Arthritis Among Children and Adolescents Aged <18 Years

Abbreviation: GED = general educational development certificate.
*Respondent relationship to the child was defined as biologic or adoptive parent, stepparent, grandparent, foster parent, other relative, other nonrelative, or missing response.
^†Diagnosed arthritis was defined by answering "yes" to the question "Has a doctor or other health care provider ever told you that this child has arthritis?" The analyses excluded respondents who did not respond to the question: 216 (1.05%) during 2017, 398 (1.32%) during 2018, 289 (0.98%) during 2019, 456 (1.07%) during 2020, and 456 (0.90%) during 2021.
^§Categories might not sum to the respondent total because of missing responses for some characteristics.
^¶Weighted estimates generalize to state and national resident populations. https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/methodology/2017-NSCH-Methodology-Report.pdf; https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2018-NSCH-Methodology-Report.pdf; https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2019-NSCH-Methodology-Report.pdf; https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2020-NSCH-Methodology-Report.pdf; and https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2021-NSCH-Methodology-Report.pdf
**Cases per 100,000 U.S. children and adolescents aged <18 years.
^††Referent group for subgroup comparisons of arthritis prevalence.
^§§Estimate might be unreliable. The absolute CI width is >20%, or the relative CI width is >120% (1.2 times the estimate).
^¶¶T-tests were used to determine statistically significant differences in arthritis prevalence for subgroups defined by selected characteristics; differences with p≤0.05 were considered statistically significant.
***Race was recoded from responses to the question, "What is this child's race?" and included American Indian or Alaska Native, Black or African American, Native Hawaiian or other Pacific Islander, White, and two or more races. The 2017 and 2018 surveys included a response for "Some other race only," which are coded as missing. Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.
^†††Depression was defined by answering "yes" to the question, "Has a doctor or other health care provider ever told you that this child has depression?"
^§§§Anxiety was defined by answering "yes" to the question, "Has a doctor or other health care provider ever told you that this child has anxiety?"
^¶¶¶Heart condition was defined by answering "yes" to the question, "Has a doctor or other health care provider ever told you that this child has a heart condition?"
****Overweight was defined by answering yes to the question, "Has a doctor or other health care provider ever told you that this child is overweight?" The 2017 survey did not include this question.
^††††Physical activity was not asked of children aged ≤5 years old, and was determined by the question, "During the past week, on how many days did this child exercise, play a sport, or participate in physical activity for at least 60 minutes?"
^§§§§Place for routine preventive care was defined by answering "yes" to the question, "Is there a place this child usually goes when he or she needs routine preventive care, such as physical examination or well-child checkups?" Starting in 2020, the survey changed pronoun language from "he or she" to "they."
^¶¶¶¶Health insurance was determined by answering "yes" to the question, "Is this child currently covered by any kind of health insurance or health coverage plan?"
*****Parents' highest level of education attained: less than high school (i.e., 8th grade or less or 9th–12th grade, no diploma); high school (e.g., high school graduate or GED obtained or completed a vocational, trade, or business school program); some college or associate degree (e.g., some college credit, but no degree or associate degree [Associate of Arts or Associate of Science]); 4-year college degree or higher (e.g., bachelor's degree [Bachelor of Arts or Bachelor of Science]; master's degree [Master of Art, Master of Science, Master of Social Work, or Master of Business Administration]; doctorate [Doctor of Philosophy or Doctor of Education]; professional degree [Doctor of Medicine, Doctor of Dental Surgery, Doctor of Veterinary Medicine, or Juris Doctorate]).
^{†††††}Household food insecurity was defined by answering "Sometimes we could not afford enough to eat" or "often we could not afford enough to eat" to the question "Which of these statements best describes your household's ability to afford the food you need during the past 12 months?"
^§§§§§Home owned was defined by answering "yes" to either, "Is this house, apartment, or mobile home owned by you or someone in this household with a mortgage or loan?" or "Is this house, apartment, or mobile home owned by you or someone in this household free and clear (without a mortgage or loan)?" The 2017 survey did not collect data on homeownership.
^¶¶¶¶¶Smoking in household was defined by answering "yes" to the question, "Does anyone living in your household use cigarettes, cigars, or pipe tobacco?" or "Does anyone smoke inside your home?"

Authors and Disclosures

Tyler D. Lites, MPH^1,2, Anika L. Foster, DrPH¹, Michael A. Boring, MS³, Elizabeth A. Fallon, PhD¹, Erica L. Odom, DrPH¹ and Puja Seth, PhD<sup>1

1</sup>Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; ²Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee; ³ASRT Inc., Smyrna, Georgia.

Corresponding author
Tyler D. Lites, toi1@cdc.gov.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

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Summary

What is already known about this topic?

Arthritis affects persons of all ages; little is known about arthritis prevalence among children and adolescents aged <18 years.

What is added by this report?

Approximately 220,000 children and adolescents had arthritis during 2017–2021. Prevalence increased with age and was highest among those aged 12–17 years, non-Hispanic Black or African American children and adolescents, children and adolescents with anxiety or depression, those who were physically inactive, had overweight or a heart condition, or lived in a food-insecure or smoking household.

What are the implications for public health practice?

Self-management interventions, physical activity or weight control, screening and linking to mental health services, and equitable access to therapies might improve arthritis outcomes in children and adolescents.