State Prevalence of Self-Reported Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation --- United States, 2003

Arthritis is costly ($86 billion annually), highly prevalent (affecting 43 million U.S. adults), the leading cause of disability, and associated with substantial disparities in pain, activity limitations, and compromised quality of life (1--3). State-based estimates of arthritis prevalence and impact help define the burden of arthritis and provide state arthritis programs with data for program planning. This report summarizes results from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey on state-specific prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation in 50 states, the District of Columbia (DC), and three territories. The findings indicated that the prevalence of adults with self-reported doctor-diagnosed arthritis ranged from 17.9% to 37.2% (state median: 27.0%) and with arthritis-attributable activity limitation ranged from 6.3% to 16.7% (state median: 9.9%); the proportion of adults with arthritis-attributable activity limitation among those with self-reported doctor-diagnosed arthritis ranged from 30.1% to 49.8% (state median: 37.4%). These high rates of arthritis prevalence and activity limitation are projected to increase with the aging of the population (4), requiring increased intervention measures to reduce this impact.

BRFSS is a state-based, random-digit--dialed telephone survey of the noninstitutionalized, civilian, U.S. adult population aged >18 years. The survey is conducted annually in all 50 states, DC, Guam, Puerto Rico, and the U.S. Virgin Islands. In odd-numbered years, a five-question module on arthritis and activity limitation is included with the core survey. In 2003, self-reported doctor-diagnosed arthritis was defined as a "yes" response to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?" Respondents with self-reported doctor-diagnosed arthritis were also asked, "Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?" Those responding "yes" were considered to have arthritis-attributable activity limitation.

To estimate the state and territory burden and impact of arthritis, calculations of the prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation used the weighted state population of adults aged >18 years as the denominator. To estimate the impact of arthritis-attributable activity limitation among adults with self-reported doctor-diagnosed arthritis, the unadjusted proportion of adults with arthritis-attributable activity limitation was calculated using the weighted number of adults aged >18 years with self-reported doctor-diagnosed arthritis as the denominator. To allow comparison of the prevalence of arthritis-attributable activity limitation between states, an age-adjusted estimate for states was calculated using the 2000 population standard. Statistical analysis software was used to calculate point estimates and 95% confidence intervals. The median response rate for the states and territories included in this report was 53.2% (range: 34.4% [New Jersey] to 80.5% [Puerto Rico]).*

During 2003, the unadjusted prevalence of arthritis ranged from 17.9% in Hawaii to 37.2% in West Virginia (state median: 27.0%) and from 16.4% to 24.4% in the territories (Table). The unadjusted prevalence of arthritis-attributable activity limitation ranged from 6.3% in Hawaii to 16.7% in West Virginia (state median: 9.9%) and from 6.1% to 11.7% in the territories. The unadjusted proportion of arthritis-attributable activity limitation among adults with self-reported doctor-diagnosed arthritis ranged from 30.1% in DC to 49.8% in Kentucky (state median: 37.4%) and from 35.7% to 48.3% in the territories. The median age-adjusted state prevalence of arthritis-attributable activity limitation was 9.6%, and the states with the highest prevalences were in the southern region (Figure). In each state, DC, and territory, arthritis was more prevalent in women than in men and in adults aged >65 years than in younger adults.

Reported by: B Steiner, Center for Health Statistics, Illinois Dept of Public Health. J Hootman, PhD, G Langmaid, J Bolen, PhD, CG Helmick MD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

The findings in this report provide the first state-specific estimates of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation for all 50 states, DC, and U.S territories using updated case-finding questions. In all state and territorial populations, self-reported doctor-diagnosed arthritis is one of the most common chronic conditions, and arthritis-attributable activity limitation has a substantial impact. As the U.S. population continues to age, the prevalence of arthritis and arthritis-attributable activity limitation is projected to increase (4), likely increasing these already substantial state estimates of arthritis burden.

Arthritis-attributable activity limitation can be prevented or reduced in many persons. For example, both aerobic and strengthening exercises can improve physical function and self-reported disability among older disabled adults with knee osteoarthritis (5). In addition, among persons with arthritis who are not limited in activity, regular physical activity can reduce the risk for functional activity limitation by 32% (6). Arthritis self-management education classes also have substantially reduced pain and disability (7). However, despite the known benefits of exercise for persons with arthritis, 44% of adults with arthritis are physically inactive (8).

The findings in this report are subject to at least four limitations. First, doctor-diagnosed arthritis is self reported and has not been confirmed by a health-care provider, although such self report appears valid for surveillance purposes (9). Second, BRFSS is a telephone survey and does not cover persons without land-line telephones, persons in the military, or those residing in institutions. Third, state comparisons of data presented (Table) are difficult because they are unadjusted for potentially important variables (e.g., age); however, age-adjusted data are presented (Figure). Finally, response rates for BRFSS are low; however, demographic characteristics of state BRFSS survey respondents are representative of the state adult populations.

These state-specific data on self-reported doctor-diagnosed arthritis prevalence and arthritis-attributable activity limitation are important for monitoring and targeting programs to reduce the burden of arthritis. One of the national Healthy People 2010 objectives (objective 2-2) is to reduce the proportion of adults with self-reported doctor-diagnosed arthritis who experience arthritis-attributable activity limitation from 36% in 2002 (baseline) to 33%. CDC funds 36 state health departments to expand the reach of evidence-based programs for persons with arthritis. These include physical activity programs (Arthritis Foundation Exercise Program, Arthritis Foundation Aquatics Program, and EnhanceFitness) and self-management education programs (Arthritis Foundation Self-Help Program and the Chronic Disease Self-Management Program) that are delivered in community settings by trained instructors. Benefits of these physical activity and self-management education programs include reduced pain, improved function and mental health, and less need for health care (10). Improving access to these evidence-based programs through national and local partnerships with states and the Arthritis Foundation might help meet the 2010 health objectives for arthritis and thereby improve the quality of life for those affected by arthritis.

References

1. CDC. Prevalence of disabilities and associated health conditions among adults---United States, 1999. MMWR 2001;50:120--5.
2. CDC. Racial/ethnic differences in the prevalence and impact of doctor-diagnosed arthritis---United States, 2002. MMWR 2005;54:119--23.
3. CDC. Update: Direct and indirect costs of arthritis and other rheumatic conditions---United States, 1997. MMWR 2004;53:388--9.
4. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;54:226--9.
5. Ettinger WH Jr, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the Fitness Arthritis and Seniors Trial (FAST). JAMA 1997;277:25--31.
6. Dunlop DD, Semanik P, Song J, Manheim LM, Shih V, Chang RW. Risk factors for functional decline in older adults with arthritis. Arthritis Rheum 2005;52:1274--82.
7. Lorig K, Ritter PL, Plant K. A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Care Res 2005;53:950--7.
8. Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis: National Health Interview Survey, 2002. Am J Prev Med 2006;30:385--93.
9. Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA. Validation of a surveillance case definition for arthritis. J Rheumatol 2005;32:340--7.
10. Brady TJ, Kruger J, Helmick CG, et al. Intervention programs for arthritis and other rheumatic diseases. Health Educ Behav 2003;30:44--63.

* 2003 Behavioral Risk Factor Surveillance System Summary Data Quality Report. Available at http://www.cdc.gov/brfss/technical_infodata/pdf/2003summarydataqualityreport.pdf.

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Date last reviewed: 5/4/2006