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Prevalence and Impact of Chronic Joint Symptoms

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By Center for Disease Control • www.ProHealth.com • January 13, 2000


SUMMARY: Results from a seven-state study conducted by the Centers for Disease Control.

ABSTRACT: Arthritis 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. 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. 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 Note
Editorial 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
1. CDC. Prevalence of disabilities and associated health conditions -- United States, 1991-1992. MMWR 1994;43:730-1,737-9.
2. Yelin E, Callahan LF. The economic cost and social and psychological impact of musculoskeletal conditions. Arthritis Rheum 1995;38:1351-62.
3. CDC. Arthritis prevalence and activity limitations -- United States, 1990. MMWR 1994;43:433-8.
4. CDC. Prevalence of arthritis -- Arizona, Missouri, and Ohio, 1991-1992. MMWR 1994;43:305-9.
5. CDC. Health risks in America: gaining insight from the Behavioral Risk Factor Surveillance System. Revised edition. Atlanta, Georgia: US Department of Health and Human Services, CDC, 1997.
6. Shah BV. SUDAAN user's manual, release 6.0. Research Triangle Park, North Carolina: Research Triangle Institute, 1992.
7. Rao JK, Callahan LF, Helmick CG III. Characteristics of persons with self-reported arthritis and other rheumatic conditions who do not see a doctor. J Rheumatol 1997;24:169-73.
8. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993;36:439-46.
9. Institute of Medicine, US Committee for the Study of the Future of Public Health. The future of public health. Washington, DC: National Academy Press, 1988.

Source: Center for Disease Control



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