Arthritis, Severe Joint Pain and Inactivity by State, 2017

An estimated 54.4 million U.S. adults — about one in four — have arthritis diagnosed by a doctor. Severe joint pain and physical inactivity are common among them and are tied to poorer mental and physical health and to limitations in daily life. Using the 2017 Behavioral Risk Factor Surveillance System (BRFSS), CDC estimated, state by state, how common arthritis is and, among adults with arthritis, how many have severe joint pain or get no physical activity.

The survey

BRFSS is an ongoing telephone survey (landline and cell) of adults living in the community, run by state and territorial health departments. In 2017 the median state response rate was 45.9% (range 30.6%–64.1%). Of 435,331 adults who reported their arthritis status and age, 144,099 had arthritis, defined as having been told by a health professional they had arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia.

• Joint pain was rated from 0 to 10 for the past 30 days: 0–3 counted as none or mild, 4–6 as moderate, 7–10 as severe.
• Physical inactivity meant answering no to whether, outside of work, the person had done any physical activity or exercise in the past month, such as running, calisthenics, golf, gardening or walking.

Estimates were age-standardized to the 2000 projected U.S. adult population.

Who has arthritis

• Arthritis rose with age, from 8.1% of adults aged 18–44 to 50.4% of those 65 and older.
• It was more common in women (25.4%) than men (19.1%), and among American Indian/Alaska Native adults (29.7%) than other groups (12.8%–25.5%); it was less common among Hispanic and Asian adults.
• It affected 51.3% of people unable to work or disabled, compared with 34.3% of retirees, 26.0% of the unemployed and 17.7% of the employed.
• It rose with body weight, from 17.9% among people of healthy weight or underweight to 30.4% among people with obesity; it was more common with less education and lower income, and in more rural areas.

Severe joint pain

Among adults with arthritis, 36.2% reported no or mild joint pain, 33.0% moderate and 30.8% severe. Severe pain declined with age, from 33.0% at 18–44 to 25.1% at 65 and older. It reached 40% or more among people unable to work or disabled (66.9%), without a high school diploma (54.1%), living at or below 125% of the federal poverty level (51.6%), Black adults (50.9%), retirees (45.8%), Hispanic adults (42.0%), American Indian/Alaska Native adults (42.0%), and lesbian, gay, bisexual, queer or questioning adults (40.7%, in 27 states). It was similar across urban and rural areas (32.7%–35.7%) except large fringe metropolitan areas (28.6%).

Severe joint pain among adults with arthritis, by state, 2017. CDC figure.

Physical inactivity

Among adults with arthritis, inactivity rose with age, from 31.0% at 18–44 to 37.0% at 65 and older. It reached 40% or more among people unable to work or disabled (51.2%), without a high school diploma (46.4%), at or below 125% of poverty (42.6%) and Black adults (40.4%). It increased with rurality and with pain: 22.6% of those with no or mild pain were inactive, 31.8% of those with moderate pain and 47.0% of those with severe pain.

By state

Arthritis was most common in Appalachia and the Lower Mississippi Valley, and severe pain and inactivity were highest in southeastern states. All three were similar to 2015.

What helps

Joint pain is often treated with medicines, which have side effects. The 2016 National Pain Strategy calls for pain care that is multifaceted, individualized and includes non-drug approaches, and the American College of Rheumatology recommends regular physical activity to relieve arthritis pain. People with arthritis often cite pain, or fear of making it worse, as a barrier to exercise, yet physical activity is inexpensive, has few side effects, and can reduce pain, prevent or delay disability, and improve mood, function and quality of life.

The Physical Activity Guidelines for Americans recommend that adults, including those with arthritis, get the equivalent of at least 150 minutes of moderate-intensity aerobic activity a week. Those who cannot because of their condition should be as active as their abilities allow and avoid inactivity; even small amounts help. Most adults with arthritis pain can safely start walking, swimming or cycling.

Evidence-based programs designed for people with arthritis are available nationwide and matter most for people with limited access to health care, medicines and surgery, such as rural residents, lower-income people and racial and ethnic minority groups:

• low-impact aquatic exercise, such as the Arthritis Foundation Aquatic Program, and strength training, such as Fit and Strong!;
• group aerobic classes, such as Walk with Ease, EnhanceFitness, the Arthritis Foundation Exercise Program and Active Living Every Day;
• self-management education, such as the Chronic Disease Self-Management Program, which increases aerobic and stretching or strengthening exercise, confidence in managing pain, and mood.

Limitations: the data are self-reported; low response rates in some states may bias results; and people in institutions were not surveyed, so the true prevalence is likely higher.

Sources

• Guglielmo D, Murphy LB, Boring MA, et al. "State-Specific Severe Joint Pain and Physical Inactivity Among Adults with Arthritis — United States, 2017." MMWR 2019;68(17).