Arthritis is the most common cause of disability among U.S. adults and is particularly
common among persons with multiple chronic conditions (1). In 2003, arthritis in the
United States resulted in an estimated $128 billion in medical-care costs and lost
earnings (2). To update previous U.S. estimates (3) of the prevalence of doctor-diagnosed
arthritis and arthritis-attributable activity limitation (AAAL), CDC analyzed 2010–2012
data from the National Health Interview Survey (NHIS). This report summarizes the
results of that analysis, which found that 52.5 million (22.7%) of adults aged ≥18
years had self-reported doctor-diagnosed arthritis, and 22.7 million (9.8%, or 43.2%
of those with arthritis) reported AAAL, matching and exceeding previous projected
increases, respectively (4). Among persons with heart disease, diabetes, and obesity,
the prevalences of doctor-diagnosed arthritis were 49.0%, 47.3%, and 31.2%, respectively;
the prevalences of AAAL among persons with these specific conditions were 26.8%, 25.7%,
and 15.2%, respectively. Greater use of evidence-based interventions, such as chronic
disease self-management education and physical activity interventions that have been
proven to reduce pain and improve quality-of-life among adults with chronic diseases
might help reduce the personal and societal burden of arthritis.
NHIS is an annual, nationally representative, in-person interview survey of the health
status and behaviors of the non-institutionalized civilian U.S. population. In each
household identified, one adult was randomly selected to complete the “sample adult”
questionnaire.* Participants were categorized into five racial/ethnic groups: Hispanic,
white, black, Asian, and other race. Persons identified as Hispanic might be of any
race. Persons identified as white, black, Asian, or other race all were non-Hispanic.
Sampling weights were applied to account for household nonresponse and oversampling
of blacks, Hispanics, and Asians. Poststratification adjustments were applied by NCHS
using 2000 U.S. Census estimates for the years 2010–2011, and 2010 U.S. Census estimates
for 2012. For this analysis, NHIS data from 2010, 2011, and 2012 were combined, and
annualized prevalence estimates were calculated overall and stratified by selected
characteristics (i.e., sex, age group, race/ethnicity, education level, employment
status, body mass index (BMI) category,† physical activity level,§ self-rated health,
doctor-diagnosed heart disease,¶ and doctor-diagnosed diabetes). Unweighted sample
sizes and final response rates were 27,157 (60.8%) in 2010, 33,014 (66.3%) in 2011;
and 34,525 (61.2%) in 2012.
Adults were defined as having doctor-diagnosed arthritis if they answered “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?” Those who
responded “yes” 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” to both
questions were categorized as having AAAL. Prevalence of AAAL was estimated for the
overall adult U.S. population and for adults with arthritis.
All analyses were weighted to account for the complex multistage sampling design.
Unadjusted prevalence estimates for arthritis and AAAL describe the absolute population
burden. Age-adjusted prevalence estimates (standardized to the projected 2000 U.S.
standard population) describe relative population burden among various analytic subgroups.
For all comparisons, differences were considered statistically significant if the
95% confidence intervals of the age-adjusted estimates did not overlap.
An estimated 22.7% (52.5 million) of U.S. adults reported doctor-diagnosed arthritis,
including 49.7% of adults aged ≥65 years. High arthritis prevalence was observed among
adults with heart disease (49.0%) and diabetes (47.3%). In age-adjusted analyses,
arthritis prevalence was significantly higher among women than men, among whites and
blacks compared with Hispanics and Asians, among those with less education, those
who were obese or overweight, and those not meeting physical activity recommendations.
Arthritis prevalence (age-adjusted) also was higher among those who were unable to
work or were disabled (29.0%) compared with those who were employed (20.9%), and higher
among those with self-reported fair or poor health (40.7%) compared with those reporting
excellent or very good health (15.8%) (Table).
Among adults with doctor-diagnosed arthritis, the unadjusted overall prevalence of
AAAL was 43.2% (22.7 million persons or 9.8% of the overall population). The highest
AAAL prevalence among adults with arthritis was for those who reported fair or poor
health (71.8%), were unable to work or disabled (61.4%), were physically inactive
(56.5%), had less than a high school diploma (55.4%), had heart disease (54.6%), or
had diabetes (54.4%). These patterns persisted after age-adjustment. Age-adjusted
AAAL prevalence among adults with doctor-diagnosed arthritis was higher for Hispanics
compared with whites, even though Hispanics’ age-adjusted prevalence of arthritis
in the general population was lower, suggesting greater average severity of arthritis
among Hispanics (Table).
In unadjusted analyses, adults with heart disease (11.5%) and diabetes (9.0%), 49.0%
and 47.3% had arthritis, respectively, and more than a quarter for each condition
had AAAL. Among obese adults (28.2%), 31.2% had arthritis and 15.2% had AAAL (Table).
What is already known on this topic?
Arthritis is the most common cause of disability among U.S. adults, resulting in annual
costs estimated at $128 billion in 2003, and is particularly common among persons
with multiple chronic conditions.
What is added by this report?
During 2010–2012, an estimated 22.7% of adults had self-reported doctor-diagnosed
arthritis, and 43.2% of those with arthritis reported arthritis-attributable activity
limitations (AAAL). Approximately half of all adults with heart disease or diabetes
had arthritis, and one fourth of adults with either condition and arthritis had AAAL.
Approximately one third of adults who were obese also had arthritis, and 15% of those
adults had AAAL.
What are the implications for public health practice?
Health-care providers and public health practitioners can address both arthritis and
other chronic conditions by prioritizing self-management education and appropriate
physical activity as effective ways to improve health outcomes (e.g., reducing pain
and increasing function and quality-of-life).
Editorial Note
During 2010–2012, an estimated 52.5 million (22.7%) of adults in the United States
reported doctor-diagnosed arthritis, and 22.7 million (9.8%) reported AAAL (43.2%
of those with arthritis). These estimates represent net increases of 0.87 million
adults with arthritis per year and 0.53 million adults with AAAL per year since the
2007–2009 estimates of 49.9 million with arthritis and 21.1 million with AAAL (3).
These increases can be attributed, in part, to the aging of the U.S. population. The
arthritis estimate is consistent with an earlier projection and suggests that projections
of 55.7 million adults with arthritis by 2015 and 67 million by 2030 (4) are reasonable.
For AAAL, the estimate exceeds the earlier projection of 22 million adults with AAAL
by 2020 and, therefore, might exceed the 25 million projected for 2030 (4).
Arthritis and AAAL create a substantial personal and societal burden in the United
States. Arthritis and AAAL prevalences were greater in the same age, sex, race/ethnicity,
and education subgroups as seen previously (3), and exceptionally high among those
who were unable to work or were disabled and those with fair or poor health, even
when adjusted for age. About half of all adults with heart disease or diabetes had
arthritis, and more than a quarter of adults with either condition and arthritis had
AAAL; almost one third of adults who were obese also had arthritis, and more than
15% of these adults had AAAL. The high prevalence of arthritis among adults with these
conditions in the general population is consistent with the results of a previous
study on co-occurrence of chronic diseases among adults aged ≥25 years who participated
in NHIS, in which arthritis was among the most common comorbidities (5). The negative
effects of combinations of arthritis and other chronic conditions are suggested by
the AAAL findings in this analysis, along with studies identifying arthritis as associated
with greater physical inactivity for adults with multiple chronic conditions (6–8).
The findings in this report are subject to at least four limitations. First, doctor-diagnosed
arthritis was self-reported and not confirmed by a health-care professional; however,
this case definition has been shown to be sufficiently sensitive for public health
surveillance (9). Second, because NHIS is a cross-sectional survey, a causal relationship
between risk factors (i.e., obesity or physical activity) and arthritis and AAAL could
not be established. Nonetheless, obesity is a factor that increases risk for osteoarthritis;
a prospective study with 10 years of follow-up found that obese adults were more than
twice as likely to develop knee and hand osteoarthritis (10). Third, social desirability
bias might play a role in some self-report characteristics, with underreporting of
weight, overreporting of height, and overreporting of leisure-time physical activity.
Finally, because response rates ranged from 60.8% to 66.3% the findings might be subject
to selection bias, although the application of sampling weights is expected to considerably
reduce nonresponse bias.
A current U.S. Department of Health and Human Service initiative** addresses the burden
of multiple chronic conditions, which now affect one in four adults and are increasingly
common with the aging of the population. The findings in this report indicate that
arthritis commonly co-occurs with obesity as well as heart disease and diabetes, and
that high prevalence of AAAL is found among adults with both arthritis and one of
these chronic conditions. CDC is promoting greater coordination with state health
departments to address these chronic disease comorbidity concerns.†† An opportunity
for collaboration is the dissemination of information regarding evidence-based self-management
education and physical activity interventions§§ that have been proven to reduce pain
and improve function, mood, confidence to manage health, and quality of life. The
physical activity interventions recommended are appropriate exercise regimens intended
to reduce activity limitations among adults with arthritis and assuage concerns over
aggravating the condition.¶¶ CDC currently funds arthritis programs in 12 states to
disseminate information and implement programs in local communities.*** Given the
high prevalence of arthritis and AAAL among adults with certain chronic conditions
and the arthritis-specific barriers to activity (6–8), health-care providers and public
health practitioners can address both arthritis and these other chronic conditions
by prioritizing self-management education and appropriate physical activity as an
effective way to improve health outcomes.