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Drenkard C, Theis KA, Daugherty TT, Helmick CG, Dunlop-Thomas C, Bao G, Aspey L, Lewis TT, Lim SS. Depression, stigma and social isolation: the psychosocial trifecta of primary chronic cutaneous lupus erythematosus, a cross-sectional and path analysis. Lupus Sci Med 2022; 9:9/1/e000697. [PMID: 35953237 PMCID: PMC9379542 DOI: 10.1136/lupus-2022-000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
Objective Depression is common in individuals with chronic cutaneous lupus erythematosus (CCLE). However, how CCLE may impact patients’ psychological well-being is poorly understood, particularly among disproportionally affected populations. We examined the relationships between depression and psychosocial factors in a cohort of predominantly Black patients with primary CCLE (CCLE without systemic manifestations). Methods Cross-sectional assessment of individuals with dermatologist-validated diagnosis of primary CCLE. NIH-PROMIS short-forms were used to measure depression, disease-related stigma, social isolation and emotional support. Linear regression analyses (ɑ=0.05) were used to test an a priori conceptual model of the relationship between stigma and depression and the effect of social isolation and emotional support on that association. Results Among 121 participants (87.6% women; 85.1% Black), 37 (30.6%) reported moderate to severe depression. Distributions of examined variables divided equally among those which did (eg, work status, stigma (more), social isolation (more), emotional support (less)) and did not (eg, age, sex, race, marital status) significantly differ by depression. Stigma was significantly associated with depression (b=0.77; 95% CI0.65 to 0.90), whereas social isolation was associated with both stigma (b=0.85; 95% CI 0.72 to 0.97) and depression (b=0.70; 95% CI0.58 to 0.92). After controlling for confounders, stigma remained associated with depression (b=0.44; 95% CI0.23 to 0.66) but lost significance (b=0.12; 95% CI −0.14 to 0.39) when social isolation (b=0.40; 95% CI 0.19 to 0.62) was added to the model. Social isolation explained 72% of the total effect of stigma on depression. Emotional support was inversely associated with depression in the univariate analysis; however, no buffer effect was found when it was added to the multivariate model. Conclusion Our findings emphasise the psychosocial challenges faced by individuals living with primary CCLE. The path analysis suggests that stigmatisation and social isolation might lead to depressive symptoms. Early clinical identification of social isolation and public education demystifying CCLE could help reduce depression in patients with CCLE.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA .,Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy T Daugherty
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Aspey
- Department Medicine/Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tené T Lewis
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
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Duca LM, Helmick CG, Barbour KE, Guglielmo D, Murphy LB, Boring MA, Theis KA, Odom EL, Liu Y, Croft JB. Self-Management Education Class Attendance and Health Care Provider Counseling for Physical Activity Among Adults with Arthritis - United States, 2019. MMWR Morb Mortal Wkly Rep 2021; 70:1466-1471. [PMID: 34673750 PMCID: PMC9361837 DOI: 10.15585/mmwr.mm7042a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Arthritis is a highly prevalent and disabling condition among U.S. adults (1); arthritis-attributable functional limitations and severe joint pain affect many aspects of health and quality of life (2). Self-management education (self-management) and physical activity can reduce pain and improve the health status and quality of life of adults with arthritis; however, in 2014, only 11.4% and 61.0% of arthritis patients reported engaging in each, respectively. To assess self-reported self-management class attendance and health care provider physical activity counseling among adults with doctor-diagnosed arthritis, CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. In 2019, an age-standardized state median of one in six (16.2%) adults with arthritis reported ever attending a self-management class, and 69.3% reported ever receiving health care provider counselling to be physically active. Prevalences of both differed by state and sociodemographic characteristics; decreased with lower educational attainment, joint pain severity, and urbanicity; and were lower in men than in women. Health care providers can play an important role in promoting self-management class attendance and physical activity by counseling arthritis patients about their benefits and referring patients to evidence-based programs (3).
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Guglielmo D, Theis KA, Murphy LB, Boring MA, Helmick CG, Omura JD, Odom EL, Duca LM, Croft JB. Physical Activity Types and Programs Recommended by Primary Care Providers Treating Adults With Arthritis, DocStyles 2018. Prev Chronic Dis 2021; 18:E92. [PMID: 34648422 PMCID: PMC8522501 DOI: 10.5888/pcd18.210194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Primary care providers (PCPs) can offer counseling to adults with arthritis on physical activity, which can reduce pain and improve physical function, mental health, and numerous other health outcomes. We analyzed cross-sectional 2018 DocStyles data for 1,366 PCPs who reported they always or sometimes recommend physical activity to adults with arthritis. Most PCPs sampled (88.2%) recommended walking, swimming, or cycling; 65.5% did not recommend any evidence-based, arthritis-appropriate physical activity programs recognized by the Centers for Disease Control and Prevention. Opportunities exist for public health awareness campaigns to educate PCPs about evidence-based physical activity programs proven to optimize health for adults with arthritis when more than counseling is needed.
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Affiliation(s)
- Dana Guglielmo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS S107-6, Atlanta, GA 30341. .,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kristina A Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Charles G Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erica L Odom
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsey M Duca
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Guglielmo D, Murphy LB, Theis KA, Boring MA, Helmick CG, Watson KB, Duca LM, Odom EL, Liu Y, Croft JB. Walking and Other Common Physical Activities Among Adults with Arthritis - United States, 2019. MMWR Morb Mortal Wkly Rep 2021; 70:1408-1414. [PMID: 34618794 PMCID: PMC8519272 DOI: 10.15585/mmwr.mm7040a3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Theis KA, Murphy LB, Guglielmo D, Boring MA, Okoro CA, Duca LM, Helmick CG. Prevalence of Arthritis and Arthritis-Attributable Activity Limitation - United States, 2016-2018. MMWR Morb Mortal Wkly Rep 2021; 70:1401-1407. [PMID: 34618800 PMCID: PMC8519273 DOI: 10.15585/mmwr.mm7040a2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Arthritis has been the most frequently reported main cause of disability among U.S. adults for >15 years (1), was responsible for >$300 billion in arthritis-attributable direct and indirect annual costs in the U.S. during 2013 (2), is linked to disproportionately high levels of anxiety and depression (3), and is projected to increase 49% in prevalence from 2010-2012 to 2040 (4). To update national prevalence estimates for arthritis and arthritis-attributable activity limitation (AAAL) among U.S. adults, CDC analyzed combined National Health Interview Survey (NHIS) data from 2016-2018. An estimated 58.5 million adults aged ≥18 years (23.7%) reported arthritis; 25.7 million (10.4% overall; 43.9% among those with arthritis) reported AAAL. Prevalence of both arthritis and AAAL was highest among adults with physical limitations, few economic opportunities, and poor overall health. Arthritis was reported by more than one half of respondents aged ≥65 years (50.4%), adults who were unable to work or disabled* (52.3%), or adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), activities of daily living (ADL)† disability (54.8%), or instrumental activities of daily living (IADL)§ disability (55.9%). More widespread dissemination of existing, evidence-based, community-delivered interventions, along with clinical coordination and attention to social determinants of health (e.g., improved social, economic, and mental health opportunities), can help reduce widespread arthritis prevalence and its adverse effects.
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Murphy LB, Theis KA, Brady TJ, Sacks JJ. Supporting self-management education for arthritis: Evidence from the Arthritis Conditions and Health Effects Survey on the influential role of health care providers. Chronic Illn 2021; 17:217-231. [PMID: 31475576 PMCID: PMC10878350 DOI: 10.1177/1742395319869431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Self-management education programs are recommended for many chronic conditions. We studied which adults with arthritis received a health care provider's recommendation to take a self-management education class and who attended. METHODS We analyzed data from a 2005--2006 national telephone survey of US adults with arthritis ≥45 years (n = 1793). We used multivariable-adjusted prevalence ratios (PR) from logistic regression models to estimate associations with: (1) receiving a health care provider recommendation to take a self-management education class; and (2) attending a self-management education class. RESULTS Among all adults with arthritis: 9.9% received a health care provider recommendation to take an self-management education class; 9.7% attended a self-management education class. Of those receiving a recommendation, 52.0% attended a self-management education class. The strongest association with self-management education class attendance was an health care provider recommendation to take one (PR = 8.9; 95% CI = 6.6-12.1). CONCLUSIONS For adults with arthritis, a health care provider recommendation to take a self-management education class was strongly associated with self-management education class attendance. Approximately 50% of adults with arthritis have ≥1 other chronic conditions; by recommending self-management education program attendance, health care providers may activate patients' self-management behaviors. If generalizable to other chronic conditions, this health care provider recommendation could be a key influencer in improving outcomes for a range of chronic conditions and patients' quality of life.
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Affiliation(s)
- Louise B Murphy
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina A Theis
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa J Brady
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Retired
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Guglielmo D, Murphy LB, Theis KA, Helmick CG, Omura JD, Odom EL, Croft JB. Physical Activity Assessment and Recommendation for Adults With Arthritis by Primary Care Providers-DocStyles, 2018. Am J Health Promot 2021; 35:559-570. [PMID: 33356415 PMCID: PMC10479947 DOI: 10.1177/0890117120981371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To examine primary care providers' (PCPs) physical activity assessment and recommendation behaviors for adults with arthritis. DESIGN Cross-sectional. SETTING 2018 DocStyles online national market research survey of US physicians and nurse practitioners. SAMPLE 1,389 PCPs seeing adults with arthritis. MEASURES 2 independent behaviors (assessment and recommendation) as 3 non-mutually exclusive groups: "always assesses," "always recommends," and "both" ("always assesses and recommends"). ANALYSIS Calculated percentages of each group (overall and by PCP characteristics), and multivariable-adjusted prevalence ratios (PRs) using binary logistic regression. RESULTS Among PCPs, 49.2% always assessed and 57.7% always recommended physical activity; 39.7% did both. Across all 3 groups, percentages were highest for seeing ≥20 adults with arthritis weekly ("both": 56.4%; "always assesses": 66.7%; "always recommends": 71.3%) and lowest among obstetrician/gynecologists ("both": 26.9%; "always assesses": 36.8%; "always recommends": 40.7%). Multivariable-adjusted associations were strongest for seeing ≥20 adults with arthritis weekly (referent: 1-9 adults) and each of "always assesses" (PR = 1.5 [95% confidence interval (CI): 1.3-1.8] and "both" (PR = 1.6 [95% CI: 1.4-1.9]). CONCLUSIONS Approximately 40% of PCPs sampled always engaged in both behaviors (assessing and recommending physical activity) with adults with arthritis; seeing a high volume of adults with arthritis was consistently related to engaging in each behavior. Evidence-based approaches to support PCP counseling include offering provider education and training, raising awareness of available resources, and using health system supports.
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Affiliation(s)
- Dana Guglielmo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Louise B. Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina A. Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles G. Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D. Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erica L. Odom
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet B. Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jetha A, Theis KA, Boring MA, Murphy LB, Guglielmo D. Depressive Symptoms and the Arthritis-Employment Interface: A Population-Level Study. Arthritis Care Res (Hoboken) 2021; 73:65-77. [PMID: 32702187 PMCID: PMC10481427 DOI: 10.1002/acr.24381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the relationship between depressive symptoms, arthritis, and employment, and to determine whether this relationship differs across young, middle-age, and older working-age adults with arthritis. METHODS Data from the US National Health Interview Survey from 2013-2017 were analyzed. Analyses were restricted to adults with doctor-diagnosed arthritis of working age (ages 18-64 years) with complete data on depressive symptoms (n = 11,380). Covariates were sociodemographic information, health, and health system utilization variables. Employment prevalence was compared by self-reported depressive symptoms. We estimated percentages, as well as univariable and multivariable logistic regression models, to examine the relationship between depression and employment among young adults (ages 18-34 years), middle-age adults (ages 35-54 years), and older adults (ages 55-64 years). RESULTS Among all working-age US adults with arthritis, the prevalence of depressive symptoms was 13%. Those reporting depressive symptoms had a higher prevalence of fair/worse health (60%) and arthritis-attributable activity limitations (70%) compared to those not reporting depression (23% and 39%, respectively). Respondents with depressive symptoms reported significantly lower employment prevalence (30%) when compared to those not reporting depressive symptoms (66%) and lower multivariable-adjusted association with employment (prevalence ratio 0.88 [95% confidence interval (95% CI) 0.83-0.93]). Middle-age adults reporting depression were significantly less likely to be employed compared to their counterparts without depression (prevalence ratio 0.83 [95% CI 0.77-0.90]); similar but borderline statistically significant relationships were observed for both young adults (prevalence ratio 0.86 [95% CI 0.74-0.99]) and older adults (prevalence ratio 0.94 [95% CI 0.86-1.03]). CONCLUSION For adults with arthritis, depressive symptoms are associated with not participating in employment. Strategies to reduce arthritis-related work disability may be more effective if they simultaneously address mental health.
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Affiliation(s)
- Arif Jetha
- Institute for Work and Health, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Dana Guglielmo
- Centers for Disease Control and Prevention, Atlanta, Georgia, and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
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Murphy LB, Cisternas MG, Theis KA, Brady TJ, Bohm MK, Guglielmo D, Hootman JM, Barbour KE, Boring MA, Helmick CG. All-Cause Opioid Prescriptions Dispensed: The Outsized Role of Adults With Arthritis. Am J Prev Med 2020; 59:355-366. [PMID: 32763134 DOI: 10.1016/j.amepre.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/28/2020] [Accepted: 03/16/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Limited estimates of prescribed opioid use among adults with arthritis exist. All-cause (i.e., for any condition) prescribed opioid dispensed (referred to as opioid prescription in the remainder of this abstract) in the past 12 months among U.S. adults aged ≥18 years (n=35,427) were studied, focusing on adults with arthritis (n=12,875). METHODS In 2018-2019, estimates were generated using Medical Expenditure Panel Survey data: (1) 2015 prevalence of 1 or more opioid prescriptions to U.S. adults overall and by arthritis status and (2) in 2014-2015, among adults with arthritis, multivariable-adjusted associations between 1 or more opioid prescriptions and sociodemographic characteristics, health status, and healthcare utilization characteristics. RESULTS In 2015, the age-standardized prevalence of 1 or more opioid prescriptions among adults with arthritis (29.6%) was almost double of that for all adults (15.4%). Adults with arthritis represented more than half of all adults (55.3%) with at least 1 opioid prescription; among those with 1 or more prescriptions, 43.2% adults had 4 or more prescriptions. The strongest multivariable-adjusted associations with 1 or more opioid prescriptions were ambulatory care visits (1-4: prevalence ratios=1.9-2.0, 5-8: prevalence ratios=2.5-2.7, 9 or more: prevalence ratios=3.4-3.7) and emergency room visits (1: prevalence ratios=1.6, 2-3: prevalence ratios=1.9-2.0, 4 or more: prevalence ratios=2.4); Ref for both: no visits. CONCLUSIONS Adults with arthritis are a high-need target group for improving pain management, representing more than half of all U.S. adults with 1 or more opioid prescriptions. The association with ambulatory care visits suggests that providers have routine opportunities to discuss comprehensive and integrative pain management strategies, including low-cost evidence-based self-management approaches (e.g., physical activity, self-management education programs, cognitive behavioral therapy). Those with multiple opioid prescriptions may need extra support if transitioning to nonopioid and nonpharmacologic pain management strategies.
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Affiliation(s)
- Louise B Murphy
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa J Brady
- Retired, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Clarity Consulting and Communications, Atlanta, Georgia
| | - Michele K Bohm
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Guglielmo
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Jennifer M Hootman
- Retired, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kamil E Barbour
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Theis KA, Brady TJ, Sacks JJ. Where Have All the Patients Gone? Profile of US Adults Who Report Doctor-Diagnosed Arthritis But Are Not Being Treated. J Clin Rheumatol 2019; 25:341-347. [PMID: 31764495 DOI: 10.1097/rhu.0000000000000896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients only benefit from clinical management of arthritis if they are under the care of a physician or other health professional. OBJECTIVES We profiled adults who reported doctor-diagnosed arthritis who are not currently being treated for it to understand better who they are. METHODS Individuals with no current treatment (NCT) were identified by "no" to "Are you currently being treated by a doctor or other health professional for arthritis or joint symptoms?" Demographics, current symptoms, physical functioning, arthritis limitations and interference in life activities, and level of agreement with treatment and attitude statements were assessed in this cross-sectional, descriptive study of noninstitutionalized US adults aged 45 years or older with self-reported, doctor-diagnosed arthritis (n = 1793). RESULTS More than half of the study population, 52%, reported NCT (n = 920). Of those with NCT, 27% reported fair/poor health, 40% reported being limited by their arthritis, 51% had daily arthritis pain, 59% reported 2 or more symptomatic joints, and 19% reported the lowest third of physical functioning. Despite NCT, 83% with NCT agreed or strongly agreed with the importance of seeing a doctor for diagnosis and treatment. CONCLUSIONS Greater than half of those aged 45 years or older with arthritis were not currently being treated for it, substantial proportions of whom experienced severe symptoms and poor physical function and may benefit from clinical management and guidance, complemented by community-delivered public health interventions (self-management education, physical activity). Further research to understand the reasons for NCT may identify promising intervention points to address missed treatment opportunities and improve quality of life and functioning.
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Affiliation(s)
- Kristina A Theis
- From the Arthritis Program, Centers for Disease Control and Prevention
| | - Teresa J Brady
- From the Arthritis Program, Centers for Disease Control and Prevention
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Guglielmo D, Murphy LB, Boring MA, Theis KA, Helmick CG, Hootman JM, Odom EL, Carlson SA, Liu Y, Lu H, Croft JB. State-Specific Severe Joint Pain and Physical Inactivity Among Adults with Arthritis - United States, 2017. MMWR Morb Mortal Wkly Rep 2019; 68:381-387. [PMID: 31048678 PMCID: PMC6541316 DOI: 10.15585/mmwr.mm6817a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Theis KA, Steinweg A, Helmick CG, Courtney-Long E, Bolen JA, Lee R. Which one? What kind? How many? Types, causes, and prevalence of disability among U.S. adults. Disabil Health J 2019; 12:411-421. [PMID: 31000498 DOI: 10.1016/j.dhjo.2019.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/29/2018] [Accepted: 03/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Quantifying the number of people with and types of disabilities is helpful for medical, policy, and public health planning. OBJECTIVE/HYPOTHESIS To update prior estimates on types, prevalence, and main causes of disability among U.S. adults using the Survey of Income and Program Participation (SIPP) data. METHODS We used cross-sectional data from the SIPP 2008 Panel Wave 6 interviews collected May-August 2010. Analyses were restricted to non-institutionalized adults ages ≥18 years (n = 66,410). Disability was ascertained via five non-mutually exclusive components: 1) specific activity difficulties, 2) selected impairments, 3) use of an assistive aid, 4) household work limitations, and 5) paid work limitations. Prioritized main cause of disability was established for the 95% of respondents with a disability type eligible for health condition questions. We generated weighted population estimates (number and percentage, with 95% confidence intervals (CIs)), accounting for the complex sample survey design. RESULTS 50 million U.S. adults (21.8%) experienced a disability in 2010. Mobility-related activity limitations were the most prevalent disabilities across all five components. The most common main causes of disability were arthritis/rheumatism, 9.1 million (19.2%, 95% CI = 18.4-20.0) and back or spine problems, 8.9 million (18.6%, 95% CI = 17.9-19.3). CONCLUSIONS A growing population with disabilities has the potential to put considerable and unsustainable demand on medical, public health, and senior service systems. Strengthening clinical community linkages and expanding the availability of existing evidence-based public health interventions to prevent, delay, and mitigate the effects of disability could improve health and outcomes for people with disabilities.
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Affiliation(s)
- Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy, Atlanta, GA, 30341, USA.
| | - Amy Steinweg
- Social, Economic, and Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Road, Washington, DC, 20233, USA.
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy, Atlanta, GA, 30341, USA.
| | - Elizabeth Courtney-Long
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), USA.
| | - Julie A Bolen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), USA.
| | - Robin Lee
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention (CDC), USA.
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Murphy LB, Sacks JJ, Helmick CG, Brady TJ, Barbour KE, Hootman JM, Boring MA, Moss S, Guglielmo D, Theis KA. Arthritis Prevalence: Which Case Definition Should Be Used for Surveillance? Comment on the Article by Jafarzadeh and Felson. Arthritis Rheumatol 2019; 71:172-175. [PMID: 30251477 PMCID: PMC10506797 DOI: 10.1002/art.40733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Dana Guglielmo
- Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
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Hootman JM, Theis KA, Barbour KE, Paul P, Carlson SA. Leisure Time and Transportation Walking Among Adults With and Without Arthritis in the United States, 2010. Arthritis Care Res (Hoboken) 2018; 71:178-188. [PMID: 30346654 DOI: 10.1002/acr.23790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/15/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Walking is a joint-friendly activity for adults with arthritis. The aim of this study was to estimate, among adults with arthritis, the prevalence of leisure and transportation walking overall (by arthritis status and by sociodemographic and health characteristics), the number of total minutes walking per week in each domain, and the distributions of walking bout length (i.e., short periods of activity) in minutes. METHODS Data were obtained from the 2010 National Health Interview Survey. Prevalence estimates (percentages and 95% confidence intervals [95% CIs]) of leisure and transportation walking in the past 7 days and walking bout times were calculated (in minutes), as were multivariable Poisson regression models, which account for the complex sample design. RESULTS Prevalence of leisure walking was 45.9% (95% CI 44.2-47.6) for adults with arthritis versus 51.9% (95% CI 50.9-52.9) for those without. Transportation walking prevalence was 23.0% (95% CI 21.7-24.4) for adults with arthritis versus 32.0% (95% CI 31.0-33.0) for those without. The total time of leisure walking per week did not differ in adults with arthritis compared to those without (77.3 versus 78.3 minutes, respectively; P = 0.62), while total time of transportation walking did differ (49.8 versus 58.1 minutes, respectively; P = 0.03). The most common walking bout length differed between leisure (26-40 minutes) and transportation (10-15 minutes) walking, but not by arthritis status. In separate adjusted multivariable models, obesity was consistently negatively associated with both walking outcomes, and being physically active was positively associated with both; lower extremity joint pain was not associated. CONCLUSION By adding short bouts, leisure and transportation walking could be adopted by large proportions of adults with arthritis. Existing evidence-based programs can help increase physical activity.
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Affiliation(s)
| | | | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Prabasaj Paul
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Guglielmo D, Hootman JM, Boring MA, Murphy LB, Theis KA, Croft JB, Barbour KE, Katz PP, Helmick CG. Symptoms of Anxiety and Depression Among Adults with Arthritis - United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2018; 67:1081-1087. [PMID: 30286053 PMCID: PMC6171892 DOI: 10.15585/mmwr.mm6739a2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
An estimated 54.4 million (22.7%) U.S. adults have doctor-diagnosed arthritis (1). A report in 2012 found that, among adults aged ≥45 years with arthritis, approximately one third reported having anxiety or depression, with anxiety more common than depression (2). Studies examining mental health conditions in adults with arthritis have focused largely on depression, arthritis subtypes, and middle-aged and older adults, or have not been nationally representative (3). To address these knowledge gaps, CDC analyzed 2015-2017 National Health Interview Survey (NHIS) data* to estimate the national prevalence of clinically relevant symptoms of anxiety and depression among adults aged ≥18 years with arthritis. Among adults with arthritis, age-standardized prevalences of symptoms of anxiety and depression were 22.5% and 12.1%, respectively, compared with 10.7% and 4.7% among adults without arthritis. Successful treatment approaches to address anxiety and depression among adults with arthritis are multifaceted and include screenings, referrals to mental health professionals, and evidence-based strategies such as regular physical activity and participation in self-management education to improve mental health.
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Theis KA, Roblin D, Helmick CG, Luo R. Employment exit and entry among U.S. adults with and without arthritis during the Great Recession. A longitudinal study: 2007-2009, NHIS/MEPS. Work 2018; 60:303-318. [PMID: 29865104 DOI: 10.3233/wor-2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Negative employment consequences of arthritis are known but not fully understood. Examining transitions in and out of work can provide valuable information. OBJECTIVE To examine associations of arthritis with employment during the Great Recession and predictors of employment transitions. METHODS Data were for 3,277 adults ages 30-62 years with and without arthritis from the 2007 National Health Interview Survey followed in the Medical Expenditure Panel Survey 2008-2009. Employment (working vs. not working) was ascertained at baseline and five follow-ups. We estimated Kaplan Meier survival curves with 95% confidence intervals (CI) separately for time to stopping work (working at baseline) and starting work (not working at baseline) using Cox proportional hazards regression models with hazard ratios (HR). RESULTS Arthritis was significantly associated with greater risk of stopping work (HR = 1.7, 95% CI = 1.3-2.2; adjusted HR= 1.5, 95% CI = 1.1-2.0) and significantly associated with 40% lower chance of starting work (HR = 0.6, 95% CI = 0.4-0.8), which reversed on adjustment (HR = 1.5, 95% CI = 1.0-2.2). Employment predictors were mixed by outcome. CONCLUSIONS During the Great Recession, adults with arthritis stopped work at higher rates and started work at lower rates than those without arthritis.
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Affiliation(s)
- K A Theis
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,Georgia State University, School of Public Health, Atlanta, GA, USA
| | - D Roblin
- Senior Research Scientist, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.,Affiliate Faculty, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - C G Helmick
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - R Luo
- Georgia State University, School of Public Health, Atlanta, GA, USA
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Guglielmo D, Hootman JM, Murphy LB, Boring MA, Theis KA, Belay B, Barbour KE, Cisternas MG, Helmick CG. Health Care Provider Counseling for Weight Loss Among Adults with Arthritis and Overweight or Obesity - United States, 2002-2014. MMWR Morb Mortal Wkly Rep 2018; 67:485-490. [PMID: 29723172 PMCID: PMC5933870 DOI: 10.15585/mmwr.mm6717a2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Barbour KE, Moss S, Croft JB, Helmick CG, Theis KA, Brady TJ, Murphy LB, Hootman JM, Greenlund KJ, Lu H, Wang Y. Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015. MMWR Surveill Summ 2018; 67:1-28. [PMID: 29543787 PMCID: PMC5857191 DOI: 10.15585/mmwr.ss6704a1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Problem/Condition Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. Reporting Period 2015. Description of System The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. Results In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking. Interpretation The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county. Public Health Action The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.
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Affiliation(s)
- Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | | | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Charles G Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kristina A Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Teresa J Brady
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Jennifer M Hootman
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Jetha A, Theis KA, Boring MA, Barbour KE. Education and Employment Participation in Young Adulthood: What Role Does Arthritis Play? Arthritis Care Res (Hoboken) 2017; 69:1582-1589. [PMID: 27998027 PMCID: PMC10476198 DOI: 10.1002/acr.23175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/04/2016] [Accepted: 12/13/2016] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To examine the association between arthritis diagnosis and education and employment participation among young adults, and to determine whether findings differ by self-rated health and age. METHODS Data from the National Health Interview Survey, in the years 2009-2015, were combined and analyzed. The study sample was restricted to those ages 18-29 years, either diagnosed with arthritis (n = 1,393) or not (n = 40,537). The prevalence and correlates of employment and education participation were compared by arthritis status. Demographic characteristics, social role participation restrictions, health factors, and health system use variables were included as covariates. Models were stratified for age (18-23 versus 24-29 years) and self-rated health. Weighted proportions and univariate and multivariate associations were calculated to examine the association between arthritis and education and employment participation. RESULTS Respondents with arthritis were more likely to be female, married, and report having more social participation restrictions, fair/poor health, and more functional limitations than those without arthritis. In multivariate models, arthritis was significantly associated with lower education (prevalence ratio [PR] 0.75 [95% confidence interval (95% CI) 0.57-0.98]) and higher employment participation (PR 1.07 [95% CI 1.03-1.13]). Additional stratified analyses indicated an association between arthritis diagnosis and greater employment participation in those ages 18-23 years and reporting higher self-rated health. CONCLUSION Young adults with arthritis may be transitioning into employment at an earlier age than their peers without arthritis. To inform the design of interventions that promote employment participation, future research on the education and employment experiences of young adults with arthritis is needed.
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Affiliation(s)
- Arif Jetha
- Institute for Work & Health, Toronto ON Canada
| | - Kristina A. Theis
- Division of Population Health Arthritis Program, Centers for Disease Control, Atlanta GA USA
| | | | - Kamil E. Barbour
- Division of Population Health Arthritis Program, Centers for Disease Control, Atlanta GA USA
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20
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Murphy LB, Brady TJ, Boring MA, Theis KA, Barbour KE, Qin J, Helmick CG. Self-Management Education Participation Among US Adults With Arthritis: Who's Attending? Arthritis Care Res (Hoboken) 2017; 69:1322-1330. [PMID: 27748081 DOI: 10.1002/acr.23129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/16/2016] [Accepted: 10/11/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Self-management education (SME) programs teach people with chronic conditions skills to manage their health conditions. We examined patterns in SME program participation among US adults with arthritis ages ≥18 years. METHODS Respondents with arthritis were those who reported ever being diagnosed with arthritis by a doctor or health care provider. We analyzed 2014 National Health Interview Survey data to estimate the percentage (unadjusted and age-standardized) who ever attended an SME program overall and for selected subgroups, representativeness of SME participants relative to all adults with arthritis, and trends in SME course participation. RESULTS In 2014, 1 in 9 US adults with arthritis (11.3% [95% confidence interval (95% CI) 10.4-12.3]; age-standardized 11.4% [95% CI 10.0-12.9]) had ever participated in an SME program. SME participation (age-standardized) was highest among those with ≥8 health care provider visits in the past 12 months (16.0% [95% CI 13.1-19.4]). Since 2002, the number of adults with arthritis who have ever participated in SME has increased by 1.7 million, but the percentage has remained constant. CONCLUSION Despite its many benefits, SME participation among US adults with arthritis remains persistently low. By recommending that their patients attend SME programs, health care providers can increase the likelihood that their patients experience SME program benefits.
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Affiliation(s)
- Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa J Brady
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jin Qin
- Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated Projected Prevalence of Self-Reported Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation Among US Adults, 2015-2040. Arthritis Rheumatol 2017; 68:1582-7. [PMID: 27015600 DOI: 10.1002/art.39692] [Citation(s) in RCA: 317] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/17/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To update the projected prevalence of arthritis and arthritis-attributable activity limitations among US adults, using a newer baseline for estimates. METHODS Baseline prevalence data were obtained from the 2010-2012 National Health Interview Survey. Arthritis was defined as an answer of "yes" to the question "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?" Arthritis-attributable activity limitation was defined as an answer of "yes" to the question "Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?" The baseline prevalence of arthritis and arthritis-attributable activity limitation was stratified according to age and sex and was statistically weighted to account for the complex survey design. The projected prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation was calculated by multiplying the age- and sex-stratified population estimates projected for 2015-2040 (in 5-year intervals; provided by the US Census Bureau) by the baseline estimates. Age- and sex-specific prevalences were summed to provide the total prevalence estimates for each year. RESULTS In 2010-2012, 52.5 million adults in the US (22.7% of all adults) had doctor-diagnosed arthritis, and 22.7 million (9.8%) had arthritis-attributable activity limitation. By 2040, the number of US adults with doctor-diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of all adults), and the number of adults with arthritis-attributable activity limitation will increase 52% to 34.6 million (11.4% of all adults). CONCLUSION Updated projections suggest that arthritis and arthritis-attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs.
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Boring MA, Hootman JM, Liu Y, Theis KA, Murphy LB, Barbour KE, Helmick CG, Brady TJ, Croft JB. Prevalence of Arthritis and Arthritis-Attributable Activity Limitation by Urban-Rural County Classification - United States, 2015. MMWR Morb Mortal Wkly Rep 2017; 66:527-532. [PMID: 28542117 PMCID: PMC5657875 DOI: 10.15585/mmwr.mm6620a2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rural populations in the United States have well documented health disparities, including higher prevalences of chronic health conditions (1,2). Doctor-diagnosed arthritis is one of the most prevalent health conditions (22.7%) in the United States, affecting approximately 54.4 million adults (3). The impact of arthritis is considerable: an estimated 23.7 million adults have arthritis-attributable activity limitation (AAAL). The age-standardized prevalence of AAAL increased nearly 20% from 2002 to 2015 (3). Arthritis prevalence varies widely by state (range = 19%-36%) and county (range = 16%-39%) (4). Despite what is known about arthritis prevalence at the national, state, and county levels and the substantial impact of arthritis, little is known about the prevalence of arthritis and AAAL across urban-rural areas overall and among selected subgroups. To estimate the prevalence of arthritis and AAAL by urban-rural categories CDC analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS). The unadjusted prevalence of arthritis in the most rural areas was 31.8% (95% confidence intervals [CI] = 31.0%-32.5%) and in the most urban, was 20.5% (95% CI = 20.1%-21.0%). The unadjusted AAAL prevalence among adults with arthritis was 55.3% in the most rural areas and 49.7% in the most urban. Approximately 1 in 3 adults in the most rural areas have arthritis and over half of these adults have AAAL. Wider use of evidence-based interventions including physical activity and self-management education in rural areas might help reduce the impact of arthritis and AAAL.
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Affiliation(s)
- Michael A Boring
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Jennifer M Hootman
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kristina A Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Charles G Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Terry J Brady
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Theis KA, Brady TJ, Helmick CG. No One Dies of Old Age Anymore: A Coordinated Approach to Comorbidities and the Rheumatic Diseases. Arthritis Care Res (Hoboken) 2016; 69:1-4. [PMID: 27723262 DOI: 10.1002/acr.23114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 01/05/2023]
Affiliation(s)
| | - Teresa J Brady
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Shaw KM, Theis KA, Self-Brown S, Roblin DW, Barker L. Chronic Disease Disparities by County Economic Status and Metropolitan Classification, Behavioral Risk Factor Surveillance System, 2013. Prev Chronic Dis 2016; 13:E119. [PMID: 27584875 PMCID: PMC5008860 DOI: 10.5888/pcd13.160088] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Racial/ethnic disparities have been studied extensively. However, the combined influence of geographic location and economic status on specific health outcomes is less well studied. This study's objective was to examine 1) the disparity in chronic disease prevalence in the United States by county economic status and metropolitan classification and 2) the social gradient by economic status. The association of hypertension, arthritis, and poor health with county economic status was also explored. METHODS We used 2013 Behavioral Risk Factor Surveillance System data. County economic status was categorized by using data on unemployment, poverty, and per capita market income. While controlling for sociodemographics and other covariates, we used multivariable logistic regression to evaluate the relationship between economic status and hypertension, arthritis, and self-rated health. RESULTS Prevalence of hypertension, arthritis, and poor health in the poorest counties was 9%, 13%, and 15% higher, respectively, than in the most affluent counties. After we controlled for covariates, poor counties still had a higher prevalence of the studied conditions. CONCLUSION We found that residents of poor counties had a higher prevalence of poor health outcomes than affluent counties, even after we controlled for known risk factors. Further, the prevalence of poor health outcomes decreased as county economics improved. Findings suggest that poor counties would benefit from targeted public health interventions, better access to health care services, and improved food and built environments.
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Affiliation(s)
- Kate M Shaw
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E28, Chamblee, GA 30329-4027. . Dr Shaw is also affiliated with Georgia State University School of Public Health, Atlanta, Georgia
| | | | | | - Douglas W Roblin
- Georgia State University School of Public Health, Atlanta, Georgia
| | - Lawrence Barker
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Barbour KE, Lui LY, Nevitt MC, Murphy LB, Helmick CG, Theis KA, Hochberg MC, Lane NE, Hootman JM, Cauley JA. Hip Osteoarthritis and the Risk of All-Cause and Disease-Specific Mortality in Older Women: A Population-Based Cohort Study. Arthritis Rheumatol 2015; 67:1798-805. [PMID: 25778744 DOI: 10.1002/art.39113] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/10/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the risk of all-cause and disease-specific mortality among older women with hip osteoarthritis (OA) and to identify mediators in the causal pathway. METHODS Data were from the Study of Osteoporotic Fractures, a US population-based cohort study of 9,704 white women age ≥65 years. The analytic sample included women with hip radiographs at baseline (n = 7,889) and year 8 (n = 5,749). Mortality was confirmed through October 2013 by death certificates and hospital discharge summaries. Radiographic hip OA (RHOA) was defined as a Croft grade of ≥2 in at least 1 hip (definite joint space narrowing or osteophytes plus 1 other radiographic feature). RESULTS The mean ± SD followup time was 16.1 ± 6.2 years. The baseline and year 8 prevalence of RHOA were 8.0% and 11.0%, respectively. The cumulative incidence (proportion of deaths during the study period) was 67.7% for all-cause mortality, 26.3% for cardiovascular disease (CVD) mortality, 11.7% for cancer mortality, 1.9% for gastrointestinal disease mortality, and 27.8% for all other mortality causes. RHOA was associated with an increased risk of all-cause mortality (hazard ratio 1.14 [95% confidence interval 1.05-1.24]) and CVD mortality (hazard ratio 1.24 [95% confidence interval 1.09-1.41]) adjusted for age, body mass index, education, smoking, health status, diabetes, and stroke. These associations were partially explained by the mediating variable of physical function. CONCLUSION RHOA was associated with an increased risk of all-cause and CVD mortality among older white women followed up for 16 years. Dissemination of evidence-based physical activity and self-management interventions for hip OA in community and clinical settings can improve physical function and might also contribute to lower mortality.
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Affiliation(s)
| | - Li-Yung Lui
- California Pacific Medical Center, San Francisco
| | | | | | | | | | | | - Nancy E Lane
- University of California at Davis School of Medicine, Sacramento
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Qin J, Theis KA, Barbour KE, Helmick CG, Baker NA, Brady TJ. Impact of arthritis and multiple chronic conditions on selected life domains - United States, 2013. MMWR Morb Mortal Wkly Rep 2015; 64:578-82. [PMID: 26042649 PMCID: PMC4584769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
About half of U.S. adults have at least one chronic health condition, and the prevalence of multiple (two or more) chronic conditions increased from 21.8% in 2001 to 25.5% in 2012. Chronic conditions profoundly affect quality of life, are leading causes of death and disability, and account for 86% of total health care spending. Arthritis is a common cause of disability, one of the most common chronic conditions, and is included in prevalent combinations of multiple chronic conditions. To determine the impact of having arthritis alone or as one of multiple chronic conditions on selected important life domains, CDC analyzed data from the 2013 National Health Interview Survey (NHIS). Having one or more chronic conditions was associated with significant and progressively higher prevalences of social participation restriction, serious psychological distress, and work limitations. Adults with arthritis as one of their multiple chronic conditions had higher prevalences of adverse outcomes on all three life domains compared with those with multiple chronic conditions but without arthritis. The high prevalence of arthritis, its common co-occurrence with other chronic conditions, and its significant adverse effect on life domains suggest the importance of considering arthritis in discussions addressing the effect of multiple chronic conditions and interventions needed to reduce that impact among researchers, health care providers, and policy makers.
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Affiliation(s)
- Jin Qin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC,Epidemic Intelligence Service, CDC,Corresponding author: Jin Qin, , 770-488-4236
| | - Kristina A. Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kamil E. Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Charles G. Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Nancy A. Baker
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Teresa J. Brady
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Murphy LB, Helmick CG, Allen KD, Theis KA, Baker NA, Murray GR, Qin J, Hootman JM, Brady TJ, Barbour KE. Arthritis among veterans - United States, 2011-2013. MMWR Morb Mortal Wkly Rep 2014; 63:999-1003. [PMID: 25375071 PMCID: PMC5779484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Arthritis is among the most common chronic conditions among veterans and is more prevalent among veterans than nonveterans. Contemporary population-based estimates of arthritis prevalence among veterans are needed because previous population-based studies predate the Persian Gulf War, were small, or studied men only despite the fact that women comprise an increasing proportion of military personnel and typically have a higher prevalence of arthritis than men. To address this knowledge gap, CDC analyzed combined 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System (BRFSS) data among all adults aged ≥18 years, by veteran status, to estimate the total and sex-specific prevalence of doctor-diagnosed arthritis overall and by sociodemographic categories, and the state-specific prevalence (overall and sex-specific) of doctor-diagnosed arthritis. This report summarizes the results of these analyses, which found that one in four veterans reported that they had arthritis (25.6%) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories, including sex (prevalence among male and female veterans was 25.0% and 31.3%, respectively). State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia. Veterans comprise a large and important target group for reducing the growing burden of arthritis. Those interested in veterans' health can help to improve the quality of life of veterans by ensuring that they have access to affordable, evidence-based, physical activity and self-management education classes that reduce the adverse effects of arthritis (e.g., pain and depression) and its common comorbidities (e.g., heart disease and diabetes).
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Affiliation(s)
- Louise B. Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC,Corresponding author: Louise B. Murphy, , 770-488-5464
| | - Charles G. Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kelli D. Allen
- Health Services Research and Development Service, U.S. Department of Veterans Affairs Medical Center, Durham, North Carolina, and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Kristina A. Theis
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Nancy A. Baker
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Glen R. Murray
- Geographic Information Systems Laboratory, University of West Georgia
| | - Jin Qin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Jennifer M. Hootman
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Teresa J. Brady
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kamil E. Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Barbour KE, Hootman JM, Helmick CG, Murphy LB, Theis KA, Schwartz TA, Kalsbeek WD, Renner JB, Jordan JM. Meeting physical activity guidelines and the risk of incident knee osteoarthritis: a population-based prospective cohort study. Arthritis Care Res (Hoboken) 2014; 66:139-46. [PMID: 23983187 DOI: 10.1002/acr.22120] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/15/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a leading cause of disability and joint pain. Although other risk factors of knee OA have been identified, how physical activity affects incident knee OA remains unclear. METHODS Using data from the first (1999-2004) and second (2005-2010) followup periods of the Johnston County Osteoarthritis Project study, we tested the association between meeting physical activity guidelines and incident knee outcomes among 1,522 adults ages ≥45 years. The median followup time was 6.5 years (range 4.0-10.2 years). Physical activity at baseline (moderate-equivalent physical activity minutes/week) was calculated using the Minnesota Leisure Time Physical Activity questionnaire. Incident knee radiographic OA (ROA) was defined as the development of Kellgren/Lawrence grade ≥2 in a knee at followup. Incident knee symptomatic ROA (sROA) was defined as the development of ROA and symptoms in at least 1 knee at followup. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for interval-censored data. RESULTS In multivariable models, meeting the 2008 Department of Health and Human Services (HHS) physical activity guidelines (≥150 minutes/week) was not significantly associated with ROA (HR 1.20 [95% CI 0.92-1.56]) or sROA (HR 1.24 [95% CI 0.87-1.76]). Adults in the highest level (≥300 minutes/week) of physical activity had a higher risk of knee ROA and sROA compared with inactive (0 to <10 minutes/week) participants; however, these associations were not statistically significant (HR 1.62 [95% CI 0.97-2.68] and HR 1.42 [95% CI 0.76-2.65], respectively). CONCLUSION Meeting the HHS physical activity guidelines was not associated with incident knee ROA or sROA in a cohort of middle-aged and older adults.
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Affiliation(s)
- K E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Theis KA, Helmick CG, Hootman JM, Barbour KE. Physical activity among adults with arthritis. Prev Chronic Dis 2014; 11:E23. [PMID: 24556249 PMCID: PMC3938955 DOI: 10.5888/pcd11.140025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kristina A Theis
- Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy, Chamblee, GA 30341
| | - Charles G Helmick
- Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy, Chamblee, GA 30341
| | - Jennifer M Hootman
- Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy, Chamblee, GA 30341
| | - Kamil E Barbour
- Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy, Chamblee, GA 30341
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Barbour KE, Helmick CG, Theis KA, Murphy LB, Hootman JM, Brady TJ. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2010-2012. MMWR Morb Mortal Wkly Rep 2013; 62:869-73. [PMID: 24196662 PMCID: PMC4585589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Arthritis is the most common cause of disability among U.S. adults and is particularly common among persons with multiple chronic conditions. In 2003, arthritis in the United States resulted in an estimated $128 billion in medical-care costs and lost earnings. To update previous U.S. estimates of the prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation (AAAL), CDC analyzed 2010-2012 data from the National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which found that 52.5 million (22.7%) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 22.7 million (9.8%, or 43.2% of those with arthritis) reported AAAL, matching and exceeding previous projected increases, respectively. Among persons with heart disease, diabetes, and obesity, the prevalences of doctor-diagnosed arthritis were 49.0%, 47.3%, and 31.2%, respectively; the prevalences of AAAL among persons with these specific conditions were 26.8%, 25.7%, and 15.2%, respectively. Greater use of evidence-based interventions, such as chronic disease self-management education and physical activity interventions that have been proven to reduce pain and improve quality-of-life among adults with chronic diseases might help reduce the personal and societal burden of arthritis.
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Theis KA, Murphy L, Hootman JM, Wilkie R. Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability and Health. Arthritis Care Res (Hoboken) 2013; 65:1059-69. [PMID: 23401463 PMCID: PMC4466902 DOI: 10.1002/acr.21977] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 01/29/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine arthritis impact among US adults with self-reported doctor-diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR. METHODS Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of the ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated to identify the correlates of SPR. Analyses using SAS, version 9.2 survey procedures accounted for the complex sample design. RESULTS SPR prevalence was 11% of adults with arthritis (5.7 million). After initial multivariable adjustment by ICF domain, serious psychological distress (impairments domain; PR 2.5 [95% CI 2.0-3.2]), ≥5 medical office visits (environmental domain; PR 3.4 [95% CI 2.5-4.4]), and physical inactivity (personal domain; PR 4.8 [95% CI 3.6-6.4]) were most strongly associated with SPR. A combined measure (key limitations [walking, standing, or carrying]; PR 31.2 [95% CI 22.3-43.5]) represented the activity limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were key limitations (PR 24.3 [95% CI 16.8-35.1]), ≥9 hours of sleep (PR 1.6 [95% CI 1.3-2.0]), and income-to-poverty ratio <2.00 and severe joint pain (PR 1.4 [95% CI 1.2-1.6] for both). CONCLUSION SPR affects 1 of 9 adults with arthritis. This study is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas as priorities for intervention to reduce negative arthritis impacts on disability, including SPR. Increased use of existing clinical and public health interventions is warranted.
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Affiliation(s)
- K A Theis
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Murphy LB, Yelin E, Theis KA. Compromised access to prescriptions and medical care because of cost among US adults with arthritis. Best Pract Res Clin Rheumatol 2012; 26:677-94. [PMID: 23218431 DOI: 10.1016/j.berh.2012.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Study objectives were to: 1) determine the magnitude of three outcomes (prescription unaffordable, care delayed and needed care not obtained) related to cost-attributable compromised medical care access among US adults ≥18 years with and without arthritis and 2) identify US adults with arthritis with the highest levels of these outcomes. MATERIALS AND METHODS We analysed 2009-2011 US National Health Interview Survey data and estimated prevalence of outcomes by arthritis status and, among people with arthritis, by socio-demographic, medical care access and health status characteristics. Unadjusted and multivariable (MV) adjusted (prevalence ratios) PRs quantified associations between each outcome and arthritis status, and, among people with arthritis, selected characteristics. Number and proportion of adults with arthritis without health insurance coverage were estimated. RESULTS Outcomes were more prevalent (statistically-significant) among those with arthritis than those without: prescription unaffordable = 14% (9%), care delayed = 14% (11%) and needed care not obtained = 11% (8%). Outcomes were marginally more likely (statistically significant) among adults with arthritis than those without (range MV PRs = 1.2-1.3). Among those with arthritis, the uninsured had the highest prevalence of, and were most likely to have, each outcome (MV PRs: prescription unaffordable = 3.6 (95% confidence interval [CI] = 3.6-4.4), delayed care = 4.7 (95% CI = 3.9-5.7) and needed care not obtained = 5.9 (95% CI = 4.7-7.5) (referent: those with both public and private coverage)). An estimated 4.5 million adults with arthritis were uninsured. CONCLUSIONS Cost-attributable compromised access is common among US adults with arthritis; they are also slightly more likely than those without arthritis to have compromised care. Compromised access is highest among the uninsured. For those with limited access, convenient, inexpensive and proven community-based strategies that improve physical and psychosocial health may be especially practical.
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Affiliation(s)
- Louise B Murphy
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Theis KA, Furner SE. Shut-In? Impact of Chronic Conditions on Community Participation Restriction among Older Adults. J Aging Res 2011; 2011:759158. [PMID: 21837277 PMCID: PMC3151523 DOI: 10.4061/2011/759158] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/28/2011] [Indexed: 11/20/2022] Open
Abstract
Community participation may be especially important for older adults, who are often at risk for unwanted declines in participation. We estimated the prevalence of community participation restriction (PR) due to perceived environmental barriers among older adults (≥50 years) and compared the impact among those with selected chronic conditions. Individuals with low-prevalence conditions reported high community PR (9.1–20.4%), while those with highly prevalent conditions (e.g., arthritis) had relatively low community PR (5.1–10.0%) but represented the greatest absolute numbers of condition-associated burden (>1 million). Across all conditions, more than half of those with community PR reported being restricted “always or often.” Community PR most often resulted from modifiable environmental barriers. Promising targets to reduce community PR among adults ≥50 years with chronic conditions, particularly arthritis, include building design, sidewalks/curbs, crowd control, and interventions that improve the built environment.
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Affiliation(s)
- Kristina A Theis
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Theis KA, Murphy L, Hootman JM, Helmick CG, Sacks JJ. Arthritis restricts volunteer participation: Prevalence and correlates of volunteer status among adults with arthritis. Arthritis Care Res (Hoboken) 2010; 62:907-16. [DOI: 10.1002/acr.20141] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
A recent project to define public health priorities for end of life (EOL) recommends incorporating EOL principles in all state/territory/tribe Comprehensive Cancer Control (CCC) Plans. The degree to which EOL content is currently included in CCC Plans was assessed through a systematic review of CCC Plans, examining keywords, definitions, topics, data, goals, and strategies. Forty-five plans (42 state, 3 tribal) were eligible. Forty-one CCC Plans (91%) included the keyword "end-of-life." EOL goals were most often categorized as use of care, access to care, and awareness of EOL issues among patients/public and providers. The top EOL strategies were research, provider education, and patient/public education. The results establish a baseline of EOL content in CCC Plans and should help improve assistance in future CCC planning efforts.
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Affiliation(s)
- Kristina A Theis
- Division of Adult and Community Health, Centers For Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Theis KA, Murphy L, Hootman JM, Helmick CG, Yelin E. Prevalence and correlates of arthritis-attributable work limitation in the US population among persons ages 18-64: 2002 National Health Interview Survey Data. ACTA ACUST UNITED AC 2007; 57:355-63. [PMID: 17394215 PMCID: PMC2875147 DOI: 10.1002/art.22622] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the national prevalence of arthritis-attributable work limitation (AAWL) among persons ages 18-64 with doctor-diagnosed arthritis and examine correlates of AAWL. METHODS Using the 2002 National Health Interview Survey, we estimated the prevalence of AAWL (limited in whether individuals work, the type of work they do, or the amount of work they do) and correlates of AAWL in univariable and multivariable-adjusted logistic regression analyses. Survey data were analyzed in SAS and SUDAAN to account for the complex sample design. RESULTS A total of 5.3% of all US adults ages 18-64 reported AAWL; in this age group, AAWL is reported by approximately 30% of those who report arthritis. The prevalence of AAWL was highest among people ages 45-64 years (10.2%), women (6.3%), non-Hispanic blacks (7.7%), people with less than a high school education (8.6%), and those with an annual household income <$20,000 (12.6%). AAWL was substantially increased among people with arthritis-attributable activity limitations (multivariable-adjusted odds ratio [OR] 9.1, 95% confidence interval [95% CI] 7.1-11.6). The multivariable-adjusted likelihood of AAWL was moderately higher among non-Hispanic blacks (OR 1.6, 95% CI 1.2-2.3), Hispanics (OR 1.8, 95% CI 1.2-2.6), and people with high levels of functional/social/leisure limitations (OR 1.8, 95% CI 1.4-2.3) and was decreased among those with a college education (OR 0.6, 95% CI 0.4-0.8). CONCLUSION AAWL is highly prevalent, affecting millions of Americans and one-third of adults with doctor-diagnosed arthritis. Findings suggest the need for more targeted research to better understand the natural history, success of interventions, and effects of policy on AAWL. Public health interventions, including self-management education programs, may be effective in countering AAWL.
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Affiliation(s)
- Kristina A Theis
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Theis KA, Helmick CG, Hootman JM. Arthritis Burden and Impact are Greater among U.S. Women than Men: Intervention Opportunities. J Womens Health (Larchmt) 2007; 16:441-53. [PMID: 17521246 DOI: 10.1089/jwh.2007.371] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To summarize arthritis burden and impact among women compared with men, using updated surveillance and impact measures; to describe public health approaches to arthritis; and to review effective, evidence-based arthritis self-management interventions. RESULTS Arthritis continues to burden the U.S. population as the leading cause of physical disability and affects women disproportionately: women with arthritis report greater prevalence of activity and work limitations, psychological distress, and severe joint pain than their male counterparts. Three main public health interventions can reduce arthritis impact: self-management education, physical activity, and weight management. Self-management education programs are proven to reduce pain and depression, delay disability, improve self-efficacy, physical function, and quality of life, and reduce healthcare costs. Appropriate physical activity decreases pain, improves function, and delays disability. The American College of Rheumatology recommends maintaining a healthy weight to benefit patients with hip or knee osteoarthritis. Women appear more receptive to certain information delivery methods (i.e., physician counseling) than men, suggesting gender-specific targeting of interventions may be of use. CONCLUSIONS Effective interventions remain underused. The Centers for Disease Control and Prevention Arthritis Program and its partners, including state arthritis programs, continue their efforts to build the arthritis public health science base, monitor burden and impact, evaluate and disseminate evidence-based interventions, and work to decrease and delay disability, and increase quality of life among those with arthritis. As new approaches are developed, women and other disproportionately impacted groups merit particular consideration in tailoring and delivering programs to reduce arthritis burden.
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Affiliation(s)
- Kristina A Theis
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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