Arthritis Afflicts Rural Residents Most

Norra MacReady

May 29, 2017

Arthritis afflicts more than 54 million American adults, but its burden falls most heavily on people living in rural areas, the authors of a new study report.

In a survey of people across the United States, nearly one in three adults in rural locations had arthritis, the most of any of the populations studied, and of those individuals, approximately one half said it limited their activities, Michael A. Boring, MS, from the Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues write.

These findings suggest that "rural residents should be targeted for interventions including physical activity and self-management education programs that help adults with arthritis manage their condition and reduce symptoms," the authors suggest in an article published in the May 26 issue of Morbidity and Mortality Weekly Report.

The findings also match the pattern established for other chronic health conditions, which similarly affect rural dwellers more than their urban counterparts.

Arthritis has long been recognized as one of the most common health conditions in the United States, but little is known about its prevalence across urban–rural areas and among certain subgroups, the authors explain. In addition, the effect of arthritis-attributable activity limitation (AAAL) has been unclear.

To learn more about the prevalence of arthritis and AAAL across urban–rural categories, the researchers analyzed data from the 2015 Behavioral Risk Factor Surveillance System, an ongoing, state-based, randomly dialled telephone survey of adults in the 50 states, the District of Columbia, and US territories.

To determine the prevalence of arthritis, the Behavioral Risk Factor Surveillance System asks respondents whether they have ever been told by a physician or other health professional that they have any form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. People who answer yes are then asked whether arthritis or joint symptoms limit their usual activities in any way. An affirmative answer is considered evidence of AAAL.

The researchers grouped respondents according to county, with each county placed in one of six geographic categories: large urban metropolitan (city), large fringe metropolitan (suburb), medium metropolitan, small metropolitan, micropolitan, and noncore (rural).

Of 426,361 people included in the survey, the unadjusted prevalence of arthritis was 20.5% among those living in urban areas (95% confidence interval [CI], 20.1% - 21.0%), rising progressively through the different categories to 31.8% (95% CI, 31.0% - 32.5%) among rural residents. The unadjusted prevalence of AAAL was lowest among urban dwellers, at 49.7% (95% CI, 48.3% - 51.1%), rising to 55.3% (95% CI, 54.0% - 56.6%) among those in rural areas.

The pattern was similar in analyses adjusted for three age categories (18 - 44 years, 45 - 64 years, and ≥65 years): arthritis prevalence was 20.0% (95% CI, 19.6% - 20.5%) among people in the most urban areas and 26.9% (95% CI, 26.2% - 27.5%) among those in the most rural locations. AAAL also followed this pattern, with a prevalence of 47.1% (95% CI, 44.9% - 49.3%) among the urban residents and 56.9% (95% CI, 54.6% - 59.2%) among the rural dwellers.

In all areas, arthritis prevalence also followed other patterns established for American adults: it was highest among women, older people, smokers, people with less education, and those who were less physically active or had a higher body mass index. In particular, it was high among people who were unemployed because of a disability, ranging from 42.3% (95% CI, 39.6% - 45.2%) among urban dwellers to 56.7% (95% CI, 53.2% - 60.2%) in rural areas.

These findings "[highlight] the need for evidence-based intervention approaches such as physical activity, self-management education, and vocational rehabilitation programs," the authors write. People in rural locations may be able to use self-directed versions of these programs such as Walk With Ease or the Arthritis Toolkit when direct access is limited. Also, local community organizations such as churches and county extension agents, which already work with rural populations, "might be able to collaborate to make the small-group versions of these low-cost programs more available." Changes in local land use, such as creating more parks and trails and building more sidewalks, is another way to promote more physical activity among people in rural areas.

Study limitations include reliance on self-reported diagnoses and health behaviors; surveillance only of a civilian, noninstitutionalized population; and a relatively low response rate among certain groups.

Nevertheless, the authors conclude, clinicians and community organizations "can help adults with arthritis in rural areas increase access to and participation in interventions that are proven to reduce pain, improve function and quality of life, and maintain workforce participation."

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2017;66:527-532. Full text

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