Arthritis Disproportionately Affects Certain Minorities

Megan Brooks

April 19, 2010

April 19, 2010 — The prevalence of arthritis is lower among blacks and Hispanics than among whites, but its effect, in terms of joint pain and physical and work limitations, is greater, according to a study published online April 15 in Preventing Chronic Disease.

The study team notes that past research exploring the prevalence and effect of arthritis has focused on large racial/ethnic groups (blacks, whites, Hispanics, and non-Hispanic "other"), and not on smaller non-Hispanic groups, "which is necessary to tailor arthritis interventions appropriately."

In the article, Julie Bolen, PhD, from the Centers for Disease Control and Prevention's Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, and colleagues provide updated and expanded estimates of physician-diagnosed arthritis and its effect on smaller racial/ethnic groups that had in previous studies been combined in a "non-Hispanic other" category.

The analysis was broken down into 6 racial/ethnic groups: non-Hispanic whites ("whites"), non-Hispanic blacks ("blacks"), Hispanics, American Indians/Alaska Natives (AI/AN), Asians and Pacific Islanders (API), and multiracial or "other" respondents (MRO).

For their research, Dr. Bolen's team combined data from the 2002, 2003, and 2006 National Health Interview Survey. The analysis included a total of 85,784 adults aged 18 years and older. Included were 54,493 whites, 12,063 blacks, 14,880 Hispanics, 391 AI/AN, 3009 API, and 948 MRO.

The overall age-adjusted prevalence of arthritis — defined as a "yes" answer 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?" — was 21.1% (95% confidence interval [CI], 20.7% - 21.4%).

The prevalence of arthritis differed among the 6 racial/ethnic groups. The estimated unadjusted prevalence and weighted population was

  • 23.8% (36 million) for whites

  • 19.4% (4.6 million) for blacks

  • 11.1% (2.9 million) for Hispanics

  • 25.2% (280,000) for AI/AN

  • 8.4% (667,000) for API

  • 20.7% (469,000) for MRO

Arthritis prevalence was significantly higher among individuals aged 45 years and older, women, the obese, and those with less education.

Among adults with arthritis, the overall age-adjusted prevalence of activity limitation was 35.8% (95% CI, 34.8% - 36.9%). Those who reported activity limitation responded "yes" to the question, "Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?"

Among working-age adults (age, 18 - 64 years) with arthritis, 30.8% (95% CI, 29.6% - 32.1%) reported work limitation, answering "yes" to the question, "Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?"

Severe joint pain during the previous month was reported by 25.4% (95% CI, 24.3% - 26.5%) of adults with arthritis. These individuals had a rating of 7 to 10 on a scale assessing average pain in the last 30 days, with 0 being no pain and 10 being worst pain.

The prevalences of activity limitation, work limitation, and joint pain were significantly higher among blacks, Hispanics, and MRO than among whites, AI/AN, and API, the investigators report.

These results, they point out, indicate that arthritis affects some racial/ethnic groups disproportionately. "For example, the prevalence of arthritis is lower among blacks and Hispanics than among whites, but impact is worse."

"Our findings can be used to develop effective and culturally sensitive interventions that can be tailored to these populations," Dr. Bolen and colleagues conclude.

"We must address these stark differences in arthritis impact by using what we know,'' Jennifer M. Hootman, PhD, Centers for Disease Control and Prevention epidemiologist and coauthor of the report, added in a written statement. "We can educate those with arthritis about increasing physical activity and self-management and reducing obesity, especially those in groups bearing a disproportionate burden from arthritis."

The reasons for the racial/ethnic differences noted are unknown and "merit further investigation," the study team notes in their report. They may be related to access to, or use of, health services, as well as language barriers and cultural differences. Willingness to report limitations and pain and variations in patterns of medication use and approaches to pain management may also play a role.

Limitations of the current study, the investigators say, include self-reports of arthritis (unconfirmed by a physician); that Hispanics and blacks report less access to healthcare than do whites and may be less likely to be diagnosed with arthritis, resulting in an underestimate of the prevalence of arthritis in these populations; and the small number of AI/AN, API, and MRO in the sample. Strengths of the study include the large sample size, impact measures important to people with arthritis, and data to classify respondents into 6 racial/ethnic groups.

Prev Chronic Dis. Published online April 15, 2010.

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