Prevalence of Arthritis and Arthritis-Attributable Activity Limitation — United States, 2016–2018

Arthritis has been the most frequently reported main cause of disability among U.S. adults for >15 years (1), was responsible for >$300 billion in arthritis-attributable direct and indirect annual costs in the U.S. during 2013 (2), is linked to disproportionately high levels of anxiety and depression (3), and is projected to increase 49% in prevalence from 2010-2012 to 2040 (4). To update national prevalence estimates for arthritis and arthritis-attributable activity limitation (AAAL) among U.S. adults, CDC analyzed combined National Health Interview Survey (NHIS) data from 2016–2018. An estimated 58.5 million adults aged ≥18 years (23.7%) reported arthritis; 25.7 million (10.4% overall; 43.9% among those with arthritis) reported AAAL. Prevalence of both arthritis and AAAL was highest among adults with physical limitations, few economic opportunities, and poor overall health. Arthritis was reported by more than one half of respondents aged ≥65 years (50.4%), adults who were unable to work or disabled* (52.3%), or adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), activities of daily living (ADL)^† disability (54.8%), or instrumental activities of daily living (IADL)^§ disability (55.9%). More widespread dissemination of existing, evidence-based, community-delivered interventions, along with clinical coordination and attention to social determinants of health (e.g., improved social, economic, and mental health opportunities), can help reduce widespread arthritis prevalence and its adverse effects.

NHIS is an ongoing, nationally representative, in-person interview health survey of the noninstitutionalized, U.S. civilian population. Analyses were limited to adults aged ≥18 years. Unweighted sample sizes and final response rates of the Sample Adult component^¶ for 2016, 2017, and 2018 were 33,028 (54.3%); 26,742 (53.0%); and 25,417 (53.1%), respectively. Arthritis was ascertained by a response of “yes” to, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” AAAL was ascertained among those with arthritis by a response of “yes” to, “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?” Annualized unadjusted and age-standardized** prevalence estimates of arthritis and AAAL were generated overall and by selected sociodemographic,^†† health,^§§ and function characteristics.^¶¶ Sampling weights were applied to account for the complex survey design, to generate nationally representative estimates, and to adjust for nonresponse. Subgroup differences were assessed using pairwise t-tests; orthogonal linear contrasts were performed to conduct linear trend tests in ordinal variables. Unadjusted estimates are reported in text unless otherwise noted; all differences are significant at α = 0.05. To examine change over time, a secondary analysis using identical methods was conducted to produce annualized absolute prevalence estimates of arthritis and AAAL for the combined years 2003–2005, 2007–2009, 2010–2012, and 2013–2015. These years were chosen to correspond to previous surveillance reports.*** A linear model trend test was conducted with significance set at α = 0.05.^††† Analyses were conducted in SAS (version 9.4; SAS Institute) and SUDAAN (version 11.0; RTI International). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.^§§§

During 2016–2018, 58.5 million U.S. adults aged ≥18 years (23.7%; 21.5% age-standardized) are estimated to have arthritis; 25.7 million (43.9%; 40.8% age-standardized) of those with arthritis are estimated to have AAAL (Figure), representing 10.4% (9.4% age-standardized) of the total U.S. adult population. Annualized absolute prevalence of both arthritis and AAAL continues nearly two decades of an increasing statistically significant linear trend (Figure). Prevalence of arthritis increased with increasing age, body mass index (BMI), aerobic physical inactivity, and worsening psychological distress and self-rated health, and decreased with increasing educational attainment and income-to-poverty ratio (Table 1). Arthritis prevalence was >50% among adults aged ≥65 years (50.4%), adults who were unable to work or disabled (52.3%), and adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), ADL disability (54.8%), and IADL disability (55.9%).

Among adults with arthritis, unadjusted prevalence of AAAL exceeded 50% in several groups, including adults with joint symptoms in the past 30 days (51.6%), adults who were unable to work or disabled (54.7%), adults of other/multiple races (54.5%) or non-Hispanic American Indian or Alaska Natives (60.7%), adults with low income (53.3%) or poor/near poor income-to-poverty ratios (63.3%), or with moderate psychological distress (59.5%) (Table 2). AAAL was also reported by a high proportion of adults with arthritis who had an ADL disability (82.6%), IADL disability (80.4%), serious psychological distress (76.3%), or fair/poor self-rated health (72.6%).

Corresponding author: Kristina A. Theis, ktheis@cdc.gov, 770-488-1351.

¹Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; ²Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee; ³ASRT Inc., Smyrna, Georgia; ⁴Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC; ⁵Epidemic Intelligence Service, CDC.

References

1. 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. Disabil Health J 2019;12:411–21. https://doi.org/10.1016/j.dhjo.2019.03.001 PMID:31000498
2. Murphy LB, Cisternas MG, Pasta DJ, Helmick CG, Yelin EH. Medical expenditures and earnings losses among U.S. adults with arthritis in 2013. Arthritis Care Res (Hoboken) 2018;70:869–76. https://doi.org/10.1002/acr.23425 PMID:28950426
3. Guglielmo D, Hootman JM, Boring MA, et al. Symptoms of anxiety and depression among adults with arthritis—United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2018;67:1081–7. https://doi.org/10.15585/mmwr.mm6739a2 PMID:30286053
4. 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 U.S. adults, 2015–2040. Arthritis Rheumatol 2016;68:1582–7. https://doi.org/10.1002/art.39692 PMID:27015600
5. Barbour KE, Helmick CG, Boring M, Brady TJ. Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013–2015. MMWR Morb Mortal Wkly Rep 2017;66:246–53. https://doi.org/10.15585/mmwr.mm6609e1 PMID:28278145
6. Hunter DJ, March L, Chew M. Osteoarthritis in 2020 and beyond: a Lancet commission. Lancet 2020;396:1711–2. https://doi.org/10.1016/S0140-6736(20)32230-3 PMID:33159851
7. Brady TJ, Murphy L, O’Colmain BJ, et al. A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program. Prev Chronic Dis 2013;10:120112. https://doi.org/10.5888/pcd10.120112 PMID:23327828
8. Kelley GA, Kelley KS, Hootman JM, Jones DL. Effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases: a meta-analysis. Arthritis Care Res (Hoboken) 2011;63:79–93. https://doi.org/10.1002/acr.20347 PMID:20824798
9. Allaire SH, Evans SR, LaValley MP, Merrigan DM. Use of the Americans with Disabilities Act by persons with rheumatic diseases and factors associated with use. Arthritis Rheum 2001;45:174–82. https://doi.org/10.1002/1529-0131(200104)45:2<174::AID-ANR171>3.0.CO;2-1 PMID:11324782
10. Woolf SH, Schoomaker H. Life expectancy and mortality rates in the United States, 1959–2017. JAMA 2019;322:1996–2016. https://doi.org/10.1001/jama.2019.16932 PMID:31769830

FIGURE. Weighted number of adults aged ≥18 years with arthritis* and arthritis-attributable activity limitation^†,§,¶,** — National Health Interview Survey, United States, 2003–2018

Abbreviation: AAAL = arthritis-attributable activity limitation.

* Responded “yes” to, “Have you ever been told by a doctor or other health professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

^† Responded “yes” to, “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?”

^§ 95% confidence intervals indicated by error bars.

^¶ Separate linear model trend tests were conducted for both outcomes with significance set at α = 0.05.

** The p for trend for both outcomes was <0.001.

Abbreviations: ADL = activities of daily Living; BMI = body mass index; CI = confidence interval; IADL = instrumental activities of daily living; NH = non-Hispanic.
* Age-standardized to the 2000 U.S. projected adult population, using three age groups: 18–44, 45–64, and ≥65 years.
^† Responded “yes” to, “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?”
^§ Might not sum to overall total for some categories because of item-specific missing data.
^¶ Might not sum to 100 because of rounding.
** Responded “I don’t know the answer” to, “Which of the following best represents how you think of yourself?”
^†† This category is a combination of respondents who self-reported their reason for not working as: “temporarily unable to work due to health reasons” or “disabled.”
^§§ Students, homemakers, and retirees.
^¶¶ Income-to-poverty ratio estimates were derived using NHIS imputed income file. https://www.cdc.gov/nchs/data/nhis/tecdoc18.pdf
*** Respondents were considered to have met recommendations if they reported ≥150 minutes of moderate-intensity leisure-time aerobic physical activity per week, insufficiently active if they reported 1–149 minutes, and inactive if they reported 0 minutes. Reported vigorous-intensity physical activity minutes were counted twice and added to moderate-intensity physical activity minutes.
^††† Responded “yes” to, “The next questions refer to your joints. Please do not include the back or neck. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?”
^§§§ Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside this home?”
^¶¶¶ Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you] need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?”
**** Psychological distress was classified as none/mild, moderate, or severe and measured by the Kessler-6 Scale. https://www.hcp.med.harvard.edu/ncs/k6_scales.php

Abbreviations: AAAL = arthritis-attributable activity limitation; ADL = activities of daily living; AI/AN = American Indian/Alaska Native; API = Asian or Other Pacific Islander; BMI = body mass index; CI = confidence interval; HS = high school; IADL = instrumental activities of daily living; N/A = not applicable; NH = non-Hispanic.
* Age-standardized to the 2000 U.S. projected adult population, using three age groups: 18–44, 45–64, and ≥65 years. Subgroup differences were assessed using pairwise t-tests with significance set at α = 0.05. Results exactly correspond to interpretation of non-overlapping CIs; all categories of education were statistically significantly different from each other per t-test results for unadjusted prevalence of AAAL among all U.S. adults.
^† Responded “yes” to, “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?”
^§ Responded “yes” to, “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?”
^¶ Might not sum to overall total for some categories because of item-specific missing data.
** Might not sum to 100 because of rounding.
^†† Responded “I don’t know the answer” to, “Which of the following best represents how you think of yourself?”
^§§ This category is a combination of respondents self-reporting their reason for not working as: “temporarily unable to work due to health reasons” or “disabled.”
^¶¶ Students, homemakers, and retirees.
*** Income-to-poverty ratio estimates were derived using NHIS imputed income file. https://www.cdc.gov/nchs/data/nhis/tecdoc18.pdf.
^††† Respondents were classified as meets recommendations if they reported ≥150 minutes of moderate intensity leisure time aerobic physical activity per week, insufficiently active if they reported 1–149 minutes, and inactive if they reported 0 minutes. Reported vigorous intensity physical activity minutes were counted twice and added to moderate intensity physical activity minutes.
^§§§ Responded “yes” to, “The next questions refer to your joints. Please do NOT include the back or neck. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?”
^¶¶¶ Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you/does anyone in the family] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside this home?”
**** Responded “yes” to, “Because of a physical, mental, or emotional problem, [do you/any of these family members] need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?”
^†††† Psychological distress was classified as none/mild, moderate, or severe and measured by the Kessler-6 Scale. https://www.hcp.med.harvard.edu/ncs/k6_scales.php