Although regional and national data about arthritis can be used to develop synthetically derived measures of prevalence for states (1), few state surveys exist for determining the prevalence and impact of arthritis at that level. To measure state-specific prevalences, during 1991-1992 Arizona, Missouri, and Ohio added questions about arthritis to their Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report presents BRFSS-derived estimates of self-reported prevalence of clinically diagnosed arthritis in these states and characteristics of adults who reported this disorder.

The BRFSS is a state-based, random-digit-dialed telephone survey that collects self-reported data from a representative sample of civilian, noninstitutionalized persons aged greater than or equal to 18 years (2). BRFSS data were analyzed from 4688 persons who resided in Arizona (n=1847), Missouri (n=1509), and Ohio (n=1332). In Arizona, respondents were asked if they currently had some form of arthritis, gout, bursitis, tendonitis, or lupus and if they had been told this by a doctor. In Ohio, respondents were asked if they ever had been told by a doctor that they had any of those conditions. In Missouri, respondents were asked if they ever had been told by a health professional that they had arthritis. For the purpose of this report, persons who answered "yes" to any of these questions were considered to have arthritis. Respondents in Arizona and Ohio also were asked how often arthritis prevented them from performing work or participating in social activities.

Prevalence rates of arthritis were 20.5% in Arizona, 23.7% in Missouri, and 24.5% in Ohio (Table_1). Prevalence increased with age, and half of respondents aged greater than or equal to 75 years were affected. For example, in Missouri, 9.7% of persons aged 18-44 years reported having arthritis, compared with 58.4% of persons aged greater than or equal to 75 years. Age-adjusted prevalence rates were higher for whites, women, and overweight adults (men: body mass index {BMI} greater than or equal to 27.8; women: BMI greater than or equal to 27.3). Of persons who reported having arthritis, 47% in Arizona and 46% in Ohio reported limited activity. Activity limitations occurred every day or almost every day for 13% in Arizona and 14% in Ohio.

Reported by: TJ Flood, MD, J Contreras, PhD, Div of Disease Prevention, Arizona Dept of Health Svcs. J Jackson-Thompson, PhD, J Ronald, MS, RC Brownson, PhD, Div of Chronic Disease Prevention and Health Promotion, Missouri Dept of Health. E Capwell, PhD, Bur of Chronic Diseases, Ohio Dept of Health. Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis; Statistics Br and Aging Studies Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Although there are few comparable state surveys to verify the validity of these results, at least two observations can be made by comparing these findings with national results. First, the patterns of arthritis prevalence presented in this report within age and sex groups are consistent with those in national studies (3). Second, when prevalence estimates for self-reported arthritis from the 1989-1991 National Health Interview Survey (NHIS) for persons aged greater than or equal to 18 years are applied to the three state populations (after adjustment for region, age, sex, race, and Hispanic origin), the prevalences are lower than those in this report (Arizona, 19.8% versus 20.5%; Missouri, 19.9% versus 23.7%; and Ohio, 19.5% versus 24.5%). Possible reasons for these differences are that the surveys' or the respondents' definitions of arthritis differ across states or across surveys or because the BRFSS is more likely than the face-to-face interviews of the NHIS to result in overreporting. In addition, Ohio's and Missouri's BRFSS questions on arthritis asked about lifetime occurrence of arthritis, whereas the NHIS asked about the preceding 12 months.

Possible reasons for state-specific differences include sampling error; differences in demographic composition; or variation in the unmeasured demographic, occupational, or other characteristics of respondents. For example, some respondents may have moved to a state because they believed the climate and/or available services might improve their health. The variation may also reflect differences in the way the questions were asked; a standardized questionnaire would resolve this problem.

Data collected at the state level will help focus appropriate interventions and prevention measures (4). Such interventions should include state arthritis programs that make diagnostic, treatment, education, and rehabilitation services accessible to persons with arthritis (5) and that promote primary-prevention measures based on knowledge of risk factors, such as avoiding joint trauma, preventing obesity, and modifying occupationally related joint stress through ergonomic approaches (6). These services can reduce musculoskeletal damage, pain, and disability and substantially improve health (7).

States have used the BRFSS to measure the prevalence and impact of self-reported risk behaviors (e.g., smoking) and chronic diseases (e.g., diabetes and hypertension). The BRFSS questions about arthritis may have the same utility and can provide arthritis data about special populations (e.g., Hispanics and other minority groups) that may have different disease frequency than the general population. State health departments can use such data to develop a health plan for arthritis and to set arthritis-related health objectives (4,8,9).

References

1. CDC. Prevalence of arthritic conditions -- United States, 1987. MMWR 1990;39:99-102.

2. Siegel PZ, Waller MN, Frazier EL, Mariolis P. Behavioral Risk Factor Surveillance System: summary of data for 1991. In: CDC surveillance summaries (August). MMWR 1993;42(no. SS-4): 23-30.

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

4. US Committee for the Study of the Future of Public Health, Institute of Medicine. The future of public health. Washington, DC: National Academy Press, 1988.

5. CDC. Arthritis program -- Missouri. MMWR 1988;37:85-7.

6. Scott JC, Hochberg MC. Arthritis and other musculoskeletal diseases. In: Brownson RC, Remington PL, David JR, eds. Chronic disease epidemiology and control. Washington, DC: American Public Health Association, 1993:295-305.

7. Fries JF, Spitz PW. The hierarchy of patient outcomes. In: Spilken B, ed. Quality of life assessment for clinical trials. New York: Raven Press, 1990:25-35.

8. Sharp GC, Signsen BH, Hazelwood SE, Hall PJ, Oliver CL, Smith C. The Missouri Arthritis Program -- legislation, implementation, and funding a regional centers program. Mo Med 1988; 85:79-83.

9. CDC. Chronic disease prevention and control activities -- United States, 1989. MMWR 1991; 40:697-700.

Table_1
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Weighted number and percentage of persons aged >=18 years who have reported arthritis, by selected characteristics --
Ohio, 1991, and Arizona and Missouri, 1992
=====================================================================================================================================================================================
                                         Arizona                                                Ohio                                                Missouri
                    ---------------------------------------------------   ---------------------------------------------------   ---------------------------------------------------
                                                    Age-                                                  Age-                                                  Age-
                    Weighted                      adjusted                Weighted                      adjusted                Weighted                      adjusted
Characteristics       no. *   (%)   (95% CI +)  prevalence &  (95% CI)      no. *   (%)    (95% CI)   prevalence &  (95% CI)      no. *   (%)    (95% CI)   prevalence &  (95% CI)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Age (yrs)
  18-44               176     10.5  (+/- 2.4%)       --          --          567    12.5  (+/- 2.7%)       --          --         204      9.7   (+/-2.2%)       --          --
  45-64               192     30.3  (+/- 6.7%)       --          --          667    31.9  (+/- 5.7%)       --          --         329     32.8   (+/-4.9%)       --          --
  65-74               103     38.3  (+/- 9.0%)       --          --          530    53.8  (+/- 8.4%)       --          --         213     50.4   (+/-7.4%)       --          --
   >=75                99     52.0  (+/-10.2%)       --          --          194    49.2  (+/-10.8%)       --          --         153     58.4   (+/-9.4%)       --          --

Race
  White                 541   21.3  (+/- 2.7%)      21.3      (+/-2.6%)     1809    25.4  (+/- 2.7%)      24.3      (+/-2.6%)     825     24.4   (+/-2.4%)      22.4      (+/-2.1%)
  Other @                26   11.1  (+/- 7.1%)      12.7      (+/-6.9%)      158    17.8  (+/- 6.3%)      19.4      (+/-5.6%)      77     18.6   (+/-6.9%)      21.4      (+/-6.4%)

Sex
  Male                  232   17.5  (+/- 3.5%)      18.6      (+/-3.3%)      729    19.3  (+/- 3.5%)      19.0      (+/-3.3%)     303     16.9   (+/-2.9%)      17.0      (+/-2.8%)
  Female                339   23.2  (+/- 3.7%)      22.3      (+/-3.4%)     1237    29.3  (+/- 3.7%)      27.6      (+/-3.4%)     599     29.8   (+/-3.3%)      26.8      (+/-2.8%)

Body mass
  index
    Men
      >=27.8             47   19.2  (+/- 7.3%)      18.9      (+/-2.9%)      208    22.2  (+/- 7.4%)      23.7      (+/-5.6%)     126     23.5   (+/-6.1%)      23.8      (+/-5.1%)
       <27.8            180   17.1  (+/- 3.9%)      18.0      (+/-5.7%)      495    18.0  (+/- 3.9%)      18.0      (+/-3.7%)     177     14.4   (+/-3.3%)      15.1      (+/-3.3%)
    Women
      >=27.3             98   32.6  (+/- 9.2%)      32.7      (+/-6.9%)      417    41.5  (+/- 8.4%)      37.2      (+/-9.2%)     234     46.5   (+/-6.9%)      38.4      (+/-6.0%)
       <27.3            218   20.1  (+/- 3.9%)      19.0      (+/-3.5%)      738    25.0  (+/- 4.1%)      25.8      (+/-3.9%)     341     24.3   (+/-3.7%)      22.3      (+/-3.2%)

Education
  <=8th grade/
    Some high
    school              114   21.4  (+/- 5.1%)      20.8      (+/-4.7%)      415    37.6  (+/- 7.1%)      25.2      (+/-5.8%)     263     42.2   (+/-6.5%)      28.9      (+/-5.6%)
  High school
    graduate/
    GED **              142   19.6  (+/- 4.9%)      18.9      (+/-4.2%)      896    24.1  (+/- 3.7%)      22.4      (+/-3.4%)     311     22.0   (+/-3.5%)      21.1      (+/-3.0%)
  Some
    technical
    school/
    Some
    college             178   18.7  (+/- 4.1%)      20.6      (+/-4.2%)      364    20.6  (+/- 5.1%)      25.8      (+/-5.6%)     194     19.5   (+/-4.1%)      22.5      (+/-4.2%)
  College
    graduate/
    Post-
    graduate/
    Professional        137   24.0  (+/- 6.5%)      22.6      (+/-4.8%)      288    20.4  (+/- 5.7%)      23.1      (+/-6.2%)     133     17.3   (+/-4.5%)      22.1      (+/-5.5%)

Activity
  limitation
    Every day/
      Almost
      every day          76   13.3  (+/- 4.3%)      10.6      (+/-4.0%)      276    14.0  (+/- 3.5%)       9.0      (+/-2.5%)      --      --       --           --          --
    Once a week/
      Occasionally      190   33.3  (+/- 5.9%)      38.0      (+/-8.3%)      619    31.5  (+/- 5.5%)      34.4      (+/-7.8%)      --      --       --           --          --
    Never               298   52.1  (+/- 6.7%)      50.4      (+/-8.9%)     1011    51.4  (+/- 5.7%)      52.9      (+/-7.9%)      --      --       --           --          --

Total                   571   20.5  (+/- 2.5%)      20.8      (+/-2.4%)     1967    24.5  (+/- 2.5%)      23.7      (+/-2.4%)     902     23.7   (+/-2.4%)      22.3      (+/-1.9%)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 * In thousands. For Arizona, sample size=1847; for Ohio, sample size=1332; and for Missouri, sample size=1509.
 + Confidence interval=1.96 X standard error.
 & Standard population for age, adjustment was 1980 U.S. Census.
 @ Numbers for races other than white were too small for separate analysis.
** General Educational Development certificate.
=====================================================================================================================================================================================

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