Progress in Chronic Disease Prevention Prevalence of Arthritic Conditions -- United States, 1987

Arthritis is a widely prevalent, disabling disease that places substantial demands on health-care resources. National estimates of the prevalence of arthritic diseases and of associated disability have been based on data from the 1960-1962 National Health Examination Survey, the 1971-1975 National Health and Nutrition Examination Survey (NHANES I), and the 1983-1985 National Health Interview Surveys (NHIS) (1,2). This report uses 1987 NHIS data to update national estimates of arthritis prevalence and resulting physical activity limitation and provides estimates of the prevalence of arthritic conditions for each state. Estimates are based on a probability sample of the civilian noninstitutionalized (CNI) population of the United States (3).

Survey respondents were asked whether they had had various arthritic conditions in the past year and, if so, whether they had seen a physician for them. The national and state estimates reported here are based on the 3036 persons reporting one or more of four conditions: arthritis, bursitis, gout, and unspecified rheumatism (Table 1). Information about limitation in activity attributable to arthritic conditions is based on responses to questions regarding whether a person is limited in or prevented from working, housekeeping, or performing other activities as a result of a health condition, followed by questions about conditions causing the limitation.

Because NHIS is a probability sample of the CNI population, the proportions of persons with arthritic conditions in each of 36 age-sex-race strata in the sample were adjusted to generate national estimates. For each state, 1987 population estimates for the same 36 strata were obtained (4) and adjusted to approximate the CNI population using unpublished estimates from the Bureau of the Census.*

In 1987, approximately 14.6% of the U.S. population (34.7 million persons) reported having an arthritic condition, and approximately 12.1% consulted a physician for it (Table 2). Self-reported arthritic conditions were over twice as prevalent in the state with the highest proportion (Florida) as in that with the lowest (Alaska) (Table 3). Arthritis was responsible for limiting the activity of 2.6% of the CNI population; for persons greater than or equal to 75 years of age, the proportion was 12.6% (Table 2). Reported by: Office of Surveillance and Analysis and Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The validity of using self-reports of arthritic conditions as a measure of "actual" prevalence is unknown. However, the national age-specific prevalence proportions for physician-consulted arthritic conditions (Table 2) are similar to estimates for clinically confirmed osteoarthritis, rheumatoid arthritis, other arthritis and rheumatism, and bursitis reported from NHANES I (5).

Excluding nursing home residents (in 1985, 1.5 million persons (6)) from NHIS did not result in a substantial underestimate of the prevalence of arthritic conditions. Based on prevalence estimates for nursing home residents (7), the inclusion of this population in the analysis probably would have increased by less than 2% the 28.6 million persons with self-reported, physician-consulted arthritic conditions.

Because of the method used to produce the state-specific estimates, differences in prevalence among the states primarily reflect variations in demographic composition. For example, Florida's high prevalence proportion for arthritic conditions is due primarily to its relatively large population of elderly persons, and the low prevalence in Alaska can be attributed partly to its high proportions of persons of "other" race (e.g., Asian/Pacific Islander and Native American), among whom the prevalence of arthritic conditions is low (Table 2). However, these estimates do not account for other factors that influence the prevalence of some arthritic conditions, such as obesity and occupation (8).

Approximately 2.5% of the U.S. population (6 million persons) believe they have an arthritic condition but have not consulted a physician for it (Table 2). These findings indicate the need for health-care providers and public and private health agencies to determine why these persons have not sought medical care and to identify approaches for overcoming barriers to care.

Given the high prevalence of arthritic conditions among older persons and trends that favor population survival to older ages, the number of persons with these conditions and associated disabilities can be expected to continue increasing. Efforts aimed at limiting disease progression and preventing disability associated with arthritic conditions should include developing education programs for patients and primary-care providers and developing specific indications for referral of patients to specialists.

References

1. Lawrence RC, Hochberg MC, Kelsey JL, et al. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol 1989;16:427-41.

2. LaPlante MP. Data on disability from the National Health Interview Survey, 1983-85. Washington DC: National Institute on Disability and Rehabilitation Research, 1988.

3. NCHS. National Health Interview Survey (machine-readable public-use data tape). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1987.

4. Irwin R. 1980-1988 Intercensal population estimates by race, sex, and age (machine-readable data file). Alexandria, Virginia: Demo-Detail, 1988.

5. Cunningham LS, Kelsey JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 1984;74:574-9.

6. NCHS. The National Nursing Home Survey: 1985 summary for the United States. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989; DHHS publication no. (PHS)89-1758. (Vital and health statistics; series 13, no. 97).

7. NCHS. Profile of chronic illness in nursing homes: United States--National Nursing Home Survey, August 1973-April 1974. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1977; DHEW publication no. (PHS)78-1780. (Vital and health statistics; series 13, no. 29).

8. Anderson JA, Felson DT. Factors associated with osteoarthritis of the knee in the first National Health and Nutrition Examination Survey. Am J Epidemiol 1988;128:179-89. *The 36 proportions from NHIS were multiplied by each state's 36 CNI population estimates and the products summed to obtain the estimated number of persons with arthritic conditions for the state. Division of this figure by the state's CNI population gave a prevalence proportion.

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