Arthritis Action Plan
IV. The Burden of Arthritis
A. National Context
Arthritis and related diseases affects one out of every three persons, which is approximately 70 million people.7 This estimate was recently revised from 48 million by the Centers for Disease Control and Prevention based on findings from the 2001 Behavior Risk Factor Surveillance System (BRFSS) conducted in each of the 50 states. While the BRFSS survey is conducted using randomly selected telephone numbers and depends upon self-reporting of certain symptoms, activity limitations and/or physician diagnosis, analysis of the results led the CDC to alter their previous estimates. Moreover, because prevalence of the disease has been shown to increase with age, the burden of arthritis and related diseases is expected to rise as the US population ages.
Arthritis and other rheumatic diseases are the leading cause of disability among adults in the United States, standing second only to heart disease as a cause of work-related disability.8 Arthritis is estimated to limit daily activity for more than 7 million citizens.9 In 1999, 17.5% of all adults with disabilities reported that the main health condition associated with their disability was arthritis and rheumatism.10
Persons with arthritis have substantially worse health-related quality of life than do persons without arthritis. Among adults with arthritis, the largest number of days reported as unhealthy was experienced by a cohort comprised of women, young people, and people with less than a college education. Among women and young people, this was associated with more bad "mental health" days. While depression is commonly reported and observed in people with all types of arthritis, it is most clearly documented among people with rheumatoid arthritis.11
Arthritis also has a significant effect on quality of life for family members and caregivers. At its worst, the disease progression can transform an active, productive person into a dependent individual. Arthritis potentially impacts mobility, energy level, emotional health, functional capacity and body image for the person suffering from the disease. This loss of a sense of well being and independence impacts the family dynamic and requires adjustments and compromises for everyone.
A finding of particularly serious note is that rheumatoid arthritis is associated with excess mortality. Specifically, rheumatoid arthritis can affect connective tissue and blood vessels throughout the body, triggering inflammation in a variety of organs, including the lungs and heart. This increases a person's risk of dying of respiratory and infectious diseases or of gastrointestinal disorders.12 Rheumatoid arthritis has been linked with a higher risk of myocardial infarction in women possibly due to the inflammatory component of both diseases.13
- Myth: Arthritis is an old person's disease.
- Fact: Although arthritis affects one of every two persons over 65 years of age, most people with arthritis, nearly three out of five in fact, are younger than 65. People of all ages are affected, including children and teens. Juvenile rheumatoid arthritis is one of the most common chronic illnesses.
B. New York State Demographics
New York State is experiencing a population change driven by forces such as foreign immigration, high levels of domestic in-and out-migration, and the high fertility levels of the Baby Boom generation, which have all shaped the population of the state and will continue to do so in the future.14 In 2000, the proportion of (23%) New York's population that was foreign born was almost twice the proportion (12%) of foreign-born residents in the nation's population.15 Meanwhile, New York State suffered the largest number of foreign and domestic residents (1.7 million) leaving the state. These out-migrants are predominately young, educated prime work-age people and financially secure retirees.16
According to the 2000 Census, since 1990, the total Black or AfricanAmerican population increased by 13% from 1990 to 3.2 million while the total Hispanic/Latino population increased by 30% to 2.9 million persons. Among the state's total elderly population, minority and ethnic elderly persons will increase at the fastest rate from 20% in 1995 to 31% in 2015 and 35% in 2025.17
Based upon 1999 data, families who were living below the poverty level in New York totaled 535,935 or 11.5% of all families. Families with related children who are below 18 years of age numbered 418,591 or 16.9%. Individuals living below the poverty level totaled 2,692, 202 or 14.6%. Another 29.2% or 294,906 people represent families with a female householder. For persons age 65 and older who live below the poverty level in the census report, the number was 264,336 or 11.3%. Of those persons age 65 and older, 26.0% are on Social Security Income; 5.5% on Supplemental Security Income; 4.9% on public assistance and another 16.9% who reported living from retirement income.18
Education in the same census presented an array with 20.9 % reporting less than 9th grade education or no high school diploma; 79.1% reporting high school graduate or higher level of attainments; and another 27.4% reporting bachelor's degree or higher.
New York State's population is getting older. The 2000 Census estimates that 12.9%, or 2,448,352, of New York's population are 65. Of those, around 40% are living with a disability. Comparatively, persons between age 21 to 64 years in New York, 21.0% report a disability. Of that group, 54.1% of them are employed.19
The median age in New York State increased from 30.3 years of age in 1970 to 32 years of age in 1980 and now exceeds 36 years. This increase is due to the aging of the Baby Boomers and the longer survival rates of the elderly.20 By the year 2015, the youngest of the Baby Boomers will be over 50 years old while the oldest will be approaching 70 years old.This group is projected to increase from 18 percent in 2000 to nearly 24 percent by the year 2015.Those age 70 and over will remain relatively constant at around 9 percent of the state's population.21 The CDC projects that by the year 2025, over 55% of New Yorkers 65 and older will report having arthritis and/or chronic joint symptoms.22
C. Prevalence of Arthritis in New York State
Using the 2001 Behavioral Risk Factor Surveillance System (BRFSS) data, the prevalence of arthritis among the non-institutionalized adult population in New York State was estimated to be 32%, or approximately 4.7 million people. Of this total number who self reported on the survey, 1.5 million indicated that they were age 65 and older.The group participating in the BRFSS fell into several reporting categories: 12% reported both a physician diagnosis of arthritis and chronic joint symptoms; another 11% reported based upon a physician diagnosis of arthritis alone;and a third group or 10% reported chronic joint symptoms only. Among survey respondents, there was a higher prevalence among four subsets: women, those aged 65 years and older, those considered obese, and those with less than a high school education.
Analysis of data from the New York 2001 BRFSS Quality of Life/Disabilities Prevention module has shown the prevalence of limitations in activity due to arthritis to be higher among older age groups. Because increases are projected in the number and proportion of the state's older population where the incidence of arthritis is greatest, the prevalence of the disease is expected to grow.The statistics underscoring New York State's challenge mirror national data:
- In New York State, 36% of the 2001 BRFSS female respondents reported having some type of arthritis.
- In New York State, 59% of the 2001 BRFSS respondents who were 65 years of age and older reported having some type of arthritis.
- In New York State, 47% of the 2001 BRFSS respondents who were obese (Body Mass Index [BMI] of 30 or higher) reported having some type of arthritis.
- In New York State, 42% of 2001 BRFSS respondents who had less than a high school diploma reported having some type of arthritis.
Figure 1 Adult New Yorkers with Arthritis by Gender
Figure 2 Adult New Yorkers with Arthritis by Age
Figure 3 Adult New Yorkers with Arthritis by Body Mass Index (BMI)
Figure 4 Adult New Yorkers with Arthritis by Education Level
Other socioeconomic characteristics of adult New Yorkers with arthritis include race, household income,and geographical region. Of the BRFSS respondents:
- 35% were white/non-Hispanic,
- 28% were black/non-Hispanic,
- 26% were Hispanic, and
- 16% reported themselves as other/non-Hispanic;
D. Economic Costs
The Arthritis Foundation estimates the economic cost of arthritis and rheumatic diseases in the United States at nearly $125 billion dollars for the year 2000, $43 billion in direct medical costs and another $82 billion in indirect costs such as those arising from lost productivity.23
In a review of the literature on arthritis presented in the journal of Arthritis and Rheumatism in 2000 by Dunlop et al, the authors conclude that all the studies over the past two decades make the same point, namely: "... there is substantial disability associated with arthritis."24 In this same article, the authors observe that among persons with arthritis:
- 40-70% of them reported a work related disability;
- Almost 20% reported loss of mobility, with those rates doubling for older adults;
- 19-25% reported being unable to do their major activity; and
- 30-50% of people older than 70 years of age reported activities of daily living (ADL) limitations."25
In 1999, a CDC study that relied upon data from the National Hospital Discharge Survey reported that Arthritis was the first listed hospital discharge diagnosis and that it was associated with 744,000 hospitalizations and 44 million ambulatory visits, of which 39 million were attributed to physician offices.26 Based on the 1993-1998 data from the Asset of Health Dynamic Among the Oldest Old (AHEAD) survey, a national probability sample of non-institutionalized adults aged 70 and older, the distribution of arthritis by health insurance coverage reflects the socioeconomic disparities in prevalence rates. For example, arthritis was more prevalent among people who received Medicaid plus Medicare coverage compared with people with only Medicare coverage or other supplemental insurance coverage.27
The New York State hospital inpatient data collected through the Statewide Planning and Research Cooperative System (SPARCS) for 2001 reported 88,401 discharges for the musculo-skeletal and connective tissue disease (MSCTD) category. Total hospital charges for this group, exclusive of physician fees, totaled $1.5 billion of which 49% were charged to Medicare or Medicaid. When looking only at discharges attributable to osteoarthritis in the same year in New York State, the total number was 26,692 with total charges of $536 million, of which 55% were charged to Medicare or Medicaid.28 Total hip and total knee replacement discharges attributed to osteoarthritis in the same year (2001) were 9,252 and 13,631 respectively, with total charges of $203 million for hips, of which Medicare or Medicaid was charged 52%, and $ 287 million for knees, of which Medicare or Medicaid was charged 56%.29
