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Public Health and Aging: Projected Prevalence of Self-Reported Arthritis
or Chronic Joint Symptoms Among Persons Aged
>65 Years --- United States, 2005--2030
Arthritis and other rheumatic conditions are among the most common chronic diseases, affecting 70 million U.S. adults in 2001 (1), and comprise the leading cause of disability among U.S. adults
(2). Arthritis prevalence increases with age,
affecting approximately 60% of the U.S. population aged
>65 years (1). As a result of better identification and treatment of other chronic diseases and lower mortality from infectious
diseases, U.S. adults are living longer, and the U.S. population is
aging (3). For this reason, the number of persons living with nonfatal but disabling conditions such as
arthritis or chronic joint symptoms (CJS) might be increasing. To estimate the projected future burden of arthritis or CJS among persons aged
>65 years, CDC applied data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) to projected
national population data for 2005--2030 and state population data for 2025. This
report summarizes the results of that analysis,
which indicate that if arthritis prevalence rates remain stable, the number of affected persons aged
>65 years will nearly double by 2030. Proven public health interventions should be applied and new interventions developed to improve function, decrease pain, and delay disability among persons with arthritis, particularly those at highest risk for functional impairment
and disability.
BRFSS is a state-based, random-digit--dialed telephone survey of the U.S. civilian, noninstitutionalized population
aged >18 years. BRFSS is administered in all 50 states, the District of Columbia, and three U.S. territories (Guam, Puerto
Rico, and the U.S. Virgin Islands) (4). The median response rate in 2001 was 51.1% (range: 33.4% [New Jersery]--81.5%
[Puerto Rico]). Respondents were classified as having CJS if they
answered "yes" to two questions: "In 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
a month?" Respondents were considered to have physician-diagnosed arthritis if they answered "yes" to the question, "Have
you ever been told by a doctor that you have arthritis?" Respondents reporting either CJS or
physician-diagnosed arthritis were classified as having arthritis or CJS. Respondents who did not know, were not sure, or refused to answer were classified as not having either condition. Sex-specific prevalence rates (males: 51.6%; females: 63.9%) for arthritis or CJS among persons
aged >65 years were multiplied by the sex-stratified U.S. Census projections of the population aged
>65 years (5) for a year and summed to produce national arthritis or CJS prevalence projections, which were reported in 5-year intervals for 2005--2030. State-specific prevalence projections also were calculated by applying 2001 BRFSS state prevalence rates to U.S.
Census projections for 2025, the latest year for which state-specific projected population estimates were available.
During 2005--2030, the percentage of the U.S. population aged
>65 years is expected to increase from 12.9% to
20.0% (Table 1). If sex-specific prevalence rates remain the same for this population, the number of persons aged
>65 years projected to have arthritis or CJS will nearly double, from 21.4 million in 2005 to 41.1 million in 2030. The percentage
of persons aged >65 years projected to have arthritis or CJS in 2025 varied by area (median: 56.5%; range: 34.8%
[Hawaii]--70.3% [Alabama]); in 11 states and Puerto Rico, approximately 60% of persons aged
>65 years will have arthritis or CJS by 2025 (Table 2).
Reported by: JM Hootman, PhD, CG Helmick, MD, G Langmaid, Div of Adult and Community Health, National Center for Chronic
Disease Prevention and Health Promotion, CDC.
Editorial Note:
The findings in this report indicate that by 2030, approximately 41 million persons aged
>65 years will have arthritis or CJS, with a median state-specific prevalence of 56.5% by 2025. Previous lower projections of arthritis cases by 2020 (6) were based on rates for persons of all ages and used a different case definition from the 1989--1991 National
Health Interview Survey. The broader BRFSS case definition includes persons with arthritis or those with CJS indicative of
arthritis whose condition might be undiagnosed.
The findings in this report are subject to at least five limitations. First, projected prevalence estimates were based on
rates calculated from self-reported data that were not confirmed by a physician. Second, BRFSS excludes military
personnel residing on bases, institutionalized populations, and persons without telephones. Third, the median response rate in
this survey (51.1%) was low; however, BRFSS demographics
mirror U.S. Census distributions. Fourth, the 2001 BRFSS
case definition might include some persons with acute, self-limiting musculoskeletal injuries rather than arthritis. To
improve sensitivity, the 2002 BRFSS questions were changed; studies validating these questions are under way. Finally, the projected estimates presented in this report might be conservative because the analysis assumed steady age- and
sex-specific rates of arthritis, and other factors affecting the prevalence of arthritis (e.g., therapy and the obesity epidemic) were not considered.
To help the large numbers of older adults manage their
arthritis or CJS, viable and affordable programs should be
available at the community level (7). CDC's Arthritis Program funds 36 state health departments to enhance public health activities
for arthritis. State programs disseminate evidence-based interventions, including the Arthritis Foundation's
PACE® (People with Arthritis Can Exercise) and aquatics programs, and self-management education classes such as the Arthritis Self-Help Course. These interventions have reduced the impact of arthritis or CJS by improving function and reducing pain and the need
for physician visits (8). Additional information about CDC-funded state arthritis programs and evidence-based interventions
is available at http://www.cdc.gov/nccdphp/arthritis.
The aging of the population is a critical issue facing the U.S. public health, medical, and economic systems
(3,9). Arthritis contributes substantially to disability, poor health-related quality of life, and increased direct and indirect medical
costs (3,10). Decreasing this impact will require effective public health interventions that improve function, decrease pain, and delay disability among persons with arthritis. Fewer than 1% of persons with arthritis who could benefit from
such interventions receive them (10). Specific interventions targeted toward persons with arthritis who are at highest risk for functional impairment and disability (e.g., persons who are overweight/obese or physically inactive) also should be developed.
Powell-Griner E, Anderson J, Murphy W. State- and sex-specific prevalence of selected characteristics---Behavioral Risk Factor Surveillance
System, 1994 and 1995. In: CDC surveillance summaries (August 1). MMWR 1997;46(No. SS-3).
Helmick CG, Lawrence RC, Pollard RA, Lloyd E, Heyse SP. Arthritis and other rheumatic conditions: who is affected now, who will be
later? Arthritis Care Res 1995;8:203--11.
Knickman J, Snell E. The 2030 problem: caring for aging baby boomers. Health Serv Res 2002;37:849--84.
Brady T, Kruger J, Helmick C, Callahan L, Boutaugh M. Intervention programs for arthritis and other rheumatic diseases. Health Educ
Behav 2003;30:44--63.
Buckwalter J, Heckman J, Petrie D. An AOA critical issue: aging of the North American population: new challenges for orthopedics.
J Bone Joint Surg 2003;85-A:748--58.
Arthritis Foundation, Association of State and Territorial Health
Officers, CDC. National Arthritis Action Plan: a public health
strategy. Atlanta, Georgia: Arthritis Foundation, 1999.
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Department of Health and Human Services. CDC is not responsible for the content
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the date of publication.
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