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Prevalence and Impact of Chronic Joint Symptoms -- Seven States, 1996Arthritis and other rheumatic conditions are the leading cause of disability in the United States (1), affecting 42.7 million persons and costing $65 billion in 1992 (2). These numbers will increase by 2020 as the population ages (3). Few surveys exist to directly determine the prevalence and impact of arthritis at the state level (4). To address this gap, in 1995 state health departments and CDC developed a standardized, optional arthritis module for the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of the analyses of 1996 data in seven states. The findings indicate that the prevalence and impact of "chronic joint symptoms" -- a proposed indicator for true arthritis and other rheumatic conditions -- is high and variable among states and that a large proportion of persons with arthritis diagnosed by a doctor do not know the type of arthritis they have. The BRFSS is an ongoing, state-based, random-digit-dialed telephone survey that collects self-reported health information from a representative sample of the civilian, noninstitutionalized U.S. population aged greater than or equal to 18 years (5). In 1996, a total of 15,656 persons in Arizona (n=1957), Kansas (n=2008), Missouri (n=1550), Montana (n=1803), New Jersey (n=2894), Pennsylvania (n=3595), and Rhode Island (n=1849) responded to the arthritis module. Persons who had chronic joint symptoms were defined as those answering "yes" to two questions: "During the past 12 months, have you had pain, aching, stiffness or swelling in or around a joint?" and "Were these symptoms present on most days for at least one month?" Persons who had activity limitation attributable to chronic joint symptoms were defined as those also answering "yes" to "Are you now limited in any way in any activities because of joint symptoms?" Persons were considered to have had arthritis diagnosed by a doctor if they answered "yes" to "Have you ever been told by a doctor that you have arthritis?" Persons who had arthritis diagnosed by a doctor were considered to know their type of arthritis if they specified a type in response to the question "What type of arthritis did the doctor say you have?" and were considered to have current doctor-based treatment for arthritis if they answered "yes" to "Are you currently being treated by a doctor for arthritis?" Weighted prevalence was used to estimate the number of persons with chronic joint symptoms in each state. Data were analyzed using SUDAAN{Registered} (6), and the results were weighted to account for the complex sample survey design. The prevalence of chronic joint symptoms ranged from 12.3% (using the weighted prevalence, an estimated 742,000 persons) in New Jersey to 22.7% (901,000 persons) in Missouri (Table_1). Population prevalences of self-reported activity limitation attributable to chronic joint symptoms ranged from 5.5% in New Jersey (304,000 persons) to 11.2% (72,000 persons) in Montana. Of persons who had chronic joint symptoms, 43.3% (Missouri) to 57.9% (Arizona) were limited in activity. Among persons who had chronic joint symptoms in the seven states, 55.7%-65.6% had arthritis diagnosed by a doctor. Among persons with arthritis diagnosed by a doctor, 30.5%-53.3% did not know their type of arthritis, and 43.0%-52.5% were being treated by a doctor for their arthritis. Within-state analyses indicated similar distributions of demographic and other variables. For example, in Pennsylvania, the prevalence of chronic joint symptoms increased markedly with age and was higher among women than men (Table_2). After adjustment for age and sex, prevalence was higher among non-Hispanic whites; among persons with fair or poor health status; and among persons who were overweight and physically inactive. The findings for persons who had activity limitation attributable to chronic joint symptoms showed similar patterns. Reported by the following BRFSS coordinators: B Bender, Arizona; M Perry, Kansas; F Ramsey, Montana; G Boeselager, MS, New Jersey; L Mann, Pennsylvania; T Breslosky, MPH, Rhode Island. E Ferraro, New Jersey Dept of Health and Senior Svcs. J Jackson-Thompson, PhD, Missouri Dept of Health. Health Care and Aging Studies Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: The findings in this report indicate that the prevalence of and activity limitation attributable to chronic joint symptoms are high and variable among the seven states. The approximately 40% of persons with chronic joint symptoms who had not been told by a doctor that they had arthritis presumably consists of the large proportion of persons who had not seen a doctor for a diagnosis (7), persons who had other chronic rheumatic conditions that were not classified clinically as arthritis (e.g., persons who had bursitis), and persons who used nontraditional medical practitioners that they would not classify as doctors. Because many persons with arthritis diagnosed by a doctor did not know their type of arthritis, they may be poorly educated about their disease and missing the documented benefits of self-management (e.g., an approximately 20% reduction in pain and a 40% reduction in the number of doctor visits) (8). The proportion of respondents with arthritis diagnosed by a doctor who were currently being treated by a doctor was low given the chronicity of arthritis and the benefits of doctor-based treatment (e.g., medications, physical therapy, and joint replacement surgery). The findings for Pennsylvania indicate much higher rates of chronic joint symptoms among persons with a fair or poor health status and risk behaviors of overweight and physical inactivity, suggesting that these persons are at higher risk for additional adverse health outcomes (e.g., heart disease and diabetes). The results presented in this report are subject to at least three limitations. First, BRFSS does not survey persons without telephones, persons in the military or institutions, or persons aged less than or equal to 18 years. Therefore, the numbers may underestimate the prevalence of chronic joint symptoms. Second, the validity of self-reported chronic joint symptoms is not known. The National Arthritis Data Workgroup has proposed that for self-reported data such as the BRFSS and the redesigned 1996 National Health Interview Survey (NHIS), chronic joint symptoms serve as a new indicator for a true diagnosis of arthritis and other rheumatic conditions. The patterns of chronic joint symptoms by demographic characteristics parallel those seen in analyses of a previous indicator of arthritis and other rheumatic conditions using earlier NHIS data (3), suggesting the usefulness of the new indicator. Finally, observed state-specific differences may reflect uncontrolled differences in population composition (e.g., age, sex, and race), socioeconomic status, or occupational and other characteristics. Additional analyses of these data are planned to examine the relations between chronic joint symptoms, arthritis diagnosed by a doctor, and activity limitations and other BRFSS measures (e.g., health-related quality of life and health promotion/ disease prevention behaviors). A public health response to this large and increasing problem requires action at the state level (9) to raise public awareness of the impact of chronic joint symptoms and the personal and public health opportunities to reduce the consequences (8). The arthritis BRFSS module can be used to gather state-level data directly about persons with chronic joint symptoms. States need direct measures of arthritis prevalence and impact rather than indirect estimates that may not account for variation from potentially confounding demographic, occupational, or other characteristics. Direct state-specific measures can help focus appropriate interventions (9) to help meet proposed national health objectives for arthritis for 2010. State health agencies, arthritis organizations, and other interested groups are drafting the National Arthritis Action Plan -- A Public Health Strategy under the sponsorship of CDC and the Arthritis Foundation. This publication, planned for release later this year, is intended to provide a comprehensive public health strategy for state health departments, the 60 Arthritis Foundation chapters, and others in the public health community to reduce the arthritis burden in the United States. References
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. Estimated numbers of persons affected by and prevalence of chronic joint symptoms *, activity limitation
attributable to chronic joint symptoms +, percentage of persons who had chronic joint symptoms who had arthritis diagnosed
by a doctor &, and percentage of persons who had arthritis diagnosed by a doctor but did not know their type of arthritis @
among persons aged >=18 years, by state -- seven states, Behavioral Risk Factor Surveillance System, 1996
==========================================================================================================================================
% persons who had % persons who had
chronic joint arthritis diagnosed by
Chronic joint symptoms Activity limitation symptoms who had a doctor but did not
---------------------------------- ------------------------------- arthritis diagnosed know their type
Estimated Prevalence Estimated Prevalence by a doctor of arthritis
no. ------------------- no. ----------------- -------------------- ----------------------
State (thousands) % (95% CI **) (thousands) % (95% CI) % (95% CI) % (95% CI)
--------------------------------------------------------------------------------------------------------------------------------------
Arizona 466 15.0 (+/-2.0) 270 8.7 (+/-1.5) 60.3 (+/-6.7) 30.5 (+/-7.8)
Kansas 352 18.6 (+/-1.8) 160 8.4 (+/-1.3) 59.3 (+/-5.4) 53.3 (+/-7.3)
Missouri 901 22.7 (+/-2.4) 390 9.8 (+/-1.7) 55.9 (+/-5.6) 52.9 (+/-7.3)
Montana 126 19.8 (+/-1.9) 72 11.2 (+/-1.5) 64.3 (+/-5.3) 51.0 (+/-6.8)
New Jersey 742 12.3 (+/-1.5) 338 5.5 (+/-0.9) 65.6 (+/-5.9) 32.6 (+/-7.4)
Pennsylvania 1424 15.4 (+/-1.3) 641 6.9 (+/-0.9) 65.3 (+/-4.5) 50.2 (+/-5.5)
Rhode Island 160 20.9 (+/-2.1) 71 9.3 (+/-1.5) 55.7 (+/-5.5) 46.1 (+/-7.5)
--------------------------------------------------------------------------------------------------------------------------------------
* Persons with chronic joint symptoms were defined as those answering "yes" to two questions: "During the past 12 months, have
you had pain, aching, stiffness or swelling in or around a joint?" and "Were these symptoms present on most days for at least one
month?" Prevalence was calculated for the 1996 civilian, noninstitutionalized population aged >= 18 years. The unweighted sample and
weighted population for the states, respectively, were as follows: Arizona, 1957 and 3,099,918; Kansas, 2008 and 1,896,121; Missouri,
1550 and 3,967885; Montana, 1803 and 638,449; New Jersey, 2894 and 5,569,056; Pennsylvania, 3595 and 9,248,879; and Rhode
Island, 1849 and 765,262.
+ Respondents who had chronic joint symptoms and answered "yes" to "Are you now limited in any way in any activities because of
joint symptoms?"
& Respondents who had chronic joint symptoms and answered "yes" to "Have you ever been told by a doctor that you have arthritis?"
@ Respondents who had chronic joint symptoms, had arthritis diagnosed by a doctor, and answered the question "What type of arthritis
did the doctor say you have?"
** Confidence interval.
==========================================================================================================================================
Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 2. Self-reported prevalence of and activity limitation attributable to chronic joint symptoms *, by selected
characteristics -- Pennsylvania, Behavioral Risk Factor Surveillance System, 1996
=====================================================================================================================================================
Activity limiation + attributable
Chronic joint symptoms to chronic joint symptoms
--------------------------------------------------- -------------------------------------------------------
Estimated Unadjusted Age-sex adjusted Estimated Unadjusted Age-sex adjusted
persons ------------------ ---------------- persons ------------------ -------------------
Characteristic (thousands) % (95% CI &) % (95% CI) (thousands) % (95% CI) % (95% CI)
---------------------------------------------------------------------------------------------------------------------------------------------------
Age group (yrs)
18-24 23 2.2 (+/-1.6) -- 6 0.6 (+/-0.7) --
25-34 136 7.9 (+/-2.5) -- 58 3.3 (+/-1.8) --
35-44 208 11.0 (+/-2.4) -- 100 5.3 (+/-1.7) --
45-54 189 13.2 (+/-3.2) -- 86 6.0 (+/-2.3) --
55-64 242 21.7 (+/-4.2) -- 117 10.5 (+/-3.1) --
65-74 419 31.8 (+/-4.4) -- 172 13.1 (+/-3.2) --
>=75 196 30.6 (+/-5.7) -- 103 16.1 (+/-4.7) --
18-64 799 11.0 (+/-1.3) -- 366 5.1 (+/-0.9) --
>=65 615 31.4 (+/-3.5) -- 275 14.0 (+/-2.6) --
Sex
Women 861 17.7 (+/-1.8) -- 417 8.5 (+/-1.3) --
Men 553 12.8 (+/-1.8) -- 224 5.2 (+/-1.2) --
Race/Ethnicity
White, non-Hispanic 1319 16.3 (+/-1.4) 16.1 (+/-1.4) 588 7.3 (+/-1.0) 7.2 (+/-1.0)
Black, non-Hispanic 51 7.6 (+/-2.9) 8.9 (+/-3.3) 25 3.7 (+/-1.9) 4.5 (+/-2.3)
Hispanic 25 10.2 (+/-6.5) 12.6 (+/-6.1) 16 6.3 (+/-5.6) 7.7 (+/-5.4)
Other @ 13 7.8 (+/-8.7) 10.3 (+/-3.2) 4 2.6 (+/-3.8) 3.6 (+/-3.1)
Education (yrs)
<=8 119 38.0 (+/-9.7) 23.2 (+/-7.9) 68 21.7 (+/-8.0) 16.3 (+/-7.5)
9-11 170 20.6 (+/-5.0) 19.0 (+/-4.9) 111 13.5 (+/-4.2) 12.7 (+/-4.1)
12 or equivalent 569 14.8 (+/-2.0) 14.4 (+/-1.9) 217 5.6 (+/-1.2) 5.5 (+/-1.2)
13-15 285 13.5 (+/-2.6) 15.3 (+/-2.8) 137 6.5 (+/-1.8) 7.2 (+/-1.9)
>=16 279 13.2 (+/-2.6) 14.8 (+/-2.7) 108 5.1 (+/-1.9) 5.6 (+/-1.9)
Annual household income
<$10,000 101 20.3 (+/-5.7) 19.1 (+/-5.3) 57 11.4 (+/-4.2) 10.0 (+/-3.6)
$10,000-$19,999 290 21.1 (+/-3.7) 19.6 (+/-4.9) 151 11.0 (+/-2.8) 9.9 (+/-2.9)
$20,000-$34,999 322 12.8 (+/-2.3) 12.6 (+/-2.2) 119 4.8 (+/-1.5) 4.8 (+/-1.5)
$35,000-$49,999 209 13.8 (+/-3.3) 17.0 (+/-4.3) 100 6.6 (+/-2.5) 8.7 (+/-3.5)
>$50,000 202 11.4 (+/-2.7) 14.3 (+/-3.7) 68 3.9 (+/-1.5) 5.7 (+/-3.1)
General health status
Excellent, 936 11.9 (+/-1.3) 12.6 (+/-1.3) 327 4.1 (+/-0.8) 4.4 (+/-0.8)
Very good, or Good
Fair or Poor 481 36.2 (+/-4.8) 29.6 (+/-4.9) 307 23.1 (+/-4.1) 20.1 (+/-4.7)
Overweight **
Yes 551 19.7 (+/-2.7) 18.6 (+/-2.3) 263 9.4 (+/-1.9) 9.0 (+/-1.8)
No 812 13.5 (+/-1.5) 13.8 (+/-1.5) 341 5.7 (+/-1.0) 5.8 (+/-1.0)
Leisure-time physical
activity
Inactive 521 21.4 (+/-2.9) 18.3 (+/-2.4) 278 11.4 (+/-2.3) 9.6 (+/-1.9)
Irregular, not sustained 447 15.1 (+/-2.3) 15.3 (+/-2.2) 196 6.7 (+/-1.5) 6.9 (+/-1.6)
Regular, not intensive 295 11.0 (+/-2.0) 12.6 (+/-2.2) 114 4.2 (+/-1.3) 4.6 (+/-1.4)
Regular, intensive 161 13.8 (+/-3.6) 13.3 (+/-3.6) 53 4.6 (+/-2.3) 4.5 (+/-2.3)
Overall 1414 15.4 (+/-1.3) -- 641 6.9 (+/-0.9) --
---------------------------------------------------------------------------------------------------------------------------------------------------
* Persons who had chronic joint symptoms were defined as those answering "yes" to two questions: "During the past 12 months,
have you had pain, aching, stiffness or swelling in or around a joint?" and "Were these symptoms present on most days for at least
one month?" Prevalence was calculated for the 1996 civilian, noninstitutionalized population aged >= 18 years. Age-sex adjusted
prevalence was standardized to the 1996 Pennsylvania population aged >= 18 years using the age categories in the table. The unweighted
sample was 3595; the weighted population was 9,248,879. Numbers and percentages do not always add up because of missing
responses and rounding.
+ Respondents who had chronic joint symptoms and answered "yes" to "Are you now limited in any way in any activities because of
joint symptoms?"
& Confidence interval.
@ Differences for races other than whites and blacks were too small for meaningful analysis.
** Overweight was defined as body mass index >= 27.8 for men and >= 27.3 for women.
=====================================================================================================================================================
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