Prevalence of Diagnosed Arthritis — United States, 2019–2021

Abstract

Arthritis includes approximately 100 conditions that affect the joints and surrounding tissues. It is a leading cause of activity limitations, disability, and chronic pain, and is associated with dispensed opioid prescriptions, substantially contributing to health care costs. Combined 2019–2021 National Health Interview Survey data were analyzed to update national prevalence estimates of self-reported diagnosed arthritis. An estimated 21.2% (18.7% age-standardized) of U.S. adults aged ≥18 years (53.2 million) had diagnosed arthritis during this time frame. Age-standardized arthritis prevalences were higher among women (20.9%) than men (16.3%), among veterans (24.2%) than nonveterans (18.5%), and among non-Hispanic White (20.1%) than among Hispanic or Latino (14.7%) or non-Hispanic Asian adults (10.3%). Adults aged ≥45 years represent 88.3% of all U.S. adults with arthritis. Unadjusted arthritis prevalence was high among adults with chronic obstructive pulmonary disease (COPD) (57.6%), dementia (55.9%), a disability (54.8%), stroke (52.6%), heart disease (51.5%), diabetes (43.1%), or cancer (43.1%). Approximately one half of adults aged ≥65 years with COPD, dementia, stroke, heart disease, diabetes, or cancer also had a diagnosis of arthritis. These prevalence estimates can be used to guide public health policies and activities to increase equitable access to physical activity opportunities within the built environment and other arthritis-appropriate, evidence-based interventions.

Introduction

Arthritis includes approximately 100 conditions that affect the joints and surrounding tissues. If not managed properly, arthritis can result in severe pain, activity limitations, and disability (1–3). Adults with arthritis have disproportionate rates of anxiety and depression and received 55.3% of all-cause prescription opioids dispensed in the United States in 2015 (4,5). Thus, arthritis is a significant driver of lost wages, disability, and medical costs (3,6). Updated arthritis prevalence estimates can help identify disproportionately affected groups, monitor arthritis prevalence over time, and guide resource allocation.

Methods

The National Health Interview Survey (NHIS) is an annual, nationally representative household survey of the noninstitutionalized U.S. civilian population.* One adult in a household is randomly selected to complete the in-home interview. When necessary, telephone follow-up is permitted to complete the interview.^† If the selected person is physically or mentally unable to answer the survey, a knowledgeable proxy can answer on behalf of the selected person. During April–June 2020, the COVID-19 pandemic necessitated a change to telephone-only data collection. During July 2020–April 2021, interviews were attempted by telephone first, with in-home follow-up to complete data collection. In May 2021, data collection returned to prepandemic procedures.^§

NHIS sample sizes and response rates for 2019, 2020, and 2021 were 31,997 (59.1%), 21,153 (48.9%), and 29,482 (50.9%), respectively.^¶ A person was identified as having arthritis if he or she responded “yes” to the question, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” Survey respondents answering “yes” or “no” to this item were included in the analytic sample (82,503; 99.8% of survey respondents). Data were weighted to account for complex survey design, selection probability, and nonresponse. Unadjusted and age-standardized** arthritis prevalence estimates for adults aged ≥18 years were calculated overall and by selected self-reported demographic and health characteristics. Subgroup prevalences were compared with a reference group using t-tests; all differences are significant at α = 0.05. Analyses were conducted in SAS (version 9.4; SAS Institute) and SUDAAN (version 11.0; RTI International). This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.^††

Results

Approximately 53.2 million (95% CI = 52.1–54.4) or 21.2% (18.7% age-standardized) of U.S. adults aged ≥18 years had diagnosed arthritis (Table 1). Age-standardized prevalence was higher among women (20.9%) than men (16.3%) and among veterans (24.2%) than nonveterans (18.5%). Age-standardized prevalence was higher among non-Hispanic White (20.1%) than among Hispanic or Latino (14.7%) or non-Hispanic Asian adults (10.3%). There was no difference between non-Hispanic White and non-Hispanic Black or African American adults (19.7%), or non-Hispanic American Indian or Alaska Native adults (21.0%). The unadjusted prevalence of arthritis among U.S. adults with a disability was 54.8% (12.3 million); after adjusting for age, prevalence was higher among adults with a disability (40.5%) than among those without a disability (16.6%).

Adults aged ≥45 years represent 88.3% of all U.S. adults with arthritis. Nearly one half of adults with arthritis (48.3%; 25.7 million) were aged ≥65 years, and 40.0% (21.3 million) were aged 45–64 years. Age-standardized prevalence of arthritis was higher among adults with dementia (47.8%),^§§ chronic obstructive pulmonary disease (COPD) (43.5%), stroke (39.0%), heart disease (36.3%), diabetes (28.8%), or cancer (27.7%), than among adults without these chronic conditions (Table 1). The U.S. arthritis prevalence was substantial among adults with COPD (57.6%; 6.8 million), dementia (55.9%; 1.4 million), stroke (52.6%; 3.7 million), heart disease (51.5%; 8.2 million), diabetes (43.1%; 10.2 million), or cancer (43.1%; 8.3 million). Among adults aged ≥65 years, approximately one half of those with COPD (62.4%), stroke (57.9%), heart disease (57.4%), obesity (body mass index ≥30 kg/m²; 56.8%), dementia (56.1%), diabetes (54.0%), or cancer (52.2%) also had diagnosed arthritis (Table 2) (Figure).

Discussion

During 2019–2021, 53.2 million (21.2%) U.S. adults aged ≥18 years had diagnosed arthritis. Approximately one half of adults aged ≥65 years with a chronic disease also reported diagnosed arthritis. Consistent with previous NHIS (1) and Behavioral Risk Factor Surveillance System data (7), arthritis prevalence was higher among women than men, among adults aged 45–64 and ≥65 years than among those aged 18–44 years, among veterans than among nonveterans, among persons with a disability than among those without a disability, and among persons reporting a comorbid chronic condition than among those without such a condition.

The 2019–2021 NHIS prevalence estimate is lower than the 2016–2018 NHIS prevalence estimate (58.5 million; 23.7%) (1). The NHIS survey was redesigned in 2019 (8), resulting in reordering and eliminating some arthritis-relevant questions, which might have led to differences in respondents’ ability to recall an arthritis diagnosis. Therefore, estimates produced by NHIS before 2019 should not be statistically compared with NHIS estimates after 2019, but instead interpreted as independent estimates obtained from different survey methodologies. This study establishes a new baseline for monitoring NHIS arthritis prevalence estimates, beginning with the combined 2019–2021 data. These estimates can be used to guide public health activities, policies, and resource allocation for improving arthritis-attributable health outcomes and associated health care costs.

Limitations

The findings in this report are subject to at least five limitations. First, because of the cross-sectional nature of NHIS, causality among selected characteristics and arthritis diagnosis cannot be inferred. Second, arthritis diagnosis was self-reported and was not validated by medical record review. Third, social desirability, recall, and proxy response biases might lead to over- or underestimation of arthritis prevalence. Fourth, the single survey item assessing diagnosed arthritis does not capture undiagnosed arthritis or allow prevalence estimates to be calculated for arthritis subtypes. Finally, although annual prevalence estimates of arthritis were similar during 2019–2021, the COVID-19 pandemic necessitated changes in data collection methods and might have altered U.S. adult health care use and potentially affected estimates of diagnosed arthritis.

Implications for Public Health Practice

Physical activity is important for managing arthritis-attributable pain and improving physical function (9). Many adults, including those with arthritis, do not meet the 2018 Physical Guidelines for Americans recommendations for physical activity despite its known benefits^¶¶; these recommendations include engaging in 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity activity per week or an equivalent combination, as well as ≥2 days of strength training per week. The guidelines also recommend that adults aged ≥65 years do multicomponent physical activity that includes balance training and aerobic and muscle strengthening activities. When an older adult or adult with arthritis cannot meet these recommendations because of health conditions, they need to be as physically active as their health and abilities allow.***

Maintaining a healthy weight, engaging in sufficient physical activity, and avoiding joint injury are important for prevention. The CDC Arthritis Management and Wellbeing Program recognizes community-based, arthritis-appropriate, evidence-based interventions (AAEBIs)^††† to increase physical activity and chronic disease self-management among adults with arthritis. A recommendation from a health care provider can increase the likelihood that adults with arthritis attend education programs and engage in physical activity (10). CDC funds national and state organizations^§§§ to increase the availability of AAEBIs in the community, as well as to increase awareness among health care providers and health systems about the need to screen adults with arthritis for physical activity and facilitate the use of appropriate tools for physical activity screening, counseling, and referral to AAEBIs, with emphasis on reaching populations and communities with high prevalences of arthritis. Increasing equitable access to physical activity opportunities within the built environment and across settings (e.g., worksites, community organizations, and home), implementing AAEBIs as independent interventions or in combination with other chronic disease management programs (e.g., Diabetes Prevention Program), and adopting health care systems policies and actions facilitating health care provider screening, counseling, and referrals or linkages, are public health priorities to address arthritis and arthritis-attributable health outcomes.