Abstract
Arthritis is a predominant cause of disability in the United States, imposing substantial economic burdens and public health challenges. This study aimed to analyze the trends and disparities in the prevalence of arthritis among US adults from 2019 to 2022. The National Health Interview Survey (NHIS) database of the Center for Disease Control and Prevention was analyzed, employing Joinpoint regression analysis for determining annual percentage changes (APCs) and prevalence percentages with 95% confidence intervals (CI). The prevalence of diagnosed arthritis among US adults remained relatively stable and slightly increased from 21.4% (95% CI: 20.9, 22.0) in 2019 to 21.6% (95% CI: 21.0, 22.2) in 2022 (APC: 0.4698; 95% CI: ‐1.0841, 2.0577). Females had a higher prevalence, which also increased from 24.3% to 25.0% (APC: 1.0218; 95% CI: ‐0.4408, 2.5223) with male prevalence ranging from 18.3% to 18.0% (APC: ‐0.3254; 95% CI: ‐2.6590, 2.0817). Age-related differences were particularly evident, with rates peaking in individuals aged ≥ 75 years at 53.9% in 2022. Racial disparities were observed, with White adults having a higher prevalence each year (23.8% in 2022). Geographic factors influenced prevalence, with higher rates noted in areas outside metropolitan areas and in the Midwest. Analysis of the NHIS database indicated a slight rise in arthritis prevalence overall, accompanied by notable demographic disparities. These results emphasize the necessity for tailored public health interventions and efficient disease management approaches tailored to specific populations.
Keywords: arthritis, disparities, NHIS, prevalence, trends, United States adults
1. Introduction
Arthritis, defined as inflammation of joints, refers to a group of rheumatic and related conditions associated with pain, swelling, and stiffness of joints.[1] The intra-articular inflammation in arthritis may involve cartilage, synovium, and supporting structures. It remains a significant contributor to disability worldwide. Based on the underlying pathophysiology, arthritis can be classified into 2 major categories: inflammatory and noninflammatory. Various mechanisms, including autoimmune (rheumatoid, psoriatic, and ankylosing spondylitis), infectious (septic arthritis), and crystal deposition (pseudogout, gout), may lead to inflammatory arthritis. It is typically associated with the classic pentad of inflammation: pain, erythema, swelling, warmth, and loss of function, and can be further subclassified as seropositive and seronegative arthritis. On the other hand, noninflammatory arthritis mainly includes osteoarthritis, which results from progressive degeneration.[2,3]
The global prevalence and trends in arthritis vary depending upon the type. In 2020, the global prevalence of osteoarthritis was reported as 7.6% (595 million) with an increase of 132.2% since 1990.[4] Similarly, 17.6 million cases of rheumatoid arthritis were reported in 2020, affecting <1 percent of the population. Relative to 1990, a rising trend was observed, with an increase of 48 to 95 percent reported depending upon joint involvement.[5] A similar rising pattern was also observed across gouty arthritis, with an incidence rate increase of 64.4 percent reported between 1990 and 2019.[6] Compared to the global image the age-adjusted prevalence of osteoarthritis and rheumatoid arthritis in the United States (US) during 1999 to 2014 was estimated to be 9.7% and 4.2%, respectively, with the overall prevalence being 24.7%.[7] Park et al also reported a decreasing trend in the prevalence of rheumatoid arthritis, whereas the opposite was noted for osteoarthritis.[7,8]
The geographical variation in the prevalence and incidence of osteoarthritis can be explained by variability in the distribution of risk factors including gender, obesity, age, and regional characteristics.[9] The factors contributing to the development of rheumatoid arthritis include smoking, physical activity, weight, socioeconomic status, education level, and race.[10] On the other hand, the incidence of psoriatic arthritis events per 100 psoriasis patient years is approximately 2.9, with skin pathology severity, family history, unspecified rheumatism, female gender, and comorbidities identified as predisposing factors.[11]
The incremental rise in the social risk factors in the US encompasses food and financial insecurities, access to healthcare services, lack of safe neighborhoods, and housing insecurity, which is related to a greater burden of arthritis in the country.[12] Consequently, the economic impact of osteoarthritis and rheumatoid arthritis, including direct and indirect costs, is substantial.[13,14]
In addition to the lack of evidence regarding the more recent trends in arthritis prevalence, the current literature does not account for the changes in data collection approaches during the COVID-19 pandemic. Nevertheless, the National Health Interview Survey (NHIS) was redesigned in 2019, necessitating an updated analysis of the reported data. Hence, understanding the incidence and prevalence trends of arthritis in the US is crucial to health policies and resource allocation. In this study, we aim to examine the prevalence trends and disparities of arthritis in the US adult population between 2019 and 2022.
2. Materials and methods
2.1. Data source
The data for this study was obtained from the Interactive Summary Health Statistics for Adults, based on the NHIS conducted by the Centers for Disease Control and Prevention and the National Center for Health Statistics. We used annual NHIS data from 2019 to 2022, which provides national estimates of various health outcomes for the US civilian noninstitutionalized population aged 18 years and older. The NHIS employs a cross-sectional household interview survey design and uses geographically clustered sampling techniques to obtain nationally representative estimates. Data collection is conducted using computer-assisted personal interviewing, with telephone interviews utilized during COVID-19 and for follow-up cases when an interview was not completed in person on the initial visit.[15,16]
2.2. Study population
The study population included US adults aged 18 and above who participated in the NHIS between 2019 and 2022. All respondents were interviewed once per survey year, with no follow-up interviews. The NHIS excludes active-duty military personnel, civilians living on military bases, and individuals in institutional settings such as nursing homes or prisons. The target population was representative of the US civilian noninstitutionalized population across all 50 states and the District of Columbia.[15]
2.3. Variables and measures
The primary outcome was the self-reported diagnosis of arthritis, which includes conditions such as rheumatoid arthritis, gout, lupus, and fibromyalgia. Respondents were classified as having an arthritis diagnosis if a doctor or other health professional had ever informed them that they had any of these conditions. This definition of doctor-diagnosed arthritis aligns with the 1994 public health description of arthritis developed by the National Arthritis Data Workgroup and has been cognitively tested and validated for population surveillance purposes.[17,18]
The data were stratified by demographic and socioeconomic characteristics, including year, gender, age, race/ethnicity, employment status, veteran status, nativity, region, social vulnerability index (SVI), and metropolitan statistical area (MSA) status. The demographic variables used were based on information obtained from the Household Roster, Sample Adult, and Sample Child components of the NHIS.[15]
2.4. Statistical analysis
We calculated the annual prevalence of arthritis diagnosis among US adults, presenting results as unadjusted (crude) percentages with corresponding 95% confidence intervals (CIs). Prevalence estimates were stratified by gender, race/ethnicity, age, veteran status, SVI, employment status, nativity, region, and MSA status.
Joinpoint regression analysis was used to evaluate trends in the annual percentage change (APC) in arthritis prevalence across demographic subgroups. We calculated the APC for each year, focusing on gender, race/ethnicity, region, and MSA, with statistical significance determined using 95% CIs. A weighted least squares method was applied to estimate APC for each line segment. A two-sided Monte Carlo Permutation test was used to calculate P-values where a P-value < .05 suggested that the APC differs from zero and the difference is statistically significant. Additionally, P-values between individual years were calculated using a Z-test, with a P-value < .05 considered statistically significant.
2.5. Weighting and variance estimation
NHIS data are weighted to produce nationally representative estimates. Sampling weights account for the complex survey design, including clustered sampling, differential probabilities of selection, and nonresponse adjustments. The weights were further calibrated to US Census Bureau population projections and American Community Survey 1-year estimates, ensuring that the data remained representative of the US population by age, sex, race/ethnicity, and other demographic characteristics. Variance estimates were generated using Taylor Series Linearization to adjust for the complex survey design, providing accurate estimates of the variability of the health outcomes.[15]
2.6. Data availability
All data used in this study are publicly available through the Centers for Disease Control and Prevention’s Interactive Summary Health Statistics for Adults query tool, which can be accessed at: https://wwwn.cdc.gov/NHISDataQueryTool/SHS_adult/index.html
3. Results
3.1. Diagnosed arthritis prevalence rates stratified by sex and age
Among US adults aged 18 and over, the prevalence of diagnosed arthritis remained relatively consistent, increasing from around 21.4% (95% CI: 20.9, 22.0) in 2019 to 21.6% (95% CI: 21.0, 22.2) in 2022 with annual trend analysis showing an insignificant change. (APC: 0.4698, 95% CI: ‐1.0841 to 2.0577). The narrow confidence intervals reflect consistent survey methodologies and stable disease rates. Female adults consistently showed higher diagnosed arthritis prevalence than males, increasing from 24.3% (95% CI: 23.6, 25.1) in 2019 to 25.0% (95% CI: 24.2, 25.8) in 2022. Contrastingly, male prevalence was lower, ranging from 18.3% (95% CI: 17.6, 19.0) in 2019 to 18.0% (95% CI: 17.3, 18.8) in 2022. However, both genders showed insignificant changes on annual trend analysis with males revealing an insignificant decrease while females demonstrated a nonsignificant increase over time (male APC: ‐0.3254, 95% CI: ‐2.6590 to 2.0817; female APC: 1.0218, 95% CI: ‐0.4408 to 2.5223). Diagnosed arthritis prevalence sequentially increased with age, peaking at 53.9% (95% CI: 52.0, 55.8) for those 75 and older in 2022. A significant decrease in prevalence was observed for individuals aged between 18 and 44 years from 6.2% (95%CI: 5.7, 6.7) in 2019 to 5.3% (95% CI: 4.8, 5.9) in 2020 followed by a significant increase from 5% (95% CI: 4.6, 5.5) to 6% (95%CI: 5.5, 6.5) between 2021 and 2022, respectively (Table 1, Fig. 1, and Table S1, Supplemental Digital Content, http://links.lww.com/MD/O565).
Table 1.
Prevalence percentage of diagnosed arthritis for adults aged 18 and over, United States, 2019–2022.
| Variable | Year | Prevalence % (95% confidence intervals) | P-value* |
|---|---|---|---|
| Total % | 2019 | 21.4 (20.9, 22.0) | – |
| 2020 | 20.9 (20.3, 21.5) | 0.229 | |
| 2021 | 21.3 (20.7, 21.8) | 0.335 | |
| 2022 | 21.6 (21.0, 22.2) | 0.470 | |
| Male | 2019 | 18.3 (17.6, 19.0) | – |
| 2020 | 17.5 (16.7, 18.3) | 0.140 | |
| 2021 | 17.8 (17.1, 18.6) | 0.592 | |
| 2022 | 18 (17.3, 18.8) | 0.712 | |
| Female | 2019 | 24.3 (23.6, 25.1) | – |
| 2020 | 24.1 (23.3, 24.9) | 0.721 | |
| 2021 | 24.5 (23.7, 25.3) | 0.488 | |
| 2022 | 25 (24.2, 25.8) | 0.386 | |
| 18–44 years | 2019 | 6.2 (5.7, 6.7) | – |
| 2020 | 5.3 (4.8, 5.9) | 0.018 | |
| 2021 | 5 (4.6, 5.5) | 0.408 | |
| 2022 | 6 (5.5, 6.5) | 0.004 | |
| 45–64 years | 2019 | 25.9 (24.9, 26.9) | – |
| 2020 | 25.5 (24.5, 26.6) | 0.589 | |
| 2021 | 25.9 (24.9, 27.0) | 0.598 | |
| 2022 | 25.7 (24.7, 26.8) | 0.792 | |
| 65–74 years | 2019 | 44.7 (43.1, 46.3) | – |
| 2020 | 44.1 (42.4, 45.8) | 0.614 | |
| 2021 | 44.2 (42.5, 45.9) | 0.935 | |
| 2022 | 44 (42.4, 45.5) | 0.865 | |
| 75 years and over | 2019 | 52.2 (50.2, 54.1) | – |
| 2020 | 51.1 (49.0, 53.1) | 0.446 | |
| 2021 | 53.8 (52.0, 55.7) | 0.055 | |
| 2022 | 53.9 (52.0, 55.8) | 0.941 | |
| White, single race | 2019 | 23.3 (22.7, 23.9) | – |
| 2020 | 23 (22.4, 23.7) | 0.506 | |
| 2021 | 23.3 (22.6, 23.9) | 0.522 | |
| 2022 | 23.8 (23.1, 24.5) | 0.305 | |
| Black or African American, single race | 2019 | 20 (18.6, 21.5) | – |
| 2020 | 20 (18.2, 21.8) | 1.000 | |
| 2021 | 20.5 (18.8, 22.2) | 0.692 | |
| 2022 | 19.6 (18.2, 21.1) | 0.430 | |
| American Indian or Alaska native, single race | 2019 | 19.4 (12.7, 27.8) | – |
| 2020 | 18.5 (13.8, 24.0) | 0.846 | |
| 2021 | 20.7 (13.9, 29.0) | 0.636 | |
| 2022 | 21.2 (15.7, 27.6) | 0.919 | |
| Asian, single race | 2019 | 10.4 (8.6, 12.4) | – |
| 2020 | 9.7 (8.1, 11.6) | 0.595 | |
| 2021 | 10.8 (9.2, 12.6) | 0.377 | |
| 2022 | 12.2 (10.4, 14.1) | 0.275 | |
| Hispanic or Latino | 2019 | 12.2 (11.1, 13.5) | – |
| 2020 | 12 (10.8, 13.3) | 0.821 | |
| 2021 | 12.8 (11.6, 14.0) | 0.366 | |
| 2022 | 12.4 (11.2, 13.6) | 0.644 | |
| US-born | 2019 | 23.3 (22.7, 23.9) | – |
| 2020 | 22.8 (22.2, 23.4) | 0.248 | |
| 2021 | 23.1 (22.4, 23.7) | 0.506 | |
| 2022 | 23.4 (22.8, 24.0) | 0.506 | |
| Foreign-born | 2019 | 13.1 (11.9, 14.3) | – |
| 2020 | 12.5 (11.3, 13.8) | 0.497 | |
| 2021 | 13.3 (12.2, 14.5) | 0.356 | |
| 2022 | 14 (12.8, 15.3) | 0.419 | |
| Veteran | 2019 | 36 (33.9, 38.1) | – |
| 2020 | 35.1 (33.0, 37.2) | 0.553 | |
| 2021 | 35.3 (33.3, 37.4) | 0.894 | |
| 2022 | 34.3 (32.2, 36.5) | 0.509 | |
| Nonveteran | 2019 | 20.1 (19.5, 20.6) | – |
| 2020 | 19.7 (19.1, 20.3) | 0.335 | |
| 2021 | 20.1 (19.6, 20.7) | 0.335 | |
| 2022 | 20.6 (20.1, 21.2) | 0.208 | |
| Large MSA | 2019 | 18.2 (17.5, 18.9) | – |
| 2020 | 18 (17.3, 18.7) | 0.692 | |
| 2021 | 18.8 (18.1, 19.5) | 0.113 | |
| 2022 | 18.6 (17.9, 19.3) | 0.692 | |
| Small MSA | 2019 | 23.6 (22.5, 24.7) | – |
| 2020 | 22.8 (21.8, 23.9) | 0.302 | |
| 2021 | 22.5 (21.4, 23.6) | 0.699 | |
| 2022 | 23.8 (22.7, 24.9) | 0.101 | |
| Not in MSA | 2019 | 28.9 (27.4, 30.4) | – |
| 2020 | 28.1 (26.1, 30.2) | 0.537 | |
| 2021 | 28.8 (26.9, 30.8) | 0.628 | |
| 2022 | 28.9 (27.2, 30.7) | 0.940 | |
| Northeast | 2019 | 22.3 (20.9, 23.7) | – |
| 2020 | 20.9 (19.6, 22.2) | 0.151 | |
| 2021 | 21.1 (19.7, 22.6) | 0.840 | |
| 2022 | 21.2 (19.8, 22.7) | 0.924 | |
| Midwest | 2019 | 23 (21.7, 24.3) | – |
| 2020 | 22.4 (21.2, 23.6) | 0.506 | |
| 2021 | 23.7 (22.5, 24.9) | 0.133 | |
| 2022 | 23.2 (21.9, 24.4) | 0.572 | |
| South | 2019 | 21.9 (21.0, 22.8) | – |
| 2020 | 21.7 (20.8, 22.7) | 0.765 | |
| 2021 | 22 (21.1, 23.0) | 0.662 | |
| 2022 | 21.9 (21.0, 22.8) | 0.881 | |
| West | 2019 | 18.6 (17.5, 19.7) | – |
| 2020 | 18.2 (17.1, 19.5) | 0.630 | |
| 2021 | 18.1 (17.1, 19.2) | 0.902 | |
| 2022 | 20.1 (18.9, 21.3) | 0.014 | |
| Little to no social vulnerability | 2019 | 21.9 (20.6, 23.2) | – |
| 2020 | 20.8 (19.5, 22.1) | 0.241 | |
| 2021 | 22 (20.7, 23.3) | 0.201 | |
| 2022 | 22.7 (21.1, 24.3) | 0.506 | |
| Low social vulnerability | 2019 | 20.3 (19.2, 21.4) | – |
| 2020 | 21 (19.9, 22.2) | 0.389 | |
| 2021 | 21.6 (20.4, 22.7) | 0.470 | |
| 2022 | 22 (20.8, 23.2) | 0.637 | |
| Medium social vulnerability | 2019 | 22.5 (21.5, 23.5) | – |
| 2020 | 21.3 (20.2, 22.3) | 0.105 | |
| 2021 | 21.2 (20.2, 22.1) | 0.890 | |
| 2022 | 22.7 (21.5, 23.9) | 0.055 | |
| High social vulnerability | 2019 | 20.9 (19.7, 22.2) | – |
| 2020 | 20.4 (18.9, 21.8) | 0.609 | |
| 2021 | 20.5 (19.2, 21.9) | 0.921 | |
| 2022 | 20 (19.0, 21.0) | 0.560 | |
| Employed | 2019 | 12.6 (12.1, 13.2) | – |
| 2020 | 12.4 (11.8, 13.0) | 0.630 | |
| 2021 | 12.7 (12.1, 13.3) | 0.488 | |
| 2022 | 13 (12.4, 13.6) | 0.488 | |
| Not employed | 2019 | 37.3 (36.2, 38.4) | – |
| 2020 | 34.5 (33.4, 35.6) | 0.0004 | |
| 2021 | 35.5 (34.4, 36.5) | 0.197 | |
| 2022 | 36.8 (35.8, 37.8) | 0.079 |
All bold P values indicate P < .05 reaching the required statistical significance threshold.
MSA = metropolitan statistical area.
P-values represent changes in prevalence from 2019–2020, 2020–2021 to 2021–2022 respectively for each group.
Figure 1.
Overall and gender stratified Annual Percentage Change of Diagnosed Arthritis for adults 18 and over in the United States 2019–2022.
3.2. Diagnosed arthritis prevalence rates stratified by race
Non-Hispanic White adults consistently had higher prevalence rates than other racial groups, peaking at 23.8% (95% CI: 23.1, 24.5) in 2022. On the other hand, Asian adults exhibited the lowest rates but experienced an increase from 10.4% (95% CI: 8.6–12.4) in 2019 to 12.2% (95% CI: 10.4–14.1) in 2022. Notably, American Indians or Alaska natives also exhibited an increasing trend, rising from 19.4% (95% CI: 12.7–27.8) to 21.2% (95% CI: 15.7–27.6) throughout the study period. In the annual trend analysis, Whites, Asians, and Hispanics or Latinos showed insignificant increases in prevalence over time, while Blacks or African Americans depicted nonsignificant decreases. Contrastingly, a significant overall increase was evident in American Indians or Alaska natives (White APC: 0.7695, 95% CI: ‐1.1192 to 2.7360; Black or African American APC: ‐0.3585, 95% CI: ‐2.4745 to 1.8165; Asian APC: 6.0384, 95% CI: 0.0434 to 7.7544; Hispanic or Latino APC: 1.1396, 95% CI: ‐2.5178 to 4.9298; American Indian or Alaska Native APC: 3.8580, 95% CI: 0.0434 to 7.7544) (Table 1, Fig. 2, and Table S1, Supplemental Digital Content, http://links.lww.com/MD/O565).
Figure 2.
Race stratified Annual Percentage Change of Diagnosed Arthritis for adults 18 and over in the United States 2019–2022.
3.3. Diagnosed arthritis prevalence rates stratified by geography
Diagnosed arthritis prevalence varied by MSA, with non-MSA areas showing the highest prevalence with consistent rates of 28.9% (95% CI: 27.2, 30.7) through the study period. Stratifying according to census regions the Midwest saw the highest rates with the West presenting the lowest annually but with a noticeable increase from 18.6% (95% CI: 17.5, 19.7) to 20.1% (95% CI: 18.9, 21.3). Increases from 18.1% (17.1, 19.2) to 20.1% (18.9, 21.3) between 2021 and 2022 were significant in the West. On trend analysis, an overall increase in prevalence was noted for the Midwest, South, and West in addition to a decrease observed in the Northeast. However, none of these changes attained statistical significance (Northeast APC: ‐1.4123, 95% CI: ‐4.3529 to 1.6584; Midwest APC: 0.8273, 95% CI: ‐2.6794 to 4.4750; South APC: 0.1374, 95% CI: ‐0.5135 to 0.7992; West APC: 2.2976, 95% CI: ‐4.1076 to 9.1999) (Table 1, Figs. 3 and 4, Table S1, Supplemental Digital Content, http://links.lww.com/MD/O565).
Figure 3.
Metropolitan statistical area stratified Annual Percentage Change of Diagnosed Arthritis for adults 18 and over in the United States 2019–2022.
Figure 4.
Census region stratified Annual Percentage Change of Diagnosed Arthritis for adults 18 and over in the United States 2019–2022.
3.4. Diagnosed arthritis prevalence rates stratified by sociodemographic
Prevalence of diagnosed arthritis varied with social vulnerability with groups showing minor changes in prevalence across the study period. However those with low social vulnerability saw a noteworthy increase from 20.3 (95% CI: 19.2, 21.4) in 2019 to 22% (95% CI: 20.8, 23.2) in 2020. Employed individuals had dramatically lower prevalence rates than the unemployed, with a gap from 12.6% (95% CI: 12.1, 13.2) in 2019 to 13% (95% CI: 12.4, 13.6) in 2022, versus 37.3% (95% CI: 36.2, 38.4) to 36.8% (95% CI: 35.8, 37.8) for the unemployed. Additionally, employed individuals showed a significant decrease from 37.3% (95% CI: 36.2, 38.4) in 2019 to 34.5% (95% CI: 33.4, 35.6) in 2020. Veterans had generally higher prevalence rates than nonveterans, though it decreased from 36% (95% CI: 33.9, 38.1) in 2019 to 34.3% (95% CI: 32.2, 36.5) in 2022, still higher than the 20.1% (95% CI: 19.5, 20.6) to 20.6% (95% CI: 20.1, 21.2) for nonveterans. Foreign-born individuals reported nearly half the prevalence rates compared to US-born (Table 1).
4. Discussion
The findings of this study indicated that the prevalence of arthritis in the US increased yet remained relatively stable during 2019 to 2022. The prevalence of arthritis was relatively greater among females and older adults. The findings of the NHIS database analysis also indicated racial, geographic, and social disparities in the prevalence of arthritis among US adults. While Whites have a greater prevalence of arthritis each year, Asians, American Indians, and Alaskan natives demonstrated an increase in the prevalence of arthritis during the year 2022. This study unveiled significant disparities among the residents of nonmetropolitan areas and in the Midwest. Moreover, a higher prevalence of diagnosed arthritis was observed in unemployed, veterans, US-born individuals, and individuals with medium SVI.
The findings of this study are consistent with a recent NHIS database study conducted by Fallon et al, which suggested an estimated prevalence of 21.2% during 2019 to 2021. Our study demonstrated an increase in the prevalence of diagnosed arthritis from 21.4% to 21.6% between 2019 and 2022.[19] Conversely, the 2019 to 2021 and 2019 to 2022 NHIS prevalence estimates are lower compared to the 2016 to 2018 NHIS prevalence estimate of 23.7%.[20] However, the statistical comparison of the NHIS survey estimates before and after 2019 is not validated, given that the survey underwent redesigning in 2019.[19,21] The projected prevalence of diagnosed arthritis is approximately 49% by the year 2040, with a concomitant increase in the prevalence of adults with activity limitations attributed to arthritis.[22,23] Another US adult survey of the prevalence of arthritis and osteoarthritis further demonstrated rising trends in the disease prevalence,[24] with significant racial, age-related, gender-related, geographic, and socioeconomic variations across the national adult population.
Similar to previous studies,[25] the prevalence of arthritis was higher in adults aged ≥ 75 years. One of the most prevalent joint disorders, osteoarthritis, involves half of the global population aged ≥ 65 years. Clinical osteoarthritis has a strong correlation with frailty and pre-frailty in the older population, with higher mortality rates in this population.[26,27] Osteoarthritis and frailty are found to be associated with challenges in receiving care and self-care.[28] The disproportionately greater prevalence of arthritis in women compared to men can be attributed to high levels of physical activity among men,[29] and menopause in women.[9] Research has also demonstrated that females are also likely to develop rheumatoid arthritis and peripheral psoriatic arthritis.[30,31]
Compared to other racial or ethnic groups, Whites have a greater prevalence of psoriatic arthritis,[32] ankylosing spondylitis,[32] and osteoarthritis,[33] however, Black US adults have a greater prevalence of rheumatoid arthritis.[33] On the contrary, based on the socioeconomic perspective, Black individuals with high socioeconomic status have greater unmet health needs compared to their high-income White counterparts, indicating racial disparities in the burden of obesity, which further leads to the racial gap in the burden of osteoarthritis.[34] Based on the findings of a recent US real-world database analysis, African Americans have greater stratified risk of psoriatic arthritis based on more frequent relevant comorbidities and increased use of disease-modifying antirheumatic drugs compared to Caucasians.[35] Regarding rheumatoid arthritis, in addition to increased disease prevalence, Blacks are prone to greater disease severity due to relatively less likelihood of receiving early treatment compared to their White counterparts.[33]
Similar to the findings of our study which demonstrated that the prevalence of arthritis among Alaskan natives and American Indians increased during the study period, Wise et al demonstrated a significantly higher age-adjusted prevalence of arthritis among these populations, according to NHIS 2019 data.[36] These differences can be explained by the cultural beliefs regarding arthritis, disease awareness among patients and physicians, and access to healthcare services. In particular, the American Indian population was found to minimize the pain described to their physician owing to cultural norms. Moreover, American Indians are more frequent recipients of traditional healing practices.[37]
Our study demonstrated that nonmetropolitan area and Midwest region residents had a greater prevalence of arthritis compared to individuals residing in other US regions and in metropolitan areas. The greater prevalence of arthritis in rural and remote areas can be explained by geographical impacts on diagnostic time, patient follow-up, access to healthcare specialists and healthcare services, and variability in the utilization and access to pharmacological treatments.[38] The rural–urban variation and geographic disparities in arthritis prevalence were also noted in Canada.[39] Notably, the social determinants of health also contribute to the prevalence and severity of arthritis in the US. Food insecurity, financial instability, and frequent stress are associated with a greater likelihood of functional limitations and higher pain scores.[40] The magnitude of social risk factors has an independent association with the prevalence of arthritis.[12]
While this study has provided a comprehensive analysis of trends and disparities in arthritis prevalence among US adults, it has several limitations characteristic of the observational nature of data acquisition. The cross-sectional design of the NHIS database limits the ability of this retrospective analysis to establish causal relationships between the demographic factors and the prevalence of arthritis in the country. Moreover, the database employed by this study did not provide individual data on the trends of specific types of arthritis. Additionally, the study relied upon the recall method to identify the diagnosed cases, hence raising potential bias, which may have been more pronounced among older and nonnative English speakers. Next, the survey assessing diagnosed arthritis in the US adult population does not consider the prevalence of undiagnosed arthritis. Moreover, altered data collection methods during the coronavirus disease 2019 (COVID-19) pandemic resulted in lower response rates and differences in characteristics of respondents between April and December 2020. These differences may introduce bias between data from 2020 and other years and may potentially skew the arthritis prevalence estimates. Lastly, the findings of this study may not be applicable to other regions across the globe, owing to differences in the healthcare systems, demographics, and lifestyle patterns.
This study’s findings on the prevalence of arthritis and disparities in the US have significant implications for future research and public health initiatives. More longitudinal studies must be conducted to explore causal relationships between arthritis incidence and independent variables, such as demographic factors and comorbidities. Further studies should differentiate between specific types of arthritis within each demographic group to facilitate the development of interventions for the unique needs of each pathology. Moreover, the association between the prevalence of arthritis and SVI warrants further investigation into the role of social determinants of health in arthritis risk management. Lastly, our study suggests the establishment of databases to track disease parameters, including erythrocyte sedimentation rate, anti-cyclic citrullinated peptides, etc, over time, to help delineate trends in disease progression and treatment effectiveness among different demographic groups.
5. Conclusion
This study investigated trends and disparities in diagnosed arthritis among US adults from 2019 to 2022. The analysis of the NHIS database revealed a modest increase in overall arthritis prevalence. However, the data also highlighted significant disparities across various demographic groups. Individuals most affected by arthritis, according to our study, included females, adults aged 75 years or older, Whites, individuals from nonmetropolitan areas and the Midwest region, those with medium SVI, US-born adults, unemployed individuals, and veterans. These findings underscore the importance of developing targeted public health interventions and effective disease management strategies that cater to the specific needs of these populations.
Author contributions
Conceptualization: Hafsah Alim Ur Rahman.
Formal analysis: Hafsah Alim Ur Rahman, Muhammad Ahmed Ali Fahim.
Methodology: Hafsah Alim Ur Rahman, Muhammad Ahmed Ali Fahim, Afia Salman.
Writing – original draft: Hafsah Alim Ur Rahman, Muhammad Ahmed Ali Fahim, Afia Salman, Syed Hassan Ahmed.
Writing – review & editing: Sajeel Ahmed, Raheel Ahmed, Zohaib Yousaf.
Supplementary Material
Abbreviations:
- APC
- annual percentage change
- CI
- confidence interval
- MSA
- metropolitan statistical area
- NHIS
- National Health Interview Survey
- SVI
- social vulnerability index
- US
- United States
This study uses publicly available data and does not require ethical approval.
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are publicly available.
Supplemental Digital Content is available for this article.
How to cite this article: Rahman HAU, Fahim MAA, Salman A, Ahmed SH, Ahmed S, Ahmed R, Yousaf Z. Trends and disparities in the prevalence of diagnosed arthritis among United States adults from 2019 to 2022. Medicine 2025;104:12(e41892).
Contributor Information
Hafsah Alim Ur Rahman, Email: hafsahalim03@gmail.com.
Muhammad Ahmed Ali Fahim, Email: faua857@gmail.com.
Afia Salman, Email: aafiais2001@gmail.com.
Syed Hassan Ahmed, Email: R.ahmed21@imperial.ac.uk.
Sajeel Ahmed, Email: R.ahmed21@imperial.ac.uk.
Zohaib Yousaf, Email: Zohaib.yousaf@gmail.com.
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