Arthritis Program Health Disparities Activities

Addressing health disparities is a central focus of the strategic plans for both the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), as well as Healthy People 2010 and the National Arthritis Action Plan: A Public Health Strategy. In keeping with this aim the CDC Arthritis Program analyzes survey data to determine racial/ethnic and gender differences associated with arthritis prevalence, incidence, risk factors, and limitations. The Arthritis Program is engaged in extensive audience research, which involves systematic research and message-testing among diverse subgroups (racial/ethnic, socioeconomic, geographic, gender, age, disability status, risk status) of adults with arthritis to determine optimal messaging when promoting physical activity and self-management education.

Epidemiology/Research Activities

The prevalence of arthritis and its effects among Hispanic subgroups in the US

CDC studied the prevalence of arthritis and three arthritis-attributable effects among specific Hispanic subgroups in a nationally representative sample of U.S. adults (National Health Interview Survey data; 2002, 2003, 2006, and 2009 combined). An estimated 3.1 million Hispanics had arthritis. 

• Puerto Ricans reported the highest prevalence of arthritis (22%) and Cuban-Cuban/Americans the lowest (12%). 
• For all Hispanic subgroups, at least 1 in 5 reported an arthritis-attributable effect. Puerto Ricans reported the highest prevalence of both arthritis-attributable activity limitations (49%) and severe pain (44%) whereas Cuban-Cuban/Americans had the lowest prevalence of each (arthritis-attributable activity limitations=21%; severe pain=24%).
• Work limitations were most prevalent among Mexican-Americans (42%) and the least prevalent among Central/South Americans (33%). 

Results of the study indicate which Hispanic subgroups have a high burden of arthritis and could benefit from interventions that improve their quality of life.

Arthritis Conditions Health Effects Survey (ACHES)

The Arthritis Conditions Health Effects Survey (ACHES) was developed and funded by theCDC Arthritis Program. ACHES is an arthritis-specific nationally representative, random-digit-dialed telephone survey that collected information from 2,238 persons with arthritis or chronic joint symptoms ages 45 years or older between June 2005 and March 2006. The survey design included oversampling of Hispanics and Non-Hispanic blacks to allow more precise estimates to be generated for these two vulnerable population groups. Data were gathered on symptoms, limitations, levels of physical functioning, effects of arthritis on work, knowledge and attitudes about arthritis, self-management of arthritis, physical activity, anxiety and depression, and demographics. ACHES analyses are ongoing and have already identified substantial unmet need in current arthritis treatment which would be decreased by wider availability and uptake of evidence-based arthritis self-management education and physical activity programs.

Racial/Ethnic differences for the prevalence and impact of doctor-diagnosed arthritis

Arthritis is a large and growing problem for U.S. adults of all racial/ethnic groups, but the disabling effects of arthritis (e.g., arthritis-attributable activity limitations, work limitations, and severe pain) are disproportionately prevalent in racial/ethnic minorities. We are currently analyzing multiple years of data to produce the first ever prevalence estimates for Native Americans, Hispanic subgroups and Asian American. Results should be available in 2010. Read more.

State-specific prevalence data

State-level data broken down by race/ethnicity and gender is provided to state health departments and partners.

The Johnston County Osteoarthritis Project: Arthritis & Disability

The Johnston County Osteoarthritis Project (JCOP) is a unique, community-based, longitudinal study of approximately 3200 white and black residents aged 45 years and older from a transitioning rural-to-urban area of North Carolina. The study is designed to determine the risk factors associated with the prevalence, incidence, and progression of hip and knee osteoarthritis (OA)—the two most common and disabling types of arthritis. JCOP data was used in a recent CDC study reporting that a person’s lifetime risk for developing symptomatic knee osteoarthritis (OA) is nearly one in two, or 45%. The study authors also found that nearly 2 of 3 obese adults will develop painful knee osteoarthritis during their lifetime. Results from JCOP have and will continue to be instrumental in quantifying racial/ethnic disparities related to hip and knee OA.

Lupus Registries

This project develops two population-based registries to better define and monitor the incidence and prevalence of systemic lupus erythematosus and better characterize individuals with this rheumatic condition. Lupus Registries are working to document the incidence and prevalence of lupus among whites and blacks. Documentation efforts will be expanding to Hispanic, Asian American, American Indian and Alaskan Native populations. Read more.

Use of Complementary Therapies Among Hispanic and Non-Hispanic White Adults with Arthritis

The use of complementary and alternative therapies (CAM) is reported to be high among people with arthritis, but little information has been available on the use of CAM by Hispanic ethnicity. CDC funded a study to assess the use of CAM among predominantly urban Hispanic and non-Hispanic adults with doctor-diagnosed rheumatoid arthritis (RA), osteoarthritis (OA), or fibromyalgia. There were 612 adults with arthritis, who saw physicians in primary care clinics associated with the University of New Mexico, and were interviewed to determine their use of CAM; of those interviewed, 45% were Hispanic and 71% were female. Read more

Total Knee Replacements (TKR) and Race

Although whites and blacks have a comparable lifetime risk of symptomatic knee osteoarthritis (OA), blacks are less likely to undergo total knee replacements (TKR). TKRs are an important surgical intervention in reducing joint pain and restoring physical function in people with knee OA. Recognizing the substantial impact of TKR on reducing disability among people with painful knee osteoarthritis, the Healthy People 2010 working group adopted objective 2.6. "Eliminate racial disparities in the rate of total knee replacements among persons aged 65 years or older". We are generating race-specific TKR rates among US adults age ≥65 years using 2000 to 2006 Medicare claims data and determing whether the racial disparity in TKRs observed in 2000 has declined. Current baseline data quantifies and illustrates existing disparities in this area.

Information about the arthritis program’s health disparities programmatic activities is available.

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