inexpensive intervention that can reduce pain, prevent or delay disability and limitations, and improve mental health, physical functioning, and quality of life with few adverse effects (7,8).¶¶ Physical Activity Guidelines for Americans recommends that adults, including those with arthritis, engage in the equivalent of at least 150 minutes of moderate-intensity aerobic physical activity per week for substantial health benefits.*** Adults who are unable to meet the aerobic guideline because of their condition (e.g., those with severe joint pain) should engage in regular physical activity according to their abilities and avoid physical inactivity. Even small amounts of physical activity can improve physical functioning in adults with joint conditions (9). Most adults with arthritis pain can safely begin walking, swimming, or cycling to increase physical activity.

Arthritis-appropriate, evidence-based, self-management programs and low-impact, group aerobic, or multicomponent physical activity programs are designed to safely increase physical activity in persons with arthritis.†††,§§§ These programs are available nationwide and are especially important for those populations that might have limited access to health care, medications, and surgical interventions (e.g., those in rural areas, those with lower income, and racial/ethnic minorities). Physical activity programs including low-impact aquatic exercises (e.g., Arthritis Foundation Aquatic Program) and strength training (e.g., Fit and Strong!) can help increase strength and endurance. Participating in self-management education programs, such as the Chronic Disease Self-Management Program, although not physical activity–focused, is also beneficial for arthritis management and results in increased physical activity. Benefits of the Chronic Disease Self-Management Program include increased frequency of aerobic and stretching/strengthening exercise, improved self-efficacy for arthritis pain management, and improved mood (10). Adults with arthritis can also engage in routine physical activity through group aerobic exercise classes (e.g., Walk with Ease, EnhanceFitness, Arthritis Foundation Exercise Program, and Active Living Every Day).

The findings in this report are subject to at least three limitations. First, BRFSS data are self-reported and susceptible to recall, social desirability, and related biases. Second, low response rates for individual states might bias findings. Finally, institutional populations are excluded from sampling, meaning prevalences of studied outcomes are likely underestimated. Strengths include a measurement of joint pain and large sample size that allows analysis of detailed characteristics and subgroups.

Effective, inexpensive physical activity and self-management education programs are available nationwide and can help adults with arthritis be safely and confidently physically active. This report provides the most current state-specific and demographic data for arthritis, severe joint pain, and physical inactivity. These data can extend collaborations among CDC, state health departments, and community organizations to increase access to and use of arthritis-appropriate, evidence-based interventions to help participants reduce joint pain and improve physical function and quality of life.¶¶¶

Corresponding author: Dana Guglielmo, obx1@cdc.gov, 404-498-5453.


1Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee; 3Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC.

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.


* Appalachia region: all of West Virginia; parts of Alabama, Georgia, Kentucky, Maryland, New York, North Carolina, Ohio, Pennsylvania, South Carolina, and Virginia (https://www.arc.gov/appalachian_region/MapofAppalachia.aspexternal icon). Lower Mississippi Valley region: Arkansas, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee (https://www.mvd.usace.army.mil/Media/Publications/Our-Mississippi/About/Lower-Mississippi/external icon).

https://www.cdc.gov/brfss/about/index.htm.

§ https://www.cdc.gov/brfss/annual_data/2017/pdf/2017-response-rates-table-508.pdfpdf icon.

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.684.5837&rep=rep1&type=pdfexternal icon.

** Estimates were age-standardized to the 2000 projected U.S. population aged ≥18 years using three age groups: 18–44, 45–64, and ≥65 years. https://www.cdc.gov/nchs/data/statnt/statnt20.pdfpdf icon.

†† https://iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdfpdf iconexternal icon.

§§ http://mqic.org/pdf/2012_ACR_OA_Guidelines_FINAL.PDFexternal icon.

¶¶ https://health.gov/paguidelines/second-edition/report/pdf/pag_advisory_committee_report.pdfpdf iconexternal icon.

*** https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdfpdf iconexternal icon.

††† https://www.cdc.gov/arthritis/interventions/physical-activity.html.

§§§ https://www.cdc.gov/arthritis/interventions/self_manage.htm.

¶¶¶ https://www.cdc.gov/arthritis/partners/index.htm.

References

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TABLE 1. Age-specific and age-standardized* prevalence of arthritis among U.S. adults aged ≥18 years, and among those with arthritis, prevalences of severe joint pain,§ and physical inactivity, by selected characteristics — Behavioral Risk Factor Surveillance System, United States, 2017Return to your place in the text
Characteristic Sample size (adults aged ≥18 yrs) Unweighted no. with arthritis** Arthritis, % (95% CI) Severe joint pain,†† % (95% CI) Physical inactivity,†† % (95% CI)
Age group (yrs)
18–44 122,340 11,615 8.1 (7.8–8.3) 33.0 (31.3–34.7) 31.0 (29.4–32.7)
45–64 159,379 54,383 31.8 (31.3–32.3) 35.6 (34.7–36.5) 35.9 (35.0–36.8)
≥65 153,612 78,101 50.4 (49.8–51.0) 25.1 (24.3–25.9) 37.0 (36.1–37.8)
Sex
Men 192,681 52,827 19.1 (18.8–19.4) 27.3 (25.9–28.7) 30.4 (29.1–31.7)
Women 242,460 91,221 25.4 (25.0–25.7) 36.0 (34.7–37.3) 35.6 (34.3–36.9)
Race/Hispanic ethnicity§§
White 331,585 116,255 24.1 (23.8–24.3) 27.4 (26.4–28.4) 31.8 (30.8–32.8)
Black 34,952 11,594 24.1 (23.3–24.9) 50.9 (48.0–53.9) 40.4 (37.3–43.5)
Hispanic 32,064 5,800 16.9 (16.2–17.7) 42.0 (38.7–45.4) 36.0 (32.8–39.3)
Asian 9,165 1,161 12.8 (11.2–14.5) 27.7 (16.9–41.8)¶¶ 36.1 (25.0–48.9)
American Indian/Alaska Native 8,206 2,805 29.7 (27.2–32.4) 42.0 (35.3–49.0) 33.2 (27.7–39.1)
Other/Multiple race 11,952 3,930 25.5 (24.1–27.0) 37.4 (33.4–41.7) 33.3 (29.1–37.7)
Highest level of education
Less than high school graduate 31,177 12,595 25.7 (24.9–26.6) 54.1 (51.0–57.2) 46.4 (43.1–49.6)
High school graduate or equivalent 118,840 43,212 23.4 (23.0–23.8) 35.5 (33.9–37.1) 38.7 (37.0–40.3)
Technical school/Some college 120,950 42,634 24.4 (23.9–24.8) 30.2 (28.5–31.9) 31.6 (30.1–33.2)
College degree or higher 163,230 45,317 17.5 (17.1–17.8) 15.1 (14.0–16.3) 20.0 (18.7–21.4)
Employment status
Employed/Self-employed 217,384 44,544 17.7 (17.4–18.1) 20.6 (19.5–21.8) 29.2 (28.0–30.4)
Unemployed 18,884 5,864 26.0 (24.9–27.2) 39.9 (36.6–43.3) 33.4 (30.4–36.7)
Retired 129,618 64,620 34.3 (28.4–40.7) 45.8 (35.0–57.1) 31.1 (24.2–39.1)
Unable to work/Disabled 31,689 20,443 51.3 (49.8–52.7) 66.9 (64.9–68.9) 51.2 (48.8–53.5)
Other 34,662 7,965 21.1 (20.2–22.0) 30.6 (27.3–34.2) 29.4 (26.0–32.9)
Federal poverty level***
≤125% FPL 59,064 23,120 28.6 (28.0–29.3) 51.6 (49.6–53.6) 42.6 (40.6–44.7)
>125% to ≤200% FPL 55,134 22,702 24.7 (24.0–25.5) 33.0 (30.5–35.5) 36.7 (33.9–39.5)
>200% to ≤400% FPL 89,104 32,172 22.4 (21.9–23.0) 24.9 (22.6–27.3) 31.1 (28.8–33.4)
>400% FPL 117,078 30,457 18.4 (17.9–18.8) 13.9 (12.0–16.1) 20.7 (18.8–22.6)
Sexual orientation†††
Straight 185,994 63,300 22.1 (21.8–22.5) 31.7 (30.1–33.3) 33.4 (32.0–34.9)
Lesbian/Gay/Bisexual/Queer/ Questioning 9,346 2,646 22.5 (21.1–24.0) 40.7 (36.3–45.4) 33.2 (29.2–37.5)
Urban-rural status§§§
Large metro center 68,712 18,857 19.5 (19.0–20.0) 34.2 (31.5–37.0) 30.7 (28.2–33.3)
Large fringe metro 83,056 26,913 22.2 (21.7–22.6) 28.6 (26.7–30.6) 31.6 (29.7–33.6)
Medium metro 90,803 29,572 23.1 (22.7–23.5) 33.0 (31.3–34.7) 34.0 (32.3–35.8)
Small metro 60,652 20,685 24.0 (23.5–24.6) 32.7 (30.8–34.7) 35.0 (33.0–37.1)
Micropolitan 65,752 23,315 26.3 (25.6–26.9) 33.3 (30.9–35.7) 37.0 (34.7–39.4)
Rural (noncore) 66,356 24,757 27.7 (26.9–28.5) 35.7 (33.2–38.3) 38.7 (36.2–41.2)
Body mass index (kg/m2)
Underweight/Healthy weight (<25) 131,890 34,818 17.9 (17.5–18.2) 29.1 (27.2–31.0) 28.6 (27.0–30.3)
Overweight (25 to <30) 145,099 46,441 20.4 (20.0–20.8) 28.6 (26.7–30.5) 27.8 (26.2–29.5)
Obese (≥30) 125,421 53,342 30.4 (29.9–30.9) 37.2 (35.7–38.7) 39.3 (37.7–40.8)

Abbreviations: CI = confidence interval; FPL = federal poverty level.
* Except for age groups, estimates were age-standardized to the 2000 projected U.S. population aged ≥18 years using three groups (18–44, 45–64, and ≥65 years): https://www.cdc.gov/nchs/data/statnt/statnt20.pdfpdf icon.
Respondents were classified as having arthritis if they responded “yes” to the question “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” Overall, 144,099 respondents reported arthritis.
§ Severe joint pain was defined as a response of 7–10 to “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. On a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be, during the past 30 days, how bad was your joint pain on average?” Overall, 141,744 (98.4%) respondents with arthritis had severe joint pain data available.
Physical inactivity was defined as reporting “no” to the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?” Overall, 135,160 (93.8%) respondents with arthritis had physical inactivity data available.
** Categories might not sum to sample total because of missing responses for some variables.
†† Among adults aged ≥18 years with arthritis.
§§ Persons who identified as Hispanic might be of any race. Persons who identified with a racial group were all non-Hispanic.
¶¶ Estimate is potentially unreliable because the relative standard error was between 20% and 30%.
*** Federal poverty level is the ratio of total family income to federal poverty level per family size. Overall, 35,648 respondents had missing data.
††† Sexual orientation was not asked in every state. The 27 states that asked sexual orientation were California, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Minnesota, Mississippi, Montana, Nevada, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, and Wisconsin. A total of 1,049 respondents refused to answer.
§§§ Urban-rural status was categorized using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties: https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdfpdf icon.

TABLE 2. State-specific crude and age-standardized* prevalence of arthritis among U.S. adults aged ≥18 years and among those with arthritis, prevalences of severe joint pain,§ and physical inactivity — Behavioral Risk Factor Surveillance System, United States, 2017Return to your place in the text
State Arthritis Severe joint pain** Physical inactivity**
No. Prevalence, % (95% CI) No. Prevalence, % (95% CI) No. Prevalence, % (95% CI)
Unweighted Weighted (x 1,000) Crude Age-standardized Unweighted Weighted (x 1,000) Crude Age-standardized Unweighted Weighted (x 1,000) Crude Age-standardized
Alabama 2,778 1,241 33.3 (31.9–34.8) 30.4 (29.0–31.8) 1,050 477 38.9 (36.5–41.4) 41.1 (37.0–45.3) 1,158 519 44.6 (42.1–47.2) 42.3 (38.1–46.6)
Alaska 943 124 22.5 (20.4–24.8) 22.8 (20.8–25.0) 193 28 22.6 (18.2–27.7) 23.8 (17.1–32.1) 267 34 29.0 (24.2–34.3) 29.1 (21.8–37.8)
Arizona 4,925 1,285 24.3 (23.5–25.1) 22.0 (21.3–22.8) 1,248 384 30.3 (28.6–32.1) 31.7 (28.6–35.0) 1,472 405 34.5 (32.7–36.3) 29.3 (26.4–32.4)
Arkansas 2,298 700 30.9 (28.8–33.0) 28.4 (26.3–30.5) 734 260 37.6 (33.9–41.5) 42.4 (35.8–49.3) 920 265 40.6 (36.9–44.3) 36.8 (30.8–43.2)
California 2,095 5,873 19.5 (18.4–20.6) 18.3 (17.4–19.3) 547 1,682 28.9 (26.1–31.8) 29.7 (24.6–35.3) 461 1,432 26.6 (23.8–29.5) 26.3 (21.8–31.3)
Colorado 2,796 920 21.4 (20.5–22.3) 20.3 (19.5–21.1) 500 188 20.8 (19.0–22.8) 20.8 (17.8–24.3) 578 200 24.5 (22.4–26.7) 23.2 (19.7–27.2)
Connecticut 3,269 639 23.1 (22.1–24.1) 20.1 (19.3–21.0) 707 161 25.6 (23.5–27.9) 28.5 (24.0–33.5) 899 185 31.9 (29.7–34.2) 30.5 (25.7–35.7)
Delaware 1,247 189 25.3 (23.6–27.1) 22.3 (20.7–24.0) 381 62 33.6 (30.0–37.5) 34.6 (28.2–41.6) 443 67 38.5 (34.7–42.5) 37.5 (30.6–45.0)
District of Columbia 900 80 14.3 (13.2–15.5) 15.7 (14.7–16.9) 298 29 37.1 (33.1–41.3) 40.4 (32.1–49.4) 262 24 30.8 (27.1–34.8) 29.9 (23.1–37.7)
Florida 7,271 4,112 24.8 (23.6–26.0) 20.5 (19.5–21.5) 2,540 1,496 37.3 (34.7–40.0) 42.0 (36.9–47.3) 2,670 1,506 39.4 (36.7–42.1) 34.4 (29.8–39.3)
Georgia 1,826 1,734 22.3 (21.1–23.5) 21.0 (19.9–22.1) 606 562 32.9 (30.2–35.9) 29.2 (25.0–33.9) 743 697 43.7 (40.6–46.9) 39.9 (34.8–45.2)
Hawaii 1,942 232 21.0 (19.8–22.3) 19.0 (17.9–20.1) 411 51 22.2 (19.5–25.2) 27.3 (22.5–32.7) 463 66 30.1 (26.8–33.6) 33.4 (27.8–39.6)
Idaho 1,540 304 24.2 (22.7–25.7) 22.2 (20.8–23.6) 338 70 23.1 (20.4–26.1) 26.1 (21.2–31.7) 455 92 32.6 (29.3–36.0) 30.9 (25.4–37.1)
Illinois 1,726 2,405 24.5 (23.1–25.9) 22.4 (21.2–23.7) 388 633 26.4 (23.5–29.5) 28.4 (22.5–35.1) 495 688 30.5 (27.7–33.4) 24.9 (20.5–29.9)
Indiana 5,118 1,428 28.4 (27.5–29.3) 26.1 (25.3–27.0) 1,383 417 29.6 (28.0–31.3) 30.3 (27.5–33.3) 1,853 517 39.5 (37.7–41.4) 36.9 (33.8–40.2)
Iowa 2,309 588 24.6 (23.6–25.7) 22.0 (21.0–22.9) 434 123 21.1 (19.1–23.3) 22.4 (18.7–26.6) 698 179 32.7 (30.5–35.1) 28.4 (24.6–32.4)
Kansas 6,540 519 24.1 (23.4–24.7) 22.2 (21.6–22.8) 1,506 129 25.3 (23.9–26.7) 26.6 (24.3–29.0) 2,205 177 37.0 (35.4–38.5) 34.6 (32.0–37.4)
Kentucky 3,350 1,095 32.3 (30.7–33.8) 29.4 (28.0–30.9) 1,222 413 38.3 (35.5–41.2) 39.2 (35.0–43.5) 1,433 474 46.4 (43.5–49.3) 44.4 (40.0–48.8)
Louisiana 1,588 962 27.2 (25.7–28.8) 25.5 (24.1–26.9) 566 363 38.3 (35.2–41.5) 39.0 (34.3–44.0) 596 369 42.8 (39.5–46.1) 41.7 (36.8–46.9)
Maine 3,619 333 31.1 (29.8–32.5) 26.5 (25.2–27.9) 730 71 21.6 (19.6–23.7) 22.2 (18.6–26.2) 1,046 96 30.8 (28.6–33.1) 26.4 (22.8–30.4)
Maryland 4,907 1,146 24.9 (23.9–26.0) 22.8 (21.9–23.8) 1,140 304 26.8 (24.7–29.0) 31.8 (27.5–36.4) 1,520 367 35.2 (33.0–37.5) 33.5 (29.0–38.3)
Massachusetts 2,126 1,262 23.7 (22.2–25.4) 21.3 (20.0–22.8) 498 327 26.6 (23.3–30.1) 25.9 (20.9–31.7) 611 377 32.1 (28.5–35.9) 27.9 (22.3–34.2)
Michigan 3,953 2,338 30.5 (29.4–31.5) 27.1 (26.2–28.1) 1,079 749 32.4 (30.4–34.4) 34.8 (31.4–38.4) 1,217 781 35.2 (33.2–37.2) 36.2 (32.7–39.8)
Minnesota 4,269 833 19.8 (19.1–20.5) 17.8 (17.2–18.5) 811 165 20.2 (18.6–21.9) 22.1 (19.3–25.2) 1,319 253 32.7 (30.9–34.6) 31.2 (28.0–34.6)
Mississippi 1,915 657 29.3 (27.6–31.0) 27.2 (25.6–28.8) 709 272 42.0 (38.8–45.3) 45.2 (39.7–50.7) 725 256 43.1 (39.8–46.4) 41.6 (35.9–47.6)
Missouri 2,752 1,296 27.8 (26.5–29.1) 24.9 (23.8–26.1) 782 373 29.4 (27.0–31.9) 30.8 (26.6–35.4) 1,051 472 37.7 (35.1–40.3) 35.4 (30.9–40.1)
Montana 1,930 207 25.5 (24.0–26.9) 22.6 (21.3–24.0) 450 51 24.8 (22.1–27.8) 27.2 (22.8–32.1) 640 68 34.0 (31.0–37.2) 32.2 (27.5–37.2)
Nebraska 4,789 345 24.0 (23.1–25.0) 22.0 (21.1–22.9) 916 69 20.2 (18.4–22.1) 22.9 (19.4–26.8) 1,553 104 32.1 (30.1–34.2) 29.5 (25.9–33.2)
Nevada 1,112 462 20.3 (18.6–22.1) 18.5 (17.0–20.1) 286 136 29.8 (25.7–34.4) 31.0 (24.4–38.5) 322 150 33.9 (29.3–38.8) 30.1 (23.2–38.1)
New Hampshire 2,064 281 26.5 (25.1–28.1) 23.0 (21.6–24.4) 447 62 22.3 (19.9–24.9) 24.7 (19.6–30.7) 584 80 31.0 (28.2–34.1) 33.7 (27.2–40.9)
New Jersey 3,751 1,576 22.9 (21.8–24.1) 20.4 (19.4–21.4) 1,089 485 31.2 (28.6–33.9) 34.0 (29.0–39.4) 1,308 585 39.9 (37.1–42.7) 36.1 (31.0–41.5)
New Mexico 2,099 398 25.3 (24.0–26.8) 23.0 (21.7–24.4) 631 136 34.3 (31.3–37.5) 38.7 (33.4–44.2) 616 111 30.2 (27.4–33.1) 25.6 (21.9–29.8)
New York 3,509 3,445 22.6 (21.6–23.6) 20.4 (19.6–21.2) 976 1,083 32.0 (29.7–34.4) 32.8 (28.9–37.1) 1,086 1,085 34.8 (32.5–37.3) 33.3 (29.2–37.7)
North Carolina 1,477 1,921 24.4 (23.0–26.0) 22.1 (20.8–23.5) 517 695 36.9 (33.6–40.4) 43.6 (38.2–49.2) 524 663 36.0 (32.7–39.5) 36.4 (30.8–42.3)
North Dakota 2,307 141 24.3 (23.1–25.6) 23.3 (22.1–24.5) 378 27 19.3 (17.0–21.7) 21.7 (17.7–26.2) 749 46 35.0 (32.3–37.9) 35.9 (31.1–41.0)
Ohio 4,741 2,598 29.1 (28.0–30.2) 25.9 (24.9–27.0) 1,291 760 29.6 (27.5–31.7) 32.4 (28.7–36.4) 1,804 936 38.1 (36.0–40.3) 34.0 (30.3–37.8)
Oklahoma 2,423 814 27.8 (26.5–29.1) 26.0 (24.8–27.2) 667 257 32.4 (30.0–35.0) 32.9 (28.8–37.2) 947 314 41.4 (38.8–44.0) 37.4 (33.3–41.8)
Oregon 1,650 847 26.6 (25.2–28.0) 23.9 (22.7–25.2) 342 193 23.3 (20.8–25.9) 23.7 (19.8–28.1) 443 236 30.1 (27.3–33.0) 27.0 (22.9–31.5)
Pennsylvania 2,128 2,915 29.2 (27.8–30.6) 25.4 (24.2–26.7) 556 789 27.4 (24.9–30.0) 28.9 (24.9–33.4) 658 956 34.9 (32.1–37.8) 35.2 (30.3–40.4)
Rhode Island 1,968 229 27.4 (25.9–29.0) 24.7 (23.2–26.1) 508 64 28.1 (25.3–31.1) 33.2 (27.4–39.6) 616 74 35.1 (32.1–38.1) 34.0 (28.2–40.4)
South Carolina 4,286 1,082 28.0 (26.9–29.1) 24.9 (23.9–25.8) 1,340 371 34.9 (32.8–37.0) 38.5 (34.4–42.7) 1,445 362 36.1 (34.0–38.2) 35.5 (31.4–39.7)
South Dakota 2,077 145 22.2 (20.6–23.9) 20.0 (18.5–21.6) 468 32 22.6 (19.5–26.1) 22.4 (17.6–28.1) 621 46 33.0 (29.2–37.0) 28.6 (22.7–35.3)
Tennessee 2,107 1,540 30.1 (28.6–31.7) 27.4 (26.0–28.8) 710 547 36.1 (33.2–39.0) 36.7 (32.1–41.5) 799 562 40.5 (37.5–43.5) 37.0 (32.7–41.5)
Texas 3,818 4,438 21.3 (19.9–22.9) 20.8 (19.5–22.3) 1,127 1,572 36.0 (32.1–40.1) 35.5 (29.1–42.4) 1,474 1,697 41.8 (37.6–46.0) 38.7 (32.2–45.6)
Utah 2,512 414 19.3 (18.4–20.2) 20.2 (19.4–21.1) 531 89 22.0 (19.9–24.2) 22.4 (19.4–25.7) 695 110 27.6 (25.4–30.0) 25.9 (22.6–29.5)
Vermont 2,184 138 27.7 (26.4–29.1) 23.7 (22.6–24.9) 430 30 22.2 (19.9–24.6) 22.5 (18.6–26.9) 538 36 28.3 (25.8–31.0) 27.0 (22.5–31.9)
Virginia 3,184 1,628 25.1 (24.0–26.2) 23.1 (22.2–24.1) 835 481 29.9 (27.7–32.3) 30.7 (26.9–34.9) 1,064 567 36.6 (34.3–39.1) 36.6 (32.4–41.0)
Washington 4,154 1,359 24.1 (23.2–25.0) 22.3 (21.5–23.2) 808 294 21.9 (20.2–23.8) 22.1 (19.3–25.1) 1,002 327 25.5 (23.8–27.4) 23.7 (20.9–26.8)
West Virginia 2,501 561 39.2 (37.7–40.8) 34.6 (33.1–36.0) 856 206 37.3 (35.0–39.6) 37.5 (33.7–41.4) 996 226 41.4 (39.1–43.8) 39.0 (35.1–43.0)
Wisconsin 1,856 1,136 25.6 (24.2–27.1) 22.9 (21.6–24.2) 463 294 26.1 (23.4–29.0) 26.9 (22.5–31.8) 493 293 27.9 (24.9–31.0) 26.2 (21.2–31.9)
Wyoming 1,470 113 25.4 (23.9–26.9) 23.4 (22.1–24.8) 290 26 23.2 (20.4–26.1) 23.6 (19.1–28.9) 499 40 36.4 (33.2–39.6) 35.4 (30.2–41.1)
State median N/A N/A 24.9 22.8 N/A N/A 28.9 30.3 N/A N/A 34.9 33.7

Abbreviations: CI = confidence interval; N/A = not applicable.
* Estimates were age-standardized to the 2000 projected U.S. population aged ≥18 years using three groups (18–44, 45–64, and ≥65 years).
Respondents were classified as having arthritis if they responded “yes” to the question “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
§ Severe joint pain was defined as a response of 7–10 to “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. On a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be, during the past 30 days, how bad was your joint pain on average?”
Physical inactivity was defined as reporting “no” to the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”
** Among adults aged ≥18 years with arthritis.

Return to your place in the textFIGURE. Age-standardized,* state-specific percentage of severe joint pain among U.S. adults aged ≥18 years with arthritis§ — Behavioral Risk Factor Surveillance System, United States, 2017
The figure is a map showing age-standardized, state-specific prevalence of severe joint pain among U.S. adults aged ≥18 years with arthritis according to the Behavioral Risk Factor Surveillance System during 2017.

* Estimates were age-standardized to the 2000 projected U.S. population aged ≥18 years using three age groups (18–44, 45–64, and ≥65 years).

Severe joint pain was defined as a response of 7–10 to “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. On a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be, during the past 30 days, how bad was your joint pain on average?”

§ Respondents were classified as having arthritis if they responded “yes” to the question “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”


Suggested citation for this article: Guglielmo D, Murphy LB, Boring MA, et al. State-Specific Severe Joint Pain and Physical Inactivity Among Adults with Arthritis — United States, 2017. MMWR Morb Mortal Wkly Rep 2019;68:381–387. DOI: http://dx.doi.org/10.15585/mmwr.mm6817a2external icon.

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