Arthritis Program Health Disparities Activities

Addressing health disparities is a central focus of the strategic plans for both the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), as well as Healthy People 2010 and the National Arthritis Action Plan: A Public Health Strategy. In keeping with this aim the CDC Arthritis Program analyzes survey data to determine racial/ethnic and gender differences associated with arthritis prevalence, incidence, risk factors, and limitations. The Arthritis Program is engaged in extensive audience research, which involves systematic research and message-testing among diverse subgroups (racial/ethnic, socioeconomic, geographic, gender, age, disability status, risk status) of adults with arthritis to determine optimal messaging when promoting physical activity and self-management education.

• Epidemiology/Research Activities
• Programmatic Activities

Epidemiology/Research Activities

Arthritis Conditions Health Effects Survey (ACHES)

The Arthritis Conditions Health Effects Survey (ACHES) was developed and funded by theCDC Arthritis Program. ACHES is an arthritis-specific nationally representative, random-digit-dialed telephone survey that collected information from 2,238 persons with arthritis or chronic joint symptoms ages 45 years or older between June 2005 and March 2006. The survey design included oversampling of Hispanics and Non-Hispanic blacks to allow more precise estimates to be generated for these two vulnerable population groups. Data were gathered for symptoms, limitations, levels of physical functioning, effects of arthritis on work, knowledge and attitudes about arthritis, self-management of arthritis, physical activity, anxiety and depression, and demographics. ACHES analyses are ongoing and have already identified substantial unmet need in current arthritis treatment which would be decreased by wider availability and uptake of evidence-based arthritis self-management education and physical activity programs.

Racial/Ethnic differences for the prevalence and impact of doctor-diagnosed arthritis

Arthritis is a large and growing problem for U.S. adults of all racial/ethnic groups, but the disabling effects of arthritis (e.g., arthritis-attributable activity limitations, work limitations, and severe pain) are disproportionately prevalent in racial/ethnic minorities. CDC is currently analyzing multiple years of data to get the first ever prevalence estimates for Native Americans, Hispanic subgroups and Asian American. Results should be available in 2009...more

State-specific prevalence data

State-level data broken down by race/ethnicity and gender is provided to state health departments and partners.

The Johnston County Osteoarthritis Project: Arthritis & Disability

The Johnston County Osteoarthritis Project (JCOP) is a unique, community-based, longitudinal study of approximately 3,200 white and black residents aged 45 years or older from a transitioning rural-to-urban area of North Carolina. The study is designed to determine the risk factors associated with the prevalence, incidence, and progression of hip and knee osteoarthritis (OA)—the two most common and disabling types of arthritis. JCOP data was used in a recent CDC study reporting that a person’s lifetime risk for developing symptomatic knee osteoarthritis (OA) is nearly one in two, or 46%. The study authors also found that nearly 2 of 3 obese adults will develop painful knee osteoarthritis during their lifetime. Results from JCOP have and will continue to be instrumental in quantifying racial/ethnic disparities related to hip and knee OA.

Lupus Registries

This project develops two population-based registries to better define and monitor the incidence and prevalence of systemic lupus erythematosus and better characterize individuals with this rheumatic condition. Lupus Registries are working to document the incidence and prevalence of lupus among whites and blacks. Documentation efforts will be expanding to Hispanic, Asian American, American Indian and Alaskan Natives populations. Read more.

Use of Complementary Therapies Among Hispanic and Non-Hispanic White Adults with Arthritis

The use of complementary and alternative therapies (CAM) use is reported to be high among people with arthritis, but little information has been available on the use of CAM by Hispanic ethnicity. CDC funded a study to assess the use of CAM among predominantly urban Hispanic and non-Hispanic adults with doctor-diagnosed rheumatoid arthritis (RA), osteoarthritis (OA), or fibromyalgia. There were 612 adults with arthritis, who saw physicians in primary care clinics associated with the University of New Mexico and were interviewed to determine their use of CAM; of those interviewed, 45% were Hispanic and 71% were female. Read more

Total Knee Replacements (TKR) and Race

Although whites and blacks have a comparable lifetime risk of symptomatic knee osteoarthritis (OA), blacks are less likely to undergo total knee replacements (TKR). TKRs are an important surgical intervention in reducing joint pain and restoring physical function in people with knee OA. Recognizing the substantial impact of TKR for reducing disability among people with painful knee osteoarthritis, the Healthy People 2010 working group adopted objective 2.6. "Eliminate racial disparities in the rate of total knee replacements among persons aged 65 years or older." We are generating race-specific TKR rates among US adults age ≥65 years using 2000 to 2006 Medicare claims data and determining whether the racial disparity in TKRs observed in 2000 has declined. Current baseline data quantifies and illustrates existing disparities in this area.

Programmatic Activities

Tomando Control de su Salud (Spanish Chronic Disease Self-Management Program (CDSMP))

Tomando Control de su Salud is a self-management education program developed for Spanish-speaking adults with a variety of chronic health problems. Workshops for this program are given once a week for two and a half hours, for a six week period, in a community setting. Each session is facilitated by two trained leaders, one or both of whom are non-health professionals with a chronic diseases themselves. All workshops are given in Spanish without translators. This program is similar in content and process to the English language version of the Chronic Disease Self-Management Program, but Tomando Control de su Salud was developed in Spanish to address health topics and concerns in a culturally appropriate manner. Topics covered in the program include appropriate use of the health care system, how to evaluate new treatments, communicating effectively with family, friends, and health professionals, healthy eating, appropriate use of medications, techniques to deal with problems, and appropriate exercises for maintaining and improving strength, flexibility, and endurance. A similar self management arthritis program* is also available.

Buenos Días, Artritis

This health communications campaign designed to reach Spanish-speaking adults with arthritis between the ages of 45–64, whose annual income is $35,000 or less. This campaign is targeted primarily to persons within the audience whose symptoms have advanced to the point where arthritis is perceived as interfering with one or more life activities, such as work or family commitments. The campaign is designed to do the following:

• Raise awareness of exercise as a way to manage arthritis pain and increase mobility.
• Increase understanding of how to use exercise (which types and for how long/duration) to ease arthritis symptoms and prevent further disability.
• Enhance the confidence or belief of persons with arthritis that they can engage in moderate exercise.
• Increase trial of moderate exercise behaviors.

Partnership with the AME church

The African Methodist Episcopal (AME) Church of South Carolina has 619 congregations and some active 253,792 members. There are 6,728 congregations and 2,511,578 members across the United States. The AME Church has the potential to reach members in remote areas and provide education and activities to enhance the quality of life for persons with arthritis.

The CDC Arthritis Program and The Palmetto Annual Conference, 7th Episcopal District, which includes Charleston, South Carolina and surrounding areas, are working together with the South Carolina Health Department and Environmental Control to incorporate a physical activity intervention (EnhanceFitness) into health programs of their churches in underserved communities. More information about the AME Church http://www.ame-church.com

State funded programs

State programs use data to focus interventions in areas with the greatest need, often partnering with organizations supporting underserved populations. State arthritis programs have previously focused on building capacity to disseminate and deliver evidence-based interventions. The current funding cycle builds on lessons learned from these activities, with a new emphasis to embed arthritis interventions in existing systems and expand their use.

State Health Department Arthritis Programs use CDC funding to strengthen partnerships with state Arthritis Foundation chapters and others, increase public awareness, improve their ability to monitor the burden of arthritis, coordinate activities, and increase the availability of interventions. The central aim is to improve the quality of life among persons affected by arthritis. One of the most important activities for states is to increase awareness of arthritis management options and to promote self-management education and physical activity.

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