Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management — United States, 2015

Surveillance Summaries / March 16, 2018 / 67(4);1–28

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Kamil E. Barbour, PhD1; Susan Moss, MS2; Janet B. Croft, PhD1; Charles G. Helmick, MD1; Kristina A. Theis, PhD1; Teresa J. Brady, PhD1; Louise B. Murphy, PhD1; Jennifer M. Hootman, PhD1; Kurt J. Greenlund, PhD1; Hua Lu, MS1; Yan Wang, PhD1 (View author affiliations)

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Abstract

Problem/Condition: Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity.

Reporting Period: 2015.

Description of System: The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method.

Results: In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking.

Interpretation: The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county.

Public Health Action: The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.

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Introduction

Doctor-diagnosed arthritis is a common chronic condition that affected an estimated 23% (54 million) of adults in the United States during 2013–2015 (1). Prevalence varies across states (2), counties (2), urban and rural communities (3), and census tracts within the largest U.S. cities (https://www.cdc.gov/500cities). The condition limits activities of 24 million adults (1), is associated with severe joint pain among 15 million adults (4), and is projected to affect 78.4 million adults by 2040 (5). In 2013, total national medical care expenditures and earnings losses attributable to arthritis were $303.5 billion (6). Public health measures focus on increasing physical activity, increasing self-management education, increasing health care provider counseling for physical activity or exercise, and encouraging walking.

Since 2003, CDC has conducted surveillance for arthritis using Behavioral Risk Factor Surveillance System (BRFSS) data (7). The findings in this report can be used by public health professionals to better understand geographic variability in prevalence, health-related characteristics, and management of arthritis between states and territories. Public health professionals can also target evidence-based nonpharmaceutical interventions, such as arthritis self-management education and physical activity, to help decrease the impact of arthritis and perhaps reduce geographic disparities in arthritis health-related characteristics and management.

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Methods

To characterize self-reported doctor-diagnosed arthritis in the United States, Guam, and Puerto Rico, CDC analyzed data from the 2015 BRFSS (Box). First, selected area-level prevalences were estimated, including prevalences of arthritis among adults aged ≥18 years with selected comorbid conditions (i.e., coronary heart disease, diabetes, and obesity). Percentages of health-related characteristics among adults with arthritis (i.e., general health, leisure-time physical activity, activity limitations, and pain) also were estimated. Second, for 13 states with available data, self-management measures for adults with arthritis were examined. Third, to examine possible clustering of arthritis health-related characteristics linear trends were tested between increasing prevalence of arthritis and increasing percentages of negative health-related characteristics among adults with arthritis at the state level. Detailed arthritis surveillance estimates for states, the District of Columbia, Guam, and Puerto Rico are available online for 2011, 2013, and 2015 (https://www.cdc.gov/arthritis/data_statistics/state-data-list-current.htm), but are unpublished elsewhere.

Data Source and Measurements

BRFSS is an annual, random-digit–dialed landline and cellular telephone survey of the noninstitutionalized U.S. adult population aged ≥18 years. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. In 2015, a total of 441,456 interviews were completed and analyzed for this report. Response rates ranged from 33.9% to 61.1% (median: 47.2%). The response rate was the number of respondents who completed the survey as a proportion of all eligible and likely eligible persons. Response rates for BRFSS were calculated using standards set by American Association for Public Opinion Research response rate formula no. 4. Additional information is available at https://www.cdc.gov/brfss/annual_data/2015/2015_responserates.html.

Respondents were classified as having doctor-diagnosed arthritis (hereafter referred to as arthritis) if they answered yes to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” Three comorbid conditions were examined: obesity, diabetes, and coronary heart disease. Body mass index (BMI) was computed from self-reported height and weight. Obesity was categorized as BMI ≥30 kg/m2. Doctor-diagnosed diabetes (hereafter referred to as diabetes) was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have diabetes?” Those with prediabetes or borderline diabetes and women who had diabetes only during pregnancy were classified as not having diabetes. Doctor-diagnosed coronary heart disease (hereafter referred to as coronary heart disease) was defined as a yes response to either of the following two questions: 1) “Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?” or 2) “Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?”

Prevalence of Arthritis

The prevalence of arthritis was estimated among all adults. Prevalence was estimated separately for adults with comorbid conditions (i.e., obesity, coronary heart disease, and diabetes).

Health-Related Characteristics

General Health. Two measures of health-related quality of life were examined. For physically and mentally unhealthy days, respondents reported the number of days during the past 30 days that their physical or mental health, or both, was not good. For each measure, a standard predetermined cutoff point of ≥14 days during the past 30 days was used to identify respondents with poor physical or mental health, respectively (8).

Leisure-Time Physical Activity and Obesity. Among adults with arthritis, the prevalences of obesity, leisure-time physical inactivity, and leisure-time walking were estimated. Leisure-time physical inactivity was defined as a no response to the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?” Among those who answered yes, leisure-time walking was ascertained via two questions: 1) “What type of physical activity or exercise did you spend the most time doing during the past month?” and 2) “What other type of physical activity gave you the next most exercise during the past month?” For the leisure-time walking measure, the numerator was adults with arthritis who listed walking as one of their top two activities and the denominator included both active and inactive adults with arthritis.

Activity Limitations. Among adults with arthritis, arthritis-attributable activity limitations were identified by a yes response to the question “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?” Arthritis-attributable social participation restriction was defined as a response of a lot to the question “During the past 30 days, to what extent has your arthritis or joint symptoms interfered with your normal social activities, such as going shopping, to the movies, or to religious or social gatherings?”

Pain. Arthritis-attributable severe joint pain was defined according to an a priori criterion (9) as a pain level of 7–10 on a scale of 0–10 where 0 is no pain and 10 is pain or aching as bad as it can be for the question “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. During the past 30 days, how bad was your joint pain on average?”

Arthritis Management

In 2015, a total of 13 states (California, Kansas, Kentucky, Michigan, Minnesota, Missouri, Montana, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, and Utah) administered the BRFSS arthritis management module to respondents with arthritis and ascertained participation in self-management education courses and receipt of health care provider counseling. Among adults with arthritis, attendance at a self-management education course was defined as a yes response to the question “Have you ever taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?” Among those who were overweight (BMI 25 to <30 kg/m2) or obese (BMI ≥30 kg/m2), health care provider counseling for weight loss was defined as a yes response to the question “Has a doctor or other health professional ever suggested losing weight to help your arthritis or joint symptoms?” Health care provider counseling for physical activity or exercise was defined as a yes response to the question “Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?”

Analyses

Direct Estimates

All directly estimated analyses included adjustment for the complex survey design; sampling weights accounted for nonresponse, noncoverage, and cellular-telephone–only households and were derived from an iterative proportional weighting (raking) procedure (https://www.cdc.gov/brfss/annual_data/2015/pdf/weighting_the-data_webpage_content.pdf). Estimates were age standardized to the 2000 U.S. projected population using three age groups (18–44, 45–64, and ≥65 years) (10). Weighted unadjusted and age-standardized prevalences with 95% confidence intervals were estimated for arthritis and arthritis-related characteristics. For each characteristic, the median and range were calculated using prevalence estimates for the 50 states and the District of Columbia (not including Guam and Puerto Rico). The unadjusted prevalence is an estimate of the actual prevalence of a characteristic in a specific area. Age-standardized prevalence estimates are provided to permit comparisons across states. Prevalence estimates of arthritis and percentages of selected characteristics among adults with arthritis that had a relative standard error (RSE) ≥30% or unweighted sample size of <50 did not meet the minimum criteria for precision and were suppressed.

Indirect (Modeled) County-Level Arthritis Prevalence Estimates

Prevalence of arthritis at the county level was estimated with a multilevel regression model and poststratification approach (11) for counties (N = 3,142) in all 50 states and the District of Columbia. The multilevel regression model included individual-level data on age group (13 categories), sex, and race/ethnicity from the 2015 BRFSS; county-level poverty data (percentage below 150% of the federal poverty level) from the American Community Survey 5-year estimates (2011–2015) (12); and random effects at county and state levels. Parameter estimates from the models were applied to Census Vintage 2015 county population estimates to generate county-level estimates of arthritis prevalence. These modeled prevalence estimates were reported in quartiles for the 3,142 counties. High internal validity was established by comparing modeled county-level estimates of arthritis with actual unweighted BRFSS survey estimates in 1,531 counties with ≥50 respondents and RSE <30% (Pearson correlation coefficient: 0.78; p<0.001) and with weighted BRFSS estimates in 205 counties with ≥500 respondents (Pearson correlation coefficient: 0.94; p<0.001).

State-Specific Clustering of Health-Related Characteristics

States and the District of Columbia were divided into quartiles (lowest to highest) according to age-adjusted state-level prevalence of arthritis in 2015. Age-standardized percentages of seven negative health-related characteristics among adults with arthritis (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days; ≥14 mentally unhealthy days; obesity; and leisure-time physical inactivity) and leisure-time walking were calculated for respondents by quartile of arthritis prevalence. A test of trend using orthogonal polynomial contrasts (by partitioning the sums of squares) was performed to determine whether the age-standardized prevalence of negative health-related characteristics increased and leisure-time walking decreased among adults with arthritis living in states with greater age-standardized prevalence of arthritis. To improve data fit and accommodate nonlinear trends, the test for trend included a quadratic term. For each health-related characteristic, a statistically significant trend in age-standardized percentage across arthritis quartiles was determined at the Bonferroni-corrected alpha level of 0.006 (α = 0.05/8) to adjust for testing multiple characteristics.

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Results

Arthritis Prevalence

In 2015, for the 50 states and the District of Columbia, age-standardized median prevalence of arthritis was 23.0% (range: 17.2% in Hawaii to 33.6% in West Virginia) (Table 1). The model-based prevalence estimates of arthritis across the 3,142 U.S. counties in 50 states and the District of Columbia ranged from 11.2% to 42.7% (Figure 1). At the county level, counties in Appalachia and along the lower Mississippi River tended to have higher predicted prevalences of arthritis. The majority of counties in Alabama, Arkansas, Kentucky, Michigan, Missouri, Tennessee, and West Virginia were in the highest quartile (31.2%–42.7%).

Arthritis Among Adults With Comorbid Conditions

For the 50 states and District of Columbia, the median age-standardized prevalence of arthritis among adults with obesity was 30.9% (range: 24.6% in Texas to 41.2% in West Virginia) (Table 2). The median age-standardized prevalence of arthritis among adults with coronary heart disease was 44.5% (range: 25.6% in the District of Columbia to 72.6% in Iowa) (Table 3). The median age-standardized prevalence of arthritis among adults with diabetes was 37.3% (range: 27.1% in California to 53.7% in Maine) (Table 4).

Health-Related Characteristics

General Health

In 2015, the percentage of poor health-related quality of life among adults with arthritis varied substantially by state. The median age-standardized percentage of ≥14 physically unhealthy days during the past 30 days was 27.7% (range: 16.9% in Alaska to 37.5% in Oklahoma) (Table 5). The median age-standardized percentage of ≥14 mentally unhealthy days during the past 30 days was 22.3% (range: 14.8% in Hawaii to 31.1% Mississippi) (Table 6).

Leisure-Time Physical Activity and Obesity

In 2015, for leisure-time physical inactivity, the median age-standardized percentage among adults with arthritis was 35.0% (range: 23.1% in California to 47.9% in Mississippi) (Table 7). States in the western United States (e.g., California, Idaho, Oregon, and Washington) tended to have the lowest prevalence of leisure-time physical inactivity among adults with arthritis, whereas states primarily in Appalachia and along the Ohio River and Mississippi River had the highest percentage of leisure-time physical inactivity (Figure 2). Age-standardized percentage of leisure-time physical inactivity was ≥40% in Alabama, Arkansas, Louisiana, Mississippi, Oklahoma, and Texas. For the 50 states and the District of Columbia, the median age-standardized percentage of leisure-time walking was 48.0% (range: 38.5% in West Virginia to 59.5% in Montana) (Table 8). Leisure-time walking tended to be highest in western states (e.g., California, Idaho, Oregon, and Washington) and lowest in states primarily in Appalachia and along the Ohio River and Mississippi River (e.g., Alabama, Arkansas, Mississippi, and West Virginia) (Figure 3).

For the 50 states and the District of Columbia, the percentage of obesity among adults with arthritis varied substantially. The median age-standardized percentage of obesity was 41.6% (range: 28.1% in California to 48.9% in Arkansas) (Table 9).

Activity Limitations

In 2015, for the 50 states and the District of Columbia, the median age-standardized percentage of arthritis-attributable activity limitations among adults with arthritis was 49.7% (range: 40.4% in Iowa to 59.4% in Missouri) (Table 10). The median age-standardized percentage for arthritis-attributable social participation restriction was 19.7% (range: 12.6% in Alaska to 30.4% in Arkansas) (Table 11).

Pain

In 2015, the median age-standardized percentage of arthritis-attributable severe joint pain among adults with arthritis was 29.7% (range: 20.3% in Utah to 46.0% in Mississippi) (Table 12). States with the highest age-standardized percentage of arthritis-attributable severe joint pain among adults with arthritis tended be primarily in Appalachia and in the South (Figure 4).

Arthritis Management

In 2015, among adults with arthritis in 13 states that included the BRFSS arthritis management module, the age-standardized median percentage of attendance at a self-management education course was 14.5% (range: 9.1% in New York to 19.0% in Montana) (Table 13). The median age-standardized percentage of health care provider counseling to lose weight if overweight or obese was 44.5% (range: 35.1% in Montana to 53.2% in New York) (Table 14). The age-standardized percentage of health care provider counseling for physical activity or exercise did not vary considerably among states (median: 58.5%; range: 52.3%–61.9%) (Table 15).

Possible State-Specific Clustering of Health-Related Characteristics

States in the highest quartile of prevalence for adults with arthritis also had the highest percentages of all seven negative health-related characteristics (arthritis-attributable activity limitations, severe joint pain, and social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentages of leisure-time walking compared with states in the lower quartiles (p-trend <0.006 for all characteristics) when both linear and quadratic tests for trends were conducted (Table 16). States in the highest quartile were Maine, Pennsylvania, West Virginia, Kentucky, Tennessee, Arkansas, Missouri, Oklahoma, Louisiana, Mississippi, Alabama, South Carolina, and Michigan.

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Discussion

This is the first report of state-level arthritis prevalence estimates. The large sample size allowed precise estimates for even limited areas and analysis of health-related characteristics and comorbidities. This report also provides model-based county-level arthritis prevalence estimates with high internal validity, which help improve understanding of arthritis disparities at a local level.

In 2015, arthritis affected approximately one in four adults in the United States overall but prevalence, including model-based estimates at the county level, varied substantially by geographic area. The percentage of negative health-related characteristics among adults with arthritis was high in every area, but also varied substantially by geographic area. Arthritis management measures by state indicated both wide variation (e.g., health care provider counseling to lose weight if overweight or obese) and moderate variation (e.g., individual report of ever attending a self-management course and health care provider counseling for exercise or physical activity). Geographic disparities exist across the United States, with arthritis having the greatest impact in southern states (e.g., West Virginia, Kentucky, Tennessee, Arkansas, Missouri, Oklahoma, Louisiana, Mississippi, Alabama, and South Carolina). More detailed estimates for each of the 50 states, the District of Columbia, Guam, and Puerto Rico, along with additional analyses not reported here are available on the CDC Arthritis Program website (https://www.cdc.gov/arthritis/data_statistics/state-data-list-current.htm).

States with greater prevalences of arthritis also had greater percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and physical inactivity) and lesser percentages of leisure-time walking (a recommended management strategy) among adults with arthritis. The reasons for this geographic clustering are unknown but suggest a greater arthritis impact among adults with arthritis who live in those states. Geographic variation in four recognized risk factors for arthritis (i.e., obesity, occupations with high physical workload, smoking, and socioeconomic status) (13–17) that are also associated with negative health consequences among adults with arthritis might account for some of the difference. Geographic variations also might exist in access to medical care, including medications, resources for physical activity, and self-management interventions. Furthermore, because those states also have greater prevalence of coronary heart disease and diabetes, two important comorbid conditions for arthritis, health care providers might focus more on treatment and management of those chronic conditions with less emphasis on treatment and management of arthritis (18).

Adults with arthritis have a complex combination of disease characteristics and negative health consequences that can limit their daily activities; reduce health-related quality of life; and contribute to sustained obesity, leisure-time physical inactivity, and lack of participation in leisure-time walking. Participation in self-management education courses among adults with arthritis remains low (19). Only half of patients with arthritis receive counseling on the self-management behaviors of physical activity and weight loss. More counseling might help reduce the proportion with arthritis reporting obesity or leisure-time physical inactivity (approximately two in five adults) (20,21). Greater use of evidence-based interventions for physical activity and self-management education could reduce pain and improve function and quality of life for all adults with arthritis (22,23).

Nationally, approximately one in four adults with arthritis reported severe joint pain in the National Health Interview Survey (4); however, the geographic variations in this report suggest that the prevalence is higher in certain states (four in 10 might experience severe joint pain). Arthritis-attributable severe joint pain can lead to poor physical function. In a cohort of retirees in the United States with arthritis, approximately three in four reported functional limitations and approximately 65% had mobility limitations (24). Poor physical function is a major risk factor linked to falls (25), and adults with arthritis are more than twice as likely to report fall injuries compared with adults without arthritis (26). In addition to decrements in physical function, adults with arthritis consistently report negative effects on health-related quality of life. One study that examined health-related quality of life measures among adults with and without arthritis found that those with arthritis had higher mean numbers of days in the prior month when physical and mental health were not good (27). In this study, approximately one in four adults with arthritis reported ≥14 physically and ≥14 mentally unhealthy days during the past 30 days.

Evidence-based interventions (https://www.cdc.gov/arthritis/interventions/index.htm) have been reported to have a positive impact on arthritis outcomes (22,23); however, interventions are underused and require more widespread dissemination. Physical activity is a proven strategy for managing arthritis symptoms and many other chronic conditions (22). For instance, a meta-analysis of community-based physical activity interventions indicated that physical activity can decrease pain and improve function by approximately 40% (22). Although persons with arthritis report typical barriers to being physically active (e.g., lack of time and lack of enjoyment), arthritis presents specific barriers (e.g., pain, functional limitations, depression, and fear of falling and injury) (28). Similarly, in a meta-analysis of self-management education interventions, participants experienced improvements of 10%–20% in confidence and skills to manage their condition and reductions in pain, fatigue, and depression (23). However, as this and other analyses illustrate, self-management education interventions are underused by adults with arthritis; nationally, only about 11% report ever having taken a course (19).

Arthritis is a common comorbid condition that might complicate the management of other chronic conditions (e.g., obesity, coronary heart disease, and diabetes), increase the negative outcomes of these conditions, and reduce quality of life (18,29). The combination of arthritis and one of these chronic conditions has been associated with higher levels of physical inactivity (30–32). Moreover, arthritis also might hinder the ability of adults with prediabetes to engage in the level of physical activity recommended to prevent diabetes (33). Counseling persons with arthritis that physical activity can improve these outcomes (e.g., lower risk for diabetes) and improving availability of safe and effective physical activity programs in their local communities can be an effective strategy for reducing physical inactivity among these groups (e.g., adults with prediabetes or other comorbid conditions).

CDC funds arthritis programs in 12 state health departments and with national partners (e.g., Young Men’s Christian Association [YMCA] and National Recreation and Park Association) to disseminate evidence-based interventions in their communities (https://www.cdc.gov/arthritis/partners/funded-states.htm). State health departments, local community-based organizations, policymakers, and others can use the estimates at the state, territory, and county levels in this report to help identify local areas with need for evidence-based interventions. For example, physical activity programs such as EnhanceFitness, Walk With Ease, and Fit & Strong! (https://www.cdc.gov/arthritis/interventions/index.htm) could be disseminated to these areas. Several CDC-funded state health departments have been successful at reaching persons with arthritis with these evidence-based programs by partnering with YMCA of the USA and local parks and recreation departments.

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Limitations

The findings in this report are subject to at least seven limitations. First, arthritis was self-reported and not confirmed by a health care professional; however, this case definition has been shown to have sufficient sensitivity for public health surveillance (34). Second, because BRFSS is a cross-sectional survey, a causal relation between risk factors (e.g., obesity) and arthritis cannot be established, although robust evidence exists that links obesity to an increased risk for knee osteoarthritis (the most common form of arthritis) (14). Third, social desirability bias might have a role in certain self-reported characteristics, with underreporting of BMI (35) and overreporting of leisure-time physical activity (36). Fourth, the 2015 BRFSS median response rate was 47.2% and ranged from 33.9% to 61.1%, indicating potential nonresponse bias, although survey weights were applied to address this bias and improve external validity (27). Fifth, some of the morbidities potentially related to arthritis (e.g., physically or mentally unhealthy days) might be primarily affected by other conditions and thus might overestimate arthritis-specific impact. Sixth, the model used for county-level estimates did not account for complex sample design features, including potential geographic correlations between counties or states (i.e., observations for nearby counties and states might be clustered and therefore not independent). Finally, because county representativeness was not captured by BRFSS, model-based estimation other than direct survey estimation was used to generate prevalences at the county level. This approach has limitations that have been described elsewhere (11); however, the method has been tested through a comparison of model-based estimates with direct local survey estimates for certain other chronic conditions at the county level (37).

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Conclusion

In 2015, the number of adults with arthritis continued to increase, matched projections of prevalence, and exceeded projections for arthritis-attributable activity limitations at the state level (38). The findings in this report describe the prevalence and health-related characteristics of arthritis across the United States. The findings also highlight geographic variability in these estimates, including gaps in arthritis management. Public health professionals can use this information to better understand and target evidence-based nonpharmaceutical interventions, such as arthritis self-management education and physical activity. These interventions can decrease the impact of arthritis, which in turn might help adults with arthritis better manage comorbid conditions such as obesity, coronary heart disease, and diabetes. These estimates demonstrate the need to create links in clinical and community settings that can enhance health care provider counseling for physical activity and weight loss and facilitate referrals to self-management education and physical activity interventions to address arthritis and related comorbidities.

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Corresponding author: Kamil E. Barbour, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Telephone: 770-488-5145; E-mail: [email protected].

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1Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia; 2G2S Corporation, San Antonio, Texas

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Return to your place in the textBOX. Understanding geographic variations in arthritis prevalence, health-related characteristics, and management

Aim 1: Estimate prevalence among adults

  • Prevalence of arthritis among adults with comorbid conditions (coronary heart disease, diabetes, and obesity)
  • Prevalence of obesity among adults with arthritis
  • Prevalence of leisure-time walking among adults with arthritis
  • Prevalence of physical inactivity among adults with arthritis
  • Prevalence of two types of negative health-related characteristics among adults with arthritis: general health (physically and mentally unhealthy days) and arthritis-attributable impact (activity limitations, severe joint pain, and social participation restriction)

Aim 2: Estimate management among adults with arthritis

  • Prevalence of participation in arthritis self-management education course
  • Prevalence of health care provider counseling for weight loss
  • Prevalence of health care provider counseling for physical activity or exercise

Aim 3: Examine possible state-specific clustering of health-related characteristics among adults with arthritis

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TABLE 1. Prevalence of arthritis,* by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area No. of respondents No. of respondents with arthritis Weighted population with arthritis (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized %† (95% CI)
Alabama 7,950 3,307 1,248,000 33.3 (31.9–34.6) 30.4 (29.2–31.7)
Alaska 3,657 1,028 117,000 21.2 (19.3–23.2) 21.5 (19.7–23.3)
Arizona 7,946 2,663 1,222,000 23.6 (22.5–24.8) 21.8 (20.7–22.9)
Arkansas 5,256 2,228 672,000 29.7 (27.8–31.7) 27.1 (25.4–28.9)
California 12,601 2,803 5,719,000 19.1 (18.3–20.0) 18.3 (17.6–19.1)
Colorado 13,537 4,136 949,000 22.7 (21.8–23.7) 21.8 (20.9–22.7)
Connecticut 11,899 3,962 690,000 24.5 (23.5–25.5) 21.6 (20.8–22.5)
Delaware 4,070 1,471 207,000 28.1 (26.3–29.9) 24.6 (23.1–26.2)
District of Columbia 3,994 1,316 101,000 18.5 (16.7–20.4) 19.9 (18.3–21.7)
Florida 9,739 3,454 4,154,000 25.9 (24.8–27.0) 21.5 (20.6–22.5)
Georgia 4,678 1,660 1,890,000 24.6 (23.1–26.1) 23.6 (22.3–24.9)
Hawaii 7,163 1,757 211,000 18.9 (17.8–20.1) 17.2 (16.2–18.3)
Idaho 5,802 2,031 309,000 25.3 (23.8–26.8) 23.2 (22.0–24.5)
Illinois 5,289 1,671 2,308,000 23.3 (22.0–24.7) 21.6 (20.4–22.7)
Indiana 6,067 2,273 1,390,000 27.6 (26.1–29.1) 25.4 (24.1–26.7)
Iowa 6,227 2,145 619,000 25.9 (24.6–27.2) 23.2 (22.1–24.4)
Kansas 23,236 7,320 536,000 24.5 (23.9–25.2) 22.7 (22.2–23.3)
Kentucky 8,806 3,565 1,087,000 32.0 (30.5–33.5) 29.3 (27.9–30.8)
Louisiana 4,716 1,748 989,000 27.9 (26.4–29.5) 26.2 (24.8–27.7)
Maine 9,063 3,459 332,000 31.0 (29.7–32.3) 26.4 (25.2–27.6)
Maryland 12,598 4,631 1,096,000 23.5 (22.2–24.9) 21.5 (20.4–22.8)
Massachusetts 9,294 2,842 1,300,000 24.1 (23.0–25.3) 22.0 (21.0–23.0)
Michigan 8,935 3,224 2,305,000 30.0 (28.9–31.1) 27.0 (26.0–28.0)
Minnesota 16,761 4,666 907,000 21.6 (20.9–22.3) 19.7 (19.1–20.4)
Mississippi 6,035 2,431 647,000 28.6 (27.1–30.1) 26.6 (25.3–28.0)
Missouri 7,307 2,808 1,372,000 29.3 (27.9–30.8) 26.8 (25.5–28.2)
Montana 6,051 2,123 216,000 26.8 (25.4–28.3) 23.9 (22.5–25.4)
Nebraska 17,561 5,522 334,000 23.4 (22.6–24.3) 21.5 (20.7–22.3)
Nevada 2,926 918 477,000 21.5 (19.5–23.8) 20.1 (18.2–22.2)
New Hampshire 7,022 2,588 282,000 26.6 (25.3–27.9) 23.0 (21.9–24.2)
New Jersey 11,465 3,442 1,590,000 22.9 (21.8–24.1) 20.5 (19.5–21.5)
New Mexico 6,734 2,248 386,000 24.5 (23.1–25.9) 22.2 (21.0–23.5)
New York 12,357 3,921 3,629,000 23.4 (22.5–24.3) 21.5 (20.6–22.3)
North Carolina 6,698 2,144 2,089,000 26.9 (25.7–28.2) 24.9 (23.8–26.0)
North Dakota 4,972 1,585 134,000 22.9 (21.5–24.3) 21.6 (20.4–22.9)
Ohio 11,929 4,730 2,547,000 28.4 (27.2–29.7) 25.3 (24.2–26.4)
Oklahoma 6,943 2,692 813,000 27.7 (26.3–29.1) 25.7 (24.5–27.0)
Oregon 5,359 1,828 838,000 26.8 (25.4–28.2) 24.5 (23.2–25.8)
Pennsylvania 5,740 2,059 2,937,000 29.2 (27.8–30.7) 25.7 (24.4–27.0)
Rhode Island 6,206 2,244 226,000 26.9 (25.5–28.4) 24.2 (22.9–25.6)
South Carolina 11,607 4,405 1,105,000 29.1 (28.1–30.2) 26.3 (25.3–27.2)
South Dakota 7,221 2,389 158,000 24.3 (22.8–25.9) 21.8 (20.5–23.2)
Tennessee 5,979 2,466 1,630,000 32.0 (30.3–33.7) 29.4 (27.9–31.1)
Texas 14,697 4,522 4,055,000 20.0 (19.0–21.1) 19.8 (18.9–20.8)
Utah 11,401 2,929 407,000 19.6 (18.8–20.4) 20.8 (20.1–21.6)
Vermont 6,489 2,089 136,000 27.0 (25.7–28.3) 23.4 (22.3–24.6)
Virginia 8,646 2,684 1,513,000 23.2 (22.1–24.3) 21.6 (20.6–22.6)
Washington 16,116 5,481 1,346,000 24.5 (23.6–25.3) 22.6 (21.9–23.4)
West Virginia 5,957 2,537 557,000 38.0 (36.6–39.4) 33.6 (32.3–34.9)
Wisconsin 6,188 1,984 1,104,000 24.7 (23.3–26.2) 22.1 (20.8–23.5)
Wyoming 5,492 2,021 116,000 25.9 (24.2–27.5) 24.1 (22.6–25.8)
Median (Range)§ 25.3 (18.5–38.0) 23.0 (17.2–33.6)
Guam 1,669 270 17,000 15.8 (13.5–18.4) 17.9 (15.5–20.6)
Puerto Rico 5,405 1,616 635,000 22.8 (21.5–24.0) 20.6 (19.5–21.7)

Abbreviation: CI = confidence interval.
* Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Median and range were calculated from estimates for the 50 states and the District of Columbia.

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Return to your place in the textFIGURE 1. Model-based prevalence* of arthritis† among adults aged ≥18 years, by county — Behavioral Risk Factor Surveillance System, United States, 2015
Map of the United States indicates prevalence of arthritis among adults aged 18 years and older, by county. The data source is the 2015 Behavioral Risk Factor Surveillance System.

Abbreviation: Q = quartile.

* Prevalence of arthritis at the county level was estimated with a multilevel regression model and poststratification approach for counties (N = 3,142) in all 50 states and the District of Columbia. Prevalence was based on the Behavioral Risk Factor Surveillance System definition of arthritis.

† Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

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TABLE 2. Unadjusted* and age-standardized† prevalences of arthritis§ among adults ≥18 years with obesity, by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area No. of respondents with obesity Weighted population with arthritis and obesity (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 2,626 512,000 41.4 (38.9–43.9) 37.9 (35.7–40.2)
Alaska 1,059 46,000 29.9 (26.1–34.0) 28.5 (24.9–32.4)
Arizona 1,892 398,000 30.0 (27.4–32.7) 27.5 (25.3–29.7)
Arkansas 1,593 275,000 37.7 (33.9–41.6) 35.0 (31.5–38.7)
California 2,808 1,749,000 26.4 (24.4–28.6) 24.8 (23.1–26.6)
Colorado 2,666 250,000 32.8 (30.3–35.4) 29.4 (27.2–31.7)
Connecticut 2,817 228,000 35.0 (32.7–37.4) 29.9 (27.8–32.0)
Delaware 1,145 70,000 35.6 (31.9–39.3) 30.2 (27.3–33.4)
District of Columbia 899 41,000 36.8 (31.2–42.8) 31.6 (26.6–37.0)
Florida 2,296 1,381,000 34.9 (32.4–37.6) 28.3 (26.1–30.6)
Georgia 1,340 759,000 35.4 (32.3–38.8) 31.3 (28.7–34.0)
Hawaii 1,509 67,000 27.6 (24.8–30.6) 26.8 (24.0–29.8)
Idaho 1,596 105,000 32.0 (29.0–35.1) 29.0 (26.4–31.8)
Illinois 1,547 946,000 32.4 (29.7–35.2) 28.4 (26.1–30.9)
Indiana 1,804 537,000 36.2 (33.2–39.4) 32.4 (29.7–35.3)
Iowa 1,805 241,000 34.4 (31.8–37.2) 30.5 (28.1–33.0)
Kansas 6,318 194,000 33.6 (32.2–34.9) 30.1 (28.9–31.4)
Kentucky 2,871 457,000 41.7 (38.8–44.7) 38.0 (35.2–41.0)
Louisiana 1,570 419,000 35.6 (32.6–38.7) 33.3 (30.6–36.1)
Maine 2,567 122,000 40.3 (37.8–43.0) 34.9 (32.3–37.7)
Maryland 3,437 448,000 36.9 (33.7–40.1) 32.5 (29.5–35.7)
Massachusetts 2,061 422,000 37.2 (34.4–40.2) 31.5 (28.9–34.2)
Michigan 2,582 875,000 39.3 (37.0–41.6) 34.8 (32.7–36.9)
Minnesota 4,213 321,000 32.0 (30.3–33.7) 27.7 (26.0–29.5)
Mississippi 1,964 260,000 34.4 (31.6–37.4) 32.8 (30.4–35.4)
Missouri 2,219 518,000 37.2 (34.5–40.0) 33.7 (31.1–36.3)
Montana 1,430 62,000 35.7 (32.3–39.1) 30.4 (27.2–33.8)
Nebraska 5,371 134,000 32.3 (30.5–34.2) 28.4 (26.7–30.2)
Nevada 700 155,000 28.6 (23.9–33.8) 26.4 (21.9–31.6)
New Hampshire 1,717 94,000 37.0 (34.1–40.0) 31.4 (28.7–34.3)
New Jersey 2,778 539,000 34.3 (31.6–37.0) 29.2 (26.9–31.7)
New Mexico 1,728 127,000 30.3 (27.3–33.4) 29.3 (26.6–32.2)
New York 2,933 1,221,000 34.6 (32.4–36.9) 30.9 (28.8–33.2)
North Carolina 1,808 780,000 37.2 (34.6–39.9) 33.5 (31.1–36.0)
North Dakota 1,477 51,000 30.7 (28.0–33.6) 27.2 (24.8–29.6)
Ohio 3,420 947,000 38.2 (35.7–40.8) 32.6 (30.3–35.1)
Oklahoma 2,126 329,000 35.5 (32.9–38.2) 33.0 (30.6–35.4)
Oregon 1401 302,000 35.3 (32.3–38.4) 32.0 (29.2–34.9)
Pennsylvania 5,740 1,114,000 39.6 (36.6–42.7) 33.7 (30.9–36.6)
Rhode Island 6,206 74,000 36.9 (33.6–40.3) 31.8 (28.7–35.0)
South Carolina 11,607 437,000 38.5 (36.3–40.7) 34.9 (32.9–36.9)
South Dakota 7,221 60,000 31.7 (28.6–35.0) 28.3 (25.6–31.1)
Tennessee 5,979 640,000 40.7 (37.4–44.1) 37.6 (34.5–40.9)
Texas 14,697 1,518,000 26.2 (24.0–28.4) 24.6 (22.9–26.4)
Utah 11,401 137,000 29.3 (27.3–31.4) 28.0 (26.2–29.9)
Vermont 6,489 43,000 37.1 (34.1–40.1) 31.2 (28.4–34.2)
Virginia 8,646 584,000 33.0 (30.5–35.5) 29.6 (27.2–32.0)
Washington 16,116 454,000 34.5 (32.6–36.5) 29.8 (28.1–31.5)
West Virginia 5,957 223,000 46.6 (44.1–49.2) 41.2 (38.7–43.7)
Wisconsin 6,188 417,000 32.6 (29.8–35.6) 28.2 (25.6–31.1)
Wyoming 5,492 41,000 34.1 (30.6–37.7) 31.2 (28.1–34.5)
Median (Range)** 35.0 (26.2–46.6) 30.9 (24.6–41.2)
Guam 1,669 7,000 20.3 (15.9–25.5) 23.4 (19.0–28.5)
Puerto Rico 5,405 215,000 27.5 (25.0–30.2) 25.7 (23.4–28.2)

Abbreviation: CI = confidence interval.
* The numerator was the estimated number of adults with arthritis and obesity (body mass index ≥30). The denominator was the estimated number of adults with obesity.
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Body mass index ≥30; calculated from self-reported height and weight.
** Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 3. Unadjusted* and age-standardized† prevalences of arthritis§ among adults aged ≥18 years with coronary heart disease, by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area No. of respondents with coronary heart disease Weighted population with arthritis and coronary heart disease (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized %* (95% CI)
Alabama 874 196,000 64.3 (59.7–68.7) 57.0 (47.0–66.6)
Alaska 223 12,000 49.1 (38.0–60.2) 31.3 (21.8–42.6)
Arizona 732 164,000 51.6 (46.1–57.1) 36.9 (27.8–47.0)
Arkansas 714 122,000 64.6 (58.5–70.3) 57.8 (41.8–72.4)
California 701 708,000 49.0 (43.8–54.2) 38.1 (28.7–48.5)
Colorado 857 99,000 53.4 (48.3–58.4) 48.2 (35.9–60.7)
Connecticut 945 80,000 52.1 (47.7–56.5) 41.2 (30.8–52.4)
Delaware 385 30,000 57.5 (49.5–65.1) 44.4 (27.2–63.0)
District of Columbia 286 11,000 45.9 (34.8–57.3) 25.6 (20.0–32.3)
Florida 1,031 667,000 56.2 (51.9–60.5) 43.0 (31.8–54.9)
Georgia 454 301,000 59.0 (52.6–65.0) 48.3 (34.6–62.3)
Hawaii 409 22,000 43.5 (36.7–50.5) 39.1 (26.9–52.8)
Idaho 469 37,000 53.8 (46.4–61.0) 36.7 (27.2–47.5)
Illinois 457 317,000 53.0 (47.0–58.9) 39.1 (26.0–54.1)
Indiana 672 239,000 60.9 (55.4–66.2) 52.2 (39.6–64.5)
Iowa 516 86,000 59.9 (54.6–65.0) 72.6 (60.6–82.1)
Kansas 1,894 72,000 56.5 (53.8–59.1) 43.5 (36.8–50.3)
Kentucky 1,055 187,000 59.3 (54.3–64.1) 48.4 (38.9–57.9)
Louisiana 527 173,000 61.1 (55.4–66.5) 55.8 (43.2–67.7)
Maine 824 51,000 60.8 (56.1–65.3) 52.6 (40.0–65.0)
Maryland 1,126 140,000 52.3 (46.5–58.0) 38.9 (27.5–51.7)
Massachusetts 656 181,000 56.8 (51.0–62.4) 48.1 (35.1–61.5)
Michigan 788 344,000 62.1 (57.9–66.2) 45.7 (35.2–56.6)
Minnesota 1,131 110,000 50.6 (47.0–54.1) 35.8 (27.9–44.7)
Mississippi 659 110,000 58.2 (52.3–63.9) 43.5 (34.0–53.4)
Missouri 780 204,000 58.3 (53.3–63.1) 38.2 (29.2–48.1)
Montana 502 26,000 57.9 (51.6–63.9) 44.0 (27.3–62.2)
Nebraska 1,447 43,000 51.8 (47.9–55.7) 35.8 (29.5–42.7)
Nevada 247 86,000 63.0 (52.9–72.0) 41.6 (27.5–57.3)
New Hampshire 614 33,000 55.2 (49.9–60.3) 43.4 (27.6–60.7)
New Jersey 848 215,000 55.9 (50.6–61.0) 50.4 (36.5–64.2)
New Mexico 572 50,000 56.0 (49.8–62.0) 30.5 (25.8–35.7)
New York 959 510,000 57.3 (53.0–61.6) 56.1 (44.4–67.3)
North Carolina 580 313,000 57.9 (52.8–62.8) 44.5 (33.4–56.2)
North Dakota 414 18,000 54.1 (47.9–60.1) 55.2 (35.8–73.2)
Ohio 1,295 382,000 61.0 (56.2–65.6) 45.3 (32.4–58.8)
Oklahoma 838 161,000 65.3 (60.2–70.2) 47.9 (36.4–59.6)
Oregon 398 97,000 56.4 (50.1–62.6) 46.4 (30.9–62.7)
Pennsylvania 485 412,000 58.4 (52.4–64.2) 49.9 (33.5–66.3)
Rhode Island 534 30,000 59.8 (53.7–65.6) 60.3 (44.3–74.3)
South Carolina 1,134 162,000 62.0 (58.0–65.8) 51.0 (41.3–60.7)
South Dakota 715 28,000 61.1 (54.9–66.9) 50.8 (36.6–64.9)
Tennessee 703 271,000 63.2 (58.1–68.0) 55.1 (42.7–66.9)
Texas 1,362 606,000 49.9 (44.3–55.5) 36.8 (28.7–45.8)
Utah 618 44,000 53.4 (48.3–58.5) 40.2 (30.6–50.6)
Vermont 477 19,000 57.8 (52.0–63.3) 43.8 (30.9–57.6)
Virginia 637 182,000 51.5 (46.4–56.5) 36.5 (28.9–44.8)
Washington 1,310 180,000 57.4 (53.5–61.3) 47.1 (38.7–55.8)
West Virginia 755 102,000 63.8 (59.7–67.7) 53.7 (44.1–63.1)
Wisconsin 494 134,000 48.9 (42.6–55.2) 35.9 (25.7–47.7)
Wyoming 564 16,000 58.6 (52.0–64.9) 58.6 (39.4–75.5)
Median (Range)** 57.4 (43.5–65.3) 44.5 (25.6–72.6)
Guam 88 3,000 49.1 (33.5–64.9) 42.2 (22.3–65.0)
Puerto Rico 586 126,000 49.2 (44.3–54.2) 37.3 (30.2–44.9)

Abbreviation: CI = confidence interval.
* The numerator was the estimated number of adults with arthritis and coronary heart disease. The denominator was the estimated number of adults with coronary heart disease.
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Doctor-diagnosed coronary heart disease was defined as a yes response to either of the following two questions: “Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?” or “Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?” Those who answered yes to either question were classified as having coronary heart disease. Those who answered no to both questions were classified as not having coronary heart disease.
** Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 4. Unadjusted* and age-standardized† prevalences of arthritis§ among adults aged ≥18 years with diabetes, by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area No. of respondents with diabetes Weighted population with arthritis and diabetes (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized %* (95% CI)
Alabama 1,355 283,000 56.4 (52.7–60.0) 43.8 (38.0–49.7)
Alaska 346 19,000 44.4 (35.3–53.8) 46.0 (29.6–63.4)
Arizona 1,095 238,000 45.7 (41.6–49.9) 32.6 (27.0–38.8)
Arkansas 951 167,000 58.9 (53.7–64.0) 48.6 (38.4–58.9)
California 1,283 1,088,000 36.4 (32.8–40.2) 27.1 (23.1–31.5)
Colorado 1,216 132,000 47.0 (42.9–51.1) 37.3 (30.3–44.9)
Connecticut 1,379 117,000 45.5 (41.8–49.2) 30.1 (25.0–35.6)
Delaware 606 42,000 50.0 (44.5–55.4) 35.4 (26.8–44.9)
District of Columbia 544 22,000 47.0 (39.2–55.0) 28.2 (22.8–34.2)
Florida 1,394 958,000 53.0 (49.2–56.7) 35.6 (28.9–43.0)
Georgia 752 453,000 52.2 (47.4–56.9) 40.0 (30.8–49.9)
Hawaii 722 37,000 38.7 (34.0–43.7) 32.0 (24.9–40.0)
Idaho 678 46,000 46.8 (41.7–52.0) 37.0 (28.6–46.2)
Illinois 680 452,000 46.1 (41.3–50.9) 34.2 (25.7–44.0)
Indiana 885 297,000 51.5 (46.6–56.3) 37.6 (30.9–44.9)
Iowa 753 110,000 52.1 (47.4–56.7) 32.2 (26.3–38.7)
Kansas 2,863 106,000 50.4 (48.2–52.6) 37.1 (33.8–40.6)
Kentucky 1,457 253,000 55.9 (51.5–60.3) 45.4 (37.9–53.0)
Louisiana 793 241,000 53.7 (49.1–58.4) 41.5 (33.7–49.7)
Maine 1,083 62,000 58.2 (54.0–62.2) 53.7 (43.8–63.3)
Maryland 1,854 207,000 43.5 (39.1–48.1) 34.8 (27.2–43.3)
Massachusetts 983 230,000 48.4 (43.8–53.0) 37.0 (30.3–44.2)
Michigan 1,087 438,000 53.2 (49.5–56.9) 40.6 (34.9–46.5)
Minnesota 1,637 150,000 47.8 (44.8–50.9) 36.9 (30.6–43.6)
Mississippi 1,151 172,000 51.7 (47.5–55.8) 39.7 (33.6–46.0)
Missouri 1,154 297,000 55.5 (51.3–59.6) 53.7 (44.9–62.2)
Montana 652 34,000 53.9 (48.2–59.5) 46.4 (34.2–59.1)
Nebraska 2,046 60,000 48.0 (44.7–51.3) 30.7 (26.5–35.1)
Nevada 337 89,000 41.8 (33.9–50.1) 28.9 (19.1–41.2)
New Hampshire 834 46,000 53.2 (48.6–57.8) 36.3 (28.4–45.0)
New Jersey 1,314 302,000 48.3 (44.1–52.6) 38.3 (29.4–48.0)
New Mexico 919 83,000 46.5 (41.7–51.3) 33.1 (27.2–39.5)
New York 1,469 730,000 48.1 (44.6–51.6) 38.8 (32.4–45.7)
North Carolina 855 440,000 53.4 (49.4–57.4) 40.5 (33.9–47.6)
North Dakota 565 22,000 43.8 (38.6–49.1) 27.4 (21.7–33.9)
Ohio 1,861 531,000 53.8 (50.1–57.5) 39.7 (33.0–46.9)
Oklahoma 1,091 188,000 55.0 (50.9–59.0) 44.2 (36.6–52.1)
Oregon 655 157,000 48.0 (43.1–52.9) 40.0 (31.1–49.5)
Pennsylvania 715 575,000 55.2 (50.3–60.1) 40.0 (31.0–49.7)
Rhode Island 748 39,000 51.5 (46.4–56.6) 42.9 (29.9–56.9)
South Carolina 1,837 254,000 56.9 (53.6–60.2) 47.6 (41.4–54.0)
South Dakota 862 28,000 46.9 (41.2–52.6) 31.6 (25.4–38.4)
Tennessee 998 348,000 54.3 (49.6–59.0) 42.2 (35.4–49.4)
Texas 2,269 977,000 42.4 (38.4–46.6) 27.8 (24.4–31.5)
Utah 1,018 68,000 46.7 (42.8–50.6) 33.0 (27.5–39.0)
Vermont 625 20,000 49.3 (44.4–54.3) 37.5 (30.1–45.5)
Virginia 1,129 328,000 48.8 (44.7–53.0) 34.3 (29.6–39.4)
Washington 1,782 219,000 47.8 (44.5–51.0) 35.4 (30.2–41.1)
West Virginia 962 132,000 62.4 (58.8–65.9) 52.3 (46.1–58.4)
Wisconsin 678 161,000 43.4 (38.2–48.8) 28.3 (22.9–34.4)
Wyoming 678 19,000 51.7 (46.1–57.2) 47.2 (33.6–61.3)
Median (Range)** 49.3 (36.4–62.4) 37.3 (27.1–53.7)
Guam 192 5,000 39.1 (29.7–49.4) 26.8 (19.2–36.1)
Puerto Rico 1,084 206,000 45.3 (41.8–48.9) 28.1 (23.9–32.8)

Abbreviation: CI = confidence interval.
* The numerator was the estimated number of adults with arthritis and diabetes. The denominator was the estimated number of adults with diabetes.
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Doctor-diagnosed diabetes was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have diabetes?” Those with prediabetes or borderline diabetes and women who had diabetes only during pregnancy were classified as not having diabetes.
** Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 5. Unadjusted and age-standardized* percentages of ≥14 physically unhealthy days† during the past 30 days among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and ≥14 physically unhealthy days (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 365,000 30.5 (28.3–32.7) 30.6 (27.2–34.2)
Alaska 117,000 23,000 21.3 (17.9–25.2) 16.9 (13.4–21.2)
Arizona 1,222,000 354,000 29.7 (27.2–32.3) 30.1 (25.8–34.8)
Arkansas 672,000 208,000 32.3 (29.0–35.8) 35.7 (29.8–42.1)
California 5,719,000 1,383,000 24.5 (22.5–26.7) 24.6 (21.3–28.2)
Colorado 949,000 232,000 25.1 (23.1–27.3) 27.7 (23.9–31.7)
Connecticut 690,000 157,000 23.4 (21.5–25.5) 25.1 (21.3–29.2)
Delaware 207,000 48,000 23.9 (21.0–27.0) 24.8 (19.9–30.5)
District of Columbia 101,000 25,000 25.6 (21.2–30.6) 23.0 (15.3–33.1)
Florida 4,154,000 1,190,000 30.0 (27.8–32.4) 33.6 (28.8–38.9)
Georgia 1,890,000 526,000 28.7 (25.8–31.8) 25.0 (20.7–29.9)
Hawaii 211,000 45,000 21.4 (18.8–24.3) 21.0 (16.7–26.2)
Idaho 309,000 68,000 22.8 (20.3–25.4) 24.7 (20.3–29.6)
Illinois 2,308,000 595,000 26.0 (23.2–28.9) 24.8 (19.9–30.4)
Indiana 1,390,000 377,000 28.3 (25.6–31.1) 30.1 (24.9–35.8)
Iowa 619,000 131,000 21.9 (19.7–24.2) 20.4 (16.6–24.7)
Kansas 536,000 119,000 23.0 (21.8–24.2) 22.9 (20.9–25.1)
Kentucky 1,087,000 338,000 31.9 (29.4–34.5) 30.2 (26.2–34.5)
Louisiana 989,000 288,000 30.5 (27.6–33.4) 29.8 (25.3–34.7)
Maine 332,000 82,000 25.2 (23.1–27.5) 29.1 (24.9–33.7)
Maryland 1,096,000 260,000 24.7 (22.0–27.5) 28.7 (23.1–35.0)
Massachusetts 1,300,000 325,000 26.1 (23.8–28.6) 29.0 (25.0–33.3)
Michigan 2,305,000 622,000 27.5 (25.6–29.5) 29.8 (26.5–33.2)
Minnesota 907,000 218,000 24.8 (23.1–26.5) 27.1 (23.7–30.6)
Mississippi 647,000 224,000 35.6 (32.8–38.5) 35.5 (30.8–40.6)
Missouri 1,372,000 390,000 29.1 (26.7–31.7) 29.3 (24.9–34.0)
Montana 216,000 54,000 25.5 (22.8–28.4) 26.7 (21.9–32.1)
Nebraska 334,000 70,000 21.3 (19.7–23.0) 20.3 (17.5–23.4)
Nevada 477,000 126,000 27.5 (22.9–32.5) 30.6 (22.6–40.0)
New Hampshire 282,000 64,000 23.1 (20.9–25.6) 25.5 (20.9–30.8)
New Jersey 1,590,000 378,000 24.8 (22.5–27.1) 24.4 (20.9–28.3)
New Mexico 386,000 111,000 29.3 (26.7–32.1) 27.8 (23.2–33.0)
New York 3,629,000 910,000 26.5 (24.5–28.6) 30.0 (26.0–34.2)
North Carolina 2,089,000 607,000 30.2 (27.7–32.7) 27.8 (24.2–31.6)
North Dakota 134,000 28,000 21.5 (18.8–24.4) 21.7 (17.1–27.0)
Ohio 2,547,000 664,000 26.8 (24.6–29.1) 27.0 (22.8–31.6)
Oklahoma 813,000 278,000 35.2 (32.5–38.0) 37.5 (32.7–42.6)
Oregon 838,000 238,000 29.6 (26.9–32.5) 30.2 (25.8–35.0)
Pennsylvania 2,937,000 682,000 23.8 (21.5–26.4) 24.4 (20.4–28.8)
Rhode Island 226,000 61,000 28.4 (25.6–31.3) 32.7 (27.1–38.9)
South Carolina 1,105,000 332,000 31.1 (29.2–33.2) 31.3 (27.8–35.0)
South Dakota 158,000 35,000 22.4 (19.7–25.5) 20.3 (16.5–24.7)
Tennessee 1,630,000 521,000 33.0 (30.2–36.0) 31.9 (27.4–36.8)
Texas 4,055,000 1,035,000 26.7 (24.2–29.3) 25.9 (22.0–30.3)
Utah 407,000 98,000 24.8 (22.8–27.0) 25.3 (22.4–28.4)
Vermont 136,000 33,000 25.3 (22.8–28.0) 26.5 (21.9–31.6)
Virginia 1,513,000 359,000 24.3 (22.1–26.6) 24.5 (20.6–28.8)
Washington 1,346,000 332,000 25.2 (23.5–26.9) 27.7 (24.3–31.3)
West Virginia 557,000 186,000 34.1 (32.0–36.4) 33.1 (29.8–36.5)
Wisconsin 1,104,000 264,000 24.2 (21.7–27.0) 21.1 (17.6–25.0)
Wyoming 116,000 30,000 26.5 (23.3–29.9) 28.9 (23.1–35.4)
Median (Range) 26.0 (21.3–35.6) 27.7 (16.9–37.5)
Guam 17,000 4,000 23.8 (17.5–31.4) 21.5 (14.8–30.2)
Puerto Rico 635,000 196,000 31.0 (28.3–33.8) 30.6 (25.8–35.9)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Respondents with arthritis who answered 14–30 days to the question “Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?”
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 6. Unadjusted and age-standardized* percentages of ≥14 mentally unhealthy days† during the past 30 days among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and ≥14 mentally unhealthy days (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 268,000 22.0 (20.0–24.1) 29.4 (25.8–33.2)
Alaska 117,000 19,000 16.6 (13.2–20.7) 18.0 (13.0–24.4)
Arizona 1,222,000 210,000 17.5 (15.5–19.7) 21.0 (17.3–25.4)
Arkansas 672,000 138,000 21.2 (18.2–24.5) 26.6 (21.2–32.7)
California 5,719,000 934,000 16.6 (14.8–18.5) 21.7 (18.4–25.4)
Colorado 949,000 145,000 15.7 (13.8–17.7) 23.1 (19.3–27.4)
Connecticut 690,000 104,000 15.3 (13.7–17.0) 21.1 (17.7–25.0)
Delaware 207,000 36,000 17.5 (15.0–20.4) 20.1 (15.4–25.7)
District of Columbia 101,000 17,000 17.5 (13.5–22.3) 20.1 (12.4–31.0)
Florida 4,154,000 772,000 19.0 (17.1–21.2) 23.9 (20.0–28.3)
Georgia 1,890,000 343,000 18.8 (16.2–21.7) 21.0 (16.1–26.9)
Hawaii 211,000 24,000 11.7 (9.7–13.9) 14.8 (10.9–19.9)
Idaho 309,000 46,000 15.3 (13.0–17.9) 22.2 (17.5–27.7)
Illinois 2,308,000 330,000 14.6 (12.4–17.0) 19.3 (15.0–24.5)
Indiana 1,390,000 241,000 17.8 (15.5–20.4) 24.4 (19.4–30.2)
Iowa 619,000 85,000 13.9 (12.0–16.1) 22.3 (17.8–27.6)
Kansas 536,000 77,000 14.6 (13.6–15.7) 20.3 (18.2–22.6)
Kentucky 1,087,000 224,000 21.1 (18.6–23.8) 26.5 (21.9–31.7)
Louisiana 989,000 199,000 20.6 (18.2–23.3) 25.6 (21.2–30.6)
Maine 332,000 57,000 17.6 (15.7–19.6) 25.0 (21.1–29.4)
Maryland 1,096,000 204,000 19.0 (16.5–21.9) 29.9 (24.2–36.2)
Massachusetts 1,300,000 238,000 18.8 (16.7–21.1) 26.3 (22.3–30.9)
Michigan 2,305,000 408,000 18.0 (16.3–19.8) 24.0 (20.9–27.4)
Minnesota 907,000 118,000 13.3 (12.0–14.7) 19.5 (16.6–22.7)
Mississippi 647,000 148,000 23.6 (21.0–26.4) 31.1 (26.3–36.3)
Missouri 1,372,000 263,000 19.6 (17.2–22.1) 25.8 (21.1–31.1)
Montana 216,000 34,000 16.0 (13.6–18.7) 21.8 (16.9–27.7)
Nebraska 334,000 43,000 13.1 (11.8–14.6) 16.7 (13.9–20.1)
Nevada 477,000 93,000 19.9 (15.4–25.3) 30.0 (21.5–40.2)
New Hampshire 282,000 45,000 16.3 (14.3–18.5) 24.1 (19.2–29.8)
New Jersey 1,590,000 249,000 16.0 (14.1–18.2) 21.3 (17.2–26.2)
New Mexico 386,000 65,000 17.2 (15.0–19.7) 21.6 (17.2–26.8)
New York 3,629,000 636,000 18.2 (16.4–20.1) 23.3 (19.9–27.0)
North Carolina 2,089,000 404,000 19.7 (17.6–22.0) 24.6 (20.8–28.8)
North Dakota 134,000 17,000 13.3 (10.7–16.4) 21.7 (16.2–28.3)
Ohio 2,547,000 470,000 18.9 (16.8–21.1) 25.6 (21.3–30.3)
Oklahoma 813,000 179,000 22.6 (20.2–25.2) 28.6 (24.1–33.5)
Oregon 838,000 167,000 20.6 (18.1–23.3) 27.4 (22.9–32.5)
Pennsylvania 2,937,000 478,000 16.6 (14.5–18.9) 21.0 (17.0–25.5)
Rhode Island 226,000 41,000 18.4 (16.0–21.2) 26.9 (21.5–33.2)
South Carolina 1,105,000 238,000 22.3 (20.5–24.2) 28.4 (24.9–32.3)
South Dakota 158,000 18,000 11.3 (9.2–13.9) 15.7 (11.6–21.1)
Tennessee 1,630,000 337,000 21.0 (18.6–23.7) 25.8 (21.3–30.8)
Texas 4,055,000 658,000 16.7 (14.6–19.1) 23.2 (18.8–28.3)
Utah 407,000 66,000 16.7 (14.9–18.6) 20.4 (17.6–23.5)
Vermont 136,000 20,000 15.1 (13.1–17.2) 20.3 (16.4–24.9)
Virginia 1,513,000 207,000 14.0 (12.2–15.9) 19.7 (16.2–23.8)
Washington 1,346,000 211,000 15.9 (14.5–17.4) 20.8 (17.9–24.1)
West Virginia 557,000 127,000 23.5 (21.5–25.5) 28.5 (25.3–32.0)
Wisconsin 1,104,000 173,000 15.8 (13.5–18.4) 22.0 (17.2–27.6)
Wyoming 116,000 18,000 15.8 (13.3–18.7) 20.0 (15.5–25.5)
Median (Range) 17.5 (11.3–23.6) 22.3 (14.8–31.1)
Guam 17,000 3,000 15.5 (10.9–21.5) 18.1 (11.5–27.3)
Puerto Rico 635,000 144,000 23.0 (20.5–25.6) 27.7 (22.9–33.0)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Respondents with arthritis who answered 14–30 days to the question “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 7. Unadjusted and age-standardized* percentages of physical inactivity† among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and physical inactivity (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 488,000 43.7 (41.2–46.2) 40.0 (36.2–44.0)
Alaska 117,000 33,000 31.8 (27.1–36.9) 30.8 (24.1–38.5)
Arizona 1,222,000 357,000 33.7 (31.1–36.4) 31.8 (27.0–36.9)
Arkansas 672,000 280,000 47.6 (43.8–51.5) 44.3 (38.0–50.8)
California 5,719,000 1,217,000 24.7 (22.5–27.1) 23.1 (19.8–26.9)
Colorado 949,000 218,000 27.0 (24.9–29.3) 25.2 (21.8–28.9)
Connecticut 690,000 195,000 32.5 (30.4–34.7) 26.7 (23.4–30.2)
Delaware 207,000 78,000 41.8 (38.2–45.5) 37.5 (31.1–44.3)
District of Columbia 101,000 25,000 30.9 (26.1–36.1) 24.9 (16.2–36.2)
Florida 4,154,000 1,396,000 39.1 (36.6–41.7) 36.6 (31.3–42.2)
Georgia 1,890,000 650,000 38.9 (35.6–42.3) 35.9 (29.6–42.6)
Hawaii 211,000 50,000 26.0 (23.2–29.0) 29.0 (23.7–34.8)
Idaho 309,000 87,000 31.1 (28.2–34.1) 28.6 (23.9–33.8)
Illinois 2,308,000 768,000 36.4 (33.4–39.5) 33.4 (28.1–39.0)
Indiana 1,390,000 505,000 40.9 (37.8–44.0) 37.0 (31.3–43.1)
Iowa 619,000 205,000 37.5 (34.7–40.3) 38.5 (33.0–44.3)
Kansas 536,000 173,000 36.9 (35.5–38.3) 33.0 (30.6–35.5)
Kentucky 1,087,000 423,000 44.1 (41.2–47.0) 39.9 (35.4–44.7)
Louisiana 989,000 375,000 44.6 (41.3–48.0) 40.1 (34.7–45.6)
Maine 332,000 111,000 36.9 (34.5–39.2) 36.0 (31.7–40.5)
Maryland 1,096,000 355,000 38.0 (34.9–41.2) 37.1 (31.2–43.5)
Massachusetts 1,300,000 408,000 37.7 (34.9–40.5) 36.0 (31.3–41.0)
Michigan 2,305,000 747,000 35.7 (33.5–37.9) 34.0 (30.5–37.7)
Minnesota 907,000 275,000 33.1 (31.3–35.0) 30.7 (27.3–34.3)
Mississippi 647,000 297,000 50.1 (47.0–53.1) 47.9 (42.7–53.1)
Missouri 1,372,000 466,000 37.3 (34.6–40.2) 36.6 (31.6–41.9)
Montana 216,000 61,000 30.3 (27.4–33.4) 28.9 (24.0–34.4)
Nebraska 334,000 104,000 34.0 (32.1–36.0) 28.5 (25.2–32.2)
Nevada 477,000 140,000 33.0 (27.9–38.5) 31.0 (23.1–40.1)
New Hampshire 282,000 87,000 35.0 (32.3–37.7) 33.0 (27.7–38.8)
New Jersey 1,590,000 523,000 37.1 (34.4–39.8) 32.8 (28.4–37.4)
New Mexico 386,000 104,000 30.3 (27.6–33.2) 29.1 (24.1–34.7)
New York 3,629,000 1,241,000 41.1 (38.8–43.4) 39.7 (35.3–44.1)
North Carolina 2,089,000 749,000 39.9 (37.2–42.7) 37.1 (32.8–41.6)
North Dakota 134,000 45,000 37.4 (34.1–40.7) 35.1 (29.3–41.4)
Ohio 2,547,000 884,000 39.2 (36.7–41.7) 35.7 (31.3–40.5)
Oklahoma 813,000 340,000 45.9 (43.1–48.7) 41.9 (37.1–46.8)
Oregon 838,000 193,000 26.8 (24.0–29.7) 24.0 (19.9–28.7)
Pennsylvania 2,937,000 1,010,000 39.2 (36.3–42.3) 38.0 (32.9–43.4)
Rhode Island 226,000 75,000 38.5 (35.5–41.7) 36.8 (30.5–43.6)
South Carolina 1,105,000 373,000 37.6 (35.5–39.7) 35.0 (31.4–38.7)
South Dakota 158,000 43,000 29.7 (26.4–33.2) 23.4 (19.3–28.0)
Tennessee 1,630,000 575,000 41.2 (38.0–44.5) 38.9 (33.7–44.3)
Texas 4,055,000 1,519,000 43.0 (40.0–46.0) 43.4 (38.5–48.5)
Utah 407,000 106,000 29.4 (27.2–31.6) 28.0 (24.8–31.4)
Vermont 136,000 40,000 32.1 (29.4–35.0) 31.0 (26.4–36.1)
Virginia 1,513,000 520,000 38.1 (35.4–40.9) 36.3 (31.9–40.9)
Washington 1,346,000 317,000 26.3 (24.6–28.0) 25.8 (22.6–29.4)
West Virginia 557,000 209,000 41.0 (38.7–43.4) 38.6 (35.0–42.3)
Wisconsin 1,104,000 281,000 29.0 (26.2–32.1) 24.6 (19.9–30.0)
Wyoming 116,000 37,000 35.2 (31.8–38.8) 34.4 (28.6–40.7)
Median (Range) 37.1 (24.7–50.1) 35.0 (23.1–47.9)
Guam 17,000 7,000 45.7 (37.1–54.5) 39.6 (29.8–50.2)
Puerto Rico 635,000 371,000 60.5 (57.5–63.5) 58.1 (52.1–63.8)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Physical inactivity was defined as a no response to the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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Return to your place in the textFIGURE 2. Age-standardized prevalence of physical inactivity* among adults aged ≥18 years with arthritis, by state — Behavioral Risk Factor Surveillance System, United States, 2015
Map of the United States indicates the prevalence of physical inactivity among adults aged 18 years and older with arthritis, by state. The data source is the 2015 Behavioral Risk Factor Surveillance System.

Abbreviations: DC = District of Columbia; Q = quartile.

* Physical inactivity was defined as a no response to the question “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”

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TABLE 8. Unadjusted and age-standardized* percentages of walking† among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and walking (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 501,000 43.6 (41.1–46.0) 44.8 (40.7–48.9)
Alaska 117,000 59,000 53.9 (48.9–58.8) 52.3 (44.8–59.7)
Arizona 1,222,000 570,000 51.5 (48.7–54.3) 50.8 (45.3–56.2)
Arkansas 672,000 249,000 40.6 (37.0–44.3) 41.8 (35.4–48.4)
California 5,719,000 2,996,000 59.4 (56.7–62.0) 55.6 (51.3–59.9)
Colorado 949,000 464,000 55.4 (52.9–57.7) 55.4 (50.9–59.8)
Connecticut 690,000 308,000 49.4 (47.2–51.7) 51.5 (47.1–55.9)
Delaware 207,000 83,000 42.9 (39.4–46.4) 43.1 (36.5–49.9)
District of Columbia 101,000 50,000 53.6 (48.2–59.0) 51.9 (40.2–63.5)
Florida 4,154,000 1,751,000 47.2 (44.7–49.7) 46.9 (41.4–52.4)
Georgia 1,890,000 829,000 47.7 (44.4–51.1) 45.2 (38.8–51.7)
Hawaii 211,000 101,000 52.1 (48.8–55.4) 47.2 (41.4–53.1)
Idaho 309,000 157,000 54.1 (50.9–57.3) 53.0 (47.3–58.5)
Illinois 2,308,000 949,000 44.6 (41.5–47.7) 45.7 (39.9–51.6)
Indiana 1,390,000 615,000 48.3 (45.2–51.4) 51.8 (45.8–57.7)
Iowa 619,000 268,000 47.2 (44.4–50.1) 43.5 (38.1–49.0)
Kansas 536,000 230,000 47.4 (46.0–48.9) 48.9 (46.2–51.5)
Kentucky 1,087,000 426,000 42.9 (40.0–45.8) 46.2 (41.2–51.2)
Louisiana 989,000 377,000 42.3 (39.0–45.6) 46.3 (40.9–51.9)
Maine 332,000 158,000 50.7 (48.2–53.1) 51.0 (46.2–55.7)
Maryland 1,096,000 457,000 46.5 (43.5–49.6) 46.2 (40.2–52.3)
Massachusetts 1,300,000 539,000 46.9 (44.1–49.7) 43.4 (38.9–48.0)
Michigan 2,305,000 1,018,000 46.8 (44.6–49.0) 45.7 (42.1–49.3)
Minnesota 907,000 441,000 51.6 (49.7–53.5) 52.6 (48.9–56.2)
Mississippi 647,000 248,000 40.2 (37.4–43.1) 40.3 (35.3–45.5)
Missouri 1,372,000 592,000 46.1 (43.4–49.0) 48.0 (42.7–53.3)
Montana 216,000 120,000 57.9 (54.8–60.9) 59.5 (53.8–64.9)
Nebraska 334,000 161,000 51.0 (48.9–53.1) 52.9 (48.7–57.1)
Nevada 477,000 226,000 51.2 (45.5–56.9) 49.3 (39.9–58.9)
New Hampshire 282,000 129,000 49.9 (47.1–52.6) 49.1 (43.2–55.0)
New Jersey 1,590,000 670,000 45.3 (42.6–48.1) 43.6 (38.8–48.6)
New Mexico 386,000 185,000 52.5 (49.4–55.6) 52.4 (46.3–58.4)
New York 3,629,000 1,540,000 48.3 (46.1–50.6) 47.3 (43.0–51.6)
North Carolina 2,089,000 892,000 45.2 (42.5–47.9) 45.6 (41.1–50.2)
North Dakota 134,000 67,000 52.7 (49.3–56.0) 52.0 (45.5–58.4)
Ohio 2,547,000 1,068,000 45.3 (42.9–47.8) 48.2 (43.4–53.0)
Oklahoma 813,000 315,000 41.1 (38.4–43.8) 43.1 (38.3–48.0)
Oregon 838,000 413,000 54.2 (51.1–57.1) 53.7 (48.5–58.9)
Pennsylvania 2,937,000 1,234,000 46.3 (43.4–49.3) 44.4 (39.3–49.6)
Rhode Island 226,000 89,000 43.9 (41.0–46.9) 41.5 (35.6–47.5)
South Carolina 1,105,000 479,000 46.2 (44.1–48.3) 45.3 (41.3–49.2)
South Dakota 158,000 80,000 53.6 (50.0–57.2) 54.5 (47.9–61.0)
Tennessee 1,630,000 680,000 46.3 (43.2–49.5) 46.4 (41.1–51.8)
Texas 4,055,000 1,651,000 45.2 (42.3–48.2) 40.3 (36.1–44.7)
Utah 407,000 201,000 53.6 (51.3–56.0) 53.1 (49.6–56.7)
Vermont 136,000 69,000 53.3 (50.4–56.1) 53.5 (48.3–58.6)
Virginia 1,513,000 663,000 46.6 (44.0–49.3) 46.1 (41.2–51.0)
Washington 1,346,000 710,000 56.4 (54.5–58.3) 54.6 (50.7–58.5)
West Virginia 557,000 208,000 39.0 (36.8–41.3) 38.5 (35.0–42.1)
Wisconsin 1,104,000 544,000 54.4 (51.0–57.7) 57.0 (50.2–63.5)
Wyoming 116,000 54,000 50.2 (46.7–53.8) 50.0 (43.8–56.3)
Median (Range) 47.7 (39.0–59.4) 48.0 (38.5–59.5)
Guam 17,000 6,000 36.3 (28.6–44.7) 34.0 (23.5–46.3)
Puerto Rico 635,000 173,000 27.8 (25.2–30.6) 28.5 (23.4–34.1)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Respondents with arthritis who reported walking or hiking for one of two questions: 1) “What type of physical activity or exercise did you spend the most time doing during the past month?” and 2) “What other type of physical activity gave you the next most exercise during the past month?” The denominator included adults with arthritis who were either physically active or inactive.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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Return to your place in the textFIGURE 3. Age-standardized prevalence of walking* among adults aged ≥18 years with arthritis, by state — Behavioral Risk Factor Surveillance System, United States, 2015
Map of the United States indicates the prevalence of walking among adults aged 18 years and older with arthritis, by state. The data source is the 2015 Behavioral Risk Factor Surveillance System.

Abbreviations: DC = District of Columbia; Q = quartile.

* Respondents with arthritis who reported walking or hiking for one of two questions: 1) “What type of physical activity or exercise did you spend the most time doing during the past month?” and 2) “What other type of physical activity gave you the next most exercise during the past month?”

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TABLE 9. Unadjusted and age-standardized* percentages of obesity† among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and obesity (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 512,000 43.8 (41.4–46.2) 45.9 (42.0–49.9)
Alaska 117,000 46,000 41.6 (36.9–46.5) 45.0 (37.8–52.4)
Arizona 1,222,000 398,000 35.6 (33.0–38.4) 34.6 (29.9–39.6)
Arkansas 672,000 275,000 44.2 (40.5–47.9) 48.9 (42.5–55.4)
California 5,719,000 1,749,000 33.0 (30.6–35.6) 33.7 (29.8–37.9)
Colorado 949,000 250,000 28.9 (26.8–31.1) 28.1 (24.7–31.9)
Connecticut 690,000 228,000 35.7 (33.6–37.9) 37.3 (33.2–41.6)
Delaware 207,000 70,000 37.5 (34.1–41.0) 38.4 (32.1–45.1)
District of Columbia 101,000 41,000 43.9 (38.5–49.5) 42.4 (30.7–55.0)
Florida 4,154,000 1,381,000 36.0 (33.6–38.5) 38.4 (33.2–43.8)
Georgia 1,890,000 759,000 42.2 (38.9–45.5) 38.0 (32.6–43.8)
Hawaii 211,000 67,000 32.5 (29.5–35.8) 42.2 (36.6–48.0)
Idaho 309,000 105,000 36.4 (33.3–39.6) 37.3 (32.1–42.8)
Illinois 2,308,000 946,000 42.1 (39.0–45.2) 41.8 (36.2–47.6)
Indiana 1,390,000 537,000 41.7 (38.7–44.7) 44.1 (38.3–50.1)
Iowa 619,000 241,000 42.2 (39.4–45.0) 44.7 (39.3–50.3)
Kansas 536,000 194,000 41.1 (39.7–42.6) 43.2 (40.6–45.9)
Kentucky 1,087,000 457,000 44.9 (42.0–47.9) 48.5 (43.5–53.5)
Louisiana 989,000 419,000 45.3 (42.0–48.6) 48.5 (43.2–53.9)
Maine 332,000 122,000 38.7 (36.3–41.1) 42.3 (37.7–47.0)
Maryland 1,096,000 448,000 44.4 (41.2–47.6) 47.9 (41.8–54.1)
Massachusetts 1,300,000 422,000 36.1 (33.4–38.9) 35.8 (31.5–40.3)
Michigan 2,305,000 875,000 40.4 (38.2–42.6) 42.1 (38.6–45.8)
Minnesota 907,000 321,000 38.3 (36.5–40.2) 40.3 (36.6–44.0)
Mississippi 647,000 260,000 42.0 (39.1–44.9) 44.3 (39.2–49.5)
Missouri 1,372,000 518,000 40.7 (38.0–43.5) 42.9 (37.8–48.2)
Montana 216,000 62,000 31.1 (28.3–34.1) 29.6 (24.8–34.8)
Nebraska 334,000 134,000 42.6 (40.6–44.7) 45.1 (40.9–49.2)
Nevada 477,000 155,000 34.4 (29.2–39.9) 35.2 (26.7–44.7)
New Hampshire 282,000 94,000 36.9 (34.3–39.6) 40.7 (35.0–46.6)
New Jersey 1,590,000 539,000 37.3 (34.6–40.1) 38.7 (34.1–43.6)
New Mexico 386,000 127,000 35.2 (32.2–38.3) 43.1 (37.3–49.1)
New York 3,629,000 1,221,000 36.4 (34.2–38.6) 40.1 (36.0–44.4)
North Carolina 2,089,000 780,000 40.0 (37.3–42.7) 41.4 (37.0–46.0)
North Dakota 134,000 51,000 41.3 (38.1–44.7) 39.7 (34.1–45.6)
Ohio 2,547,000 947,000 40.2 (37.8–42.7) 40.4 (35.7–45.2)
Oklahoma 813,000 329,000 42.9 (40.2–45.7) 44.9 (40.1–49.8)
Oregon 838,000 302,000 39.3 (36.4–42.4) 41.6 (36.6–46.8)
Pennsylvania 2,937,000 1,114,000 40.8 (37.9–43.7) 43.3 (38.2–48.5)
Rhode Island 226,000 74,000 35.1 (32.2–38.1) 34.7 (29.1–40.7)
South Carolina 1,105,000 437,000 42.0 (39.9–44.1) 46.4 (42.6–50.3)
South Dakota 158,000 60,000 40.4 (36.9–44.0) 41.8 (35.3–48.5)
Tennessee 1,630,000 640,000 42.3 (39.2–45.5) 46.5 (41.3–51.8)
Texas 4,055,000 1,518,000 41.0 (38.1–43.9) 37.6 (33.4–42.0)
Utah 407,000 137,000 36.2 (33.9–38.5) 36.2 (32.9–39.6)
Vermont 136,000 43,000 34.2 (31.5–36.9) 35.7 (30.8–40.9)
Virginia 1,513,000 584,000 41.1 (38.4–43.9) 44.0 (39.2–48.9)
Washington 1,346,000 454,000 36.9 (35.0–38.8) 36.5 (33.0–40.3)
West Virginia 557,000 223,000 43.7 (41.4–46.1) 45.6 (41.9–49.3)
Wisconsin 1,104,000 417,000 40.2 (37.0–43.5) 41.0 (34.9–47.4)
Wyoming 116,000 41,000 37.6 (34.2–41.1) 36.1 (30.6–42.0)
Median (Range) 40.2 (28.9–45.3) 41.6 (28.1–48.9)
Guam 17,000 7,000 39.3 (31.5–47.6) 42.6 (31.9–54.1)
Puerto Rico 635,000 215,000 35.6 (32.6–38.6) 41.1 (35.3–47.2)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Body mass index ≥30; calculated from self-reported height and weight.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 10. Unadjusted and age-standardized* percentages of arthritis-attributable activity limitations† among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and arthritis-attributable activity limitations (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 640,000 56.7 (54.3–59.1) 59.2 (55.2–63.0)
Alaska 117,000 55,000 51.2 (46.2–56.1) 51.1 (43.6–58.6)
Arizona 1,222,000 558,000 52.1 (49.3–54.9) 52.5 (46.9–58.0)
Arkansas 672,000 345,000 57.0 (53.2–60.7) 56.1 (49.4–62.5)
California 5,719,000 2,446,000 49.6 (46.9–52.3) 48.6 (44.2–52.9)
Colorado 949,000 398,000 48.4 (46.0–50.8) 47.6 (43.1–52.1)
Connecticut 690,000 290,000 47.6 (45.3–49.8) 46.7 (42.3–51.2)
Delaware 207,000 90,000 47.1 (43.5–50.8) 46.9 (39.9–54.0)
District of Columbia 101,000 48,000 53.9 (48.4–59.3) 57.0 (45.0–68.2)
Florida 4,154,000 1,941,000 53.1 (50.6–55.6) 54.5 (48.9–59.9)
Georgia 1,890,000 882,000 51.9 (48.4–55.3) 50.9 (44.1–57.6)
Hawaii 211,000 81,000 42.2 (39.0–45.5) 42.0 (36.2–48.0)
Idaho 309,000 137,000 48.0 (44.8–51.2) 50.4 (44.8–56.0)
Illinois 2,308,000 982,000 46.5 (43.3–49.6) 46.3 (40.5–52.2)
Indiana 1,390,000 599,000 47.7 (44.6–50.8) 43.7 (38.1–49.5)
Iowa 619,000 228,000 40.8 (38.1–43.6) 40.4 (34.9–46.0)
Kansas 536,000 228,000 48.2 (46.7–49.7) 46.3 (43.7–49.0)
Kentucky 1,087,000 562,000 57.2 (54.3–60.0) 57.7 (52.7–62.6)
Louisiana 989,000 472,000 53.9 (50.6–57.2) 50.6 (45.0–56.1)
Maine 332,000 149,000 48.5 (46.0–50.9) 51.2 (46.4–56.0)
Maryland 1,096,000 405,000 42.2 (39.2–45.2) 42.2 (36.3–48.4)
Massachusetts 1,300,000 555,000 49.0 (46.2–51.9) 47.0 (42.2–51.9)
Michigan 2,305,000 1,038,000 48.8 (46.6–51.1) 50.3 (46.5–54.0)
Minnesota 907,000 393,000 46.7 (44.8–48.5) 47.0 (43.3–50.6)
Mississippi 647,000 346,000 56.7 (53.7–59.6) 52.4 (47.2–57.4)
Missouri 1,372,000 694,000 54.6 (51.8–57.4) 59.4 (54.5–64.1)
Montana 216,000 103,000 50.2 (47.0–53.4) 52.0 (46.3–57.8)
Nebraska 334,000 137,000 44.0 (41.9–46.1) 44.3 (40.1–48.6)
Nevada 477,000 212,000 48.7 (43.0–54.5) 53.3 (44.2–62.3)
New Hampshire 282,000 115,000 45.6 (42.8–48.3) 49.9 (43.8–55.9)
New Jersey 1,590,000 675,000 46.5 (43.8–49.3) 47.0 (42.0–52.2)
New Mexico 386,000 176,000 50.5 (47.4–53.6) 49.2 (43.1–55.4)
New York 3,629,000 1,503,000 48.3 (46.0–50.6) 45.5 (41.2–49.9)
North Carolina 2,089,000 1,080,000 55.6 (52.9–58.3) 54.5 (49.9–59.0)
North Dakota 134,000 57,000 46.3 (42.9–49.6) 47.2 (40.5–53.9)
Ohio 2,547,000 1,136,000 49.1 (46.6–51.6) 46.6 (42.0–51.3)
Oklahoma 813,000 419,000 55.9 (53.2–58.7) 56.9 (51.9–61.7)
Oregon 838,000 425,000 57.1 (54.1–60.1) 54.0 (48.8–59.2)
Pennsylvania 2,937,000 1,118,000 42.7 (39.8–45.7) 42.1 (37.0–47.4)
Rhode Island 226,000 89,000 45.1 (42.0–48.2) 44.1 (37.6–50.7)
South Carolina 1,105,000 555,000 54.8 (52.7–56.9) 54.4 (50.3–58.4)
South Dakota 158,000 73,000 48.7 (45.1–52.4) 49.5 (42.7–56.3)
Tennessee 1,630,000 772,000 53.8 (50.6–57.0) 55.2 (49.8–60.5)
Texas 4,055,000 1,773,000 50.0 (47.0–53.0) 48.2 (43.3–53.1)
Utah 407,000 168,000 45.5 (43.1–47.8) 44.2 (40.8–47.8)
Vermont 136,000 61,000 49.0 (46.2–51.9) 48.6 (43.4–53.8)
Virginia 1,513,000 631,000 44.8 (42.2–47.5) 46.7 (41.9–51.6)
Washington 1,346,000 657,000 53.3 (51.4–55.2) 50.6 (46.6–54.5)
West Virginia 557,000 303,000 57.3 (55.0–59.6) 57.5 (53.8–61.2)
Wisconsin 1,104,000 479,000 49.2 (45.9–52.7) 50.9 (44.1–57.7)
Wyoming 116,000 49,000 46.6 (43.0–50.3) 49.7 (43.4–55.9)
Median (Range) 49.0 (40.8–57.3) 49.7 (40.4–59.4)
Guam 17,000 7,000 43.5 (35.4–52.0) 44.6 (33.4–56.3)
Puerto Rico 635,000 353,000 57.0 (54.0–60.0) 60.8 (54.9–66.4)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Respondents with arthritis who answered yes to the question “Arthritis can cause symptoms like pain, aching, or stiffness in or around the joint. Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?”
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 11. Unadjusted and age-standardized* percentages of arthritis-attributable social participation restriction† among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and arthritis-attributable social participation restriction (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 321,000 28.5 (26.3–30.9) 29.3 (25.8–33.0)
Alaska 117,000 16,000 14.4 (11.3–18.3) 12.6 (9.3–16.9)
Arizona 1,222,000 212,000 19.7 (17.6–22.0) 18.1 (14.8–22.1)
Arkansas 672,000 165,000 27.3 (24.1–30.9) 30.4 (24.5–37.0)
California 5,719,000 859,000 17.4 (15.6–19.4) 17.6 (14.6–21.0)
Colorado 949,000 128,000 15.5 (13.7–17.4) 16.4 (13.4–20.1)
Connecticut 690,000 97,000 15.9 (14.2–17.8) 14.5 (12.1–17.4)
Delaware 207,000 35,000 18.5 (15.7–21.6) 18.8 (13.4–25.8)
District of Columbia 101,000 22,000 25.2 (20.4–30.7) 26.8 (17.4–38.8)
Florida 4,154,000 843,000 23.3 (21.1–25.6) 25.7 (21.0–31.1)
Georgia 1,890,000 378,000 22.3 (19.5–25.3) 19.8 (15.3–25.3)
Hawaii 211,000 26,000 13.4 (11.1–16.0) 15.9 (11.4–21.7)
Idaho 309,000 53,000 18.7 (16.2–21.6) 22.4 (17.7–28.0)
Illinois 2,308,000 365,000 17.4 (15.0–20.1) 15.0 (11.7–19.0)
Indiana 1,390,000 237,000 18.8 (16.6–21.4) 20.0 (15.7–25.2)
Iowa 619,000 83,000 14.9 (13.0–17.0) 15.3 (11.6–19.9)
Kansas 536,000 84,000 17.6 (16.5–18.8) 17.6 (15.7–19.6)
Kentucky 1,087,000 265,000 27.1 (24.6–29.9) 28.3 (23.6–33.6)
Louisiana 989,000 234,000 26.8 (23.9–29.8) 25.5 (20.8–30.7)
Maine 332,000 52,000 16.9 (15.1–18.9) 21.4 (17.5–25.9)
Maryland 1,096,000 160,000 16.6 (14.4–19.0) 19.7 (14.9–25.7)
Massachusetts 1,300,000 206,000 18.2 (16.1–20.6) 20.0 (16.2–24.5)
Michigan 2,305,000 420,000 19.6 (17.8–21.5) 19.6 (16.8–22.7)
Minnesota 907,000 136,000 16.1 (14.7–17.7) 18.5 (15.5–22.0)
Mississippi 647,000 172,000 28.5 (25.8–31.3) 26.0 (22.1–30.4)
Missouri 1,372,000 255,000 20.2 (18.0–22.5) 23.4 (19.2–28.3)
Montana 216,000 33,000 16.2 (13.8–18.8) 18.6 (14.2–24.0)
Nebraska 334,000 46,000 14.6 (13.2–16.2) 12.9 (10.7–15.6)
Nevada 477,000 98,000 22.7 (17.9–28.3) 26.0 (17.6–36.6)
New Hampshire 282,000 40,000 15.7 (13.8–17.9) 20.2 (15.6–25.8)
New Jersey 1,590,000 241,000 16.8 (14.9–18.9) 18.5 (15.2–22.3)
New Mexico 386,000 71,000 20.6 (18.1–23.2) 21.0 (16.5–26.4)
New York 3,629,000 587,000 19.0 (17.2–20.9) 19.8 (16.4–23.7)
North Carolina 2,089,000 488,000 25.0 (22.7–27.6) 23.7 (20.1–27.6)
North Dakota 134,000 18,000 14.7 (12.5–17.3) 14.8 (10.8–19.9)
Ohio 2,547,000 486,000 21.1 (19.1–23.2) 19.7 (16.6–23.2)
Oklahoma 813,000 207,000 27.5 (24.9–30.3) 29.9 (25.4–34.7)
Oregon 838,000 142,000 19.0 (16.6–21.6) 19.4 (15.7–23.7)
Pennsylvania 2,937,000 419,000 16.0 (13.9–18.4) 16.8 (13.0–21.3)
Rhode Island 226,000 39,000 20.0 (17.4–22.9) 25.8 (20.0–32.6)
South Carolina 1,105,000 245,000 24.2 (22.4–26.1) 23.8 (20.5–27.5)
South Dakota 158,000 20,000 13.7 (11.3–16.5) 14.4 (9.5–21.1)
Tennessee 1,630,000 372,000 26.0 (23.2–28.9) 24.7 (20.3–29.6)
Texas 4,055,000 739,000 20.8 (18.5–23.3) 20.7 (16.9–25.2)
Utah 407,000 58,000 15.6 (13.9–17.4) 16.0 (13.6–18.8)
Vermont 136,000 21,000 16.3 (14.1–18.7) 18.9 (14.9–23.6)
Virginia 1,513,000 251,000 17.8 (16.0–19.8) 18.1 (14.9–21.9)
Washington 1,346,000 221,000 17.8 (16.3–19.4) 18.0 (15.3–21.0)
West Virginia 557,000 140,000 26.7 (24.6–28.9) 26.6 (23.5–30.0)
Wisconsin 1,104,000 153,000 15.9 (13.6–18.4) 16.6 (12.8–21.1)
Wyoming 116,000 19,000 17.2 (14.3–20.6) 19.3 (14.1–25.8)
Median (Range) 18.5 (13.4–28.5) 19.7 (12.6–30.4)
Guam 17,000 2,000 12.7 (8.5–18.4) 13.1 (7.7–21.5)
Puerto Rico 635,000 144,000 23.2 (20.8–25.9) 25.9 (21.2–31.2)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Respondents with arthritis who answered a lot to the question “During the past 30 days, to what extent has your arthritis or joint symptoms interfered with your normal social activities, such as going shopping, to the movies, or to religious or social gatherings?”
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Median and range were calculated from estimates for the 50 states and the District of Columbia.

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TABLE 12. Unadjusted and age-standardized* percentages of arthritis-attributable severe joint pain† among adults aged ≥18 years with arthritis,§ by area — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Area Weighted population with arthritis (rounded to 1,000s) Weighted population with arthritis and arthritis-attributable severe joint pain (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
Alabama 1,248,000 433,000 39.2 (36.8–41.6) 39.7 (35.7–43.8)
Alaska 117,000 — — —
Arizona 1,222,000 328,000 30.6 (28.0–33.3) 32.9 (28.0–38.2)
Arkansas 672,000 218,000 36.3 (32.6–40.1) 41.6 (35.3–48.3)
California 5,719,000 1,510,000 30.2 (27.9–32.7) 29.3 (25.8–33.0)
Colorado 949,000 194,000 24.0 (21.9–26.2) 26.2 (22.3–30.4)
Connecticut 690,000 153,000 25.3 (23.3–27.4) 25.9 (22.3–29.8)
Delaware 207,000 57,000 30.8 (27.3–34.4) 31.6 (25.2–38.7)
District of Columbia 101,000 36,000 40.5 (35.0–46.3) 36.5 (26.5–47.9)
Florida 4,154,000 1,195,000 34.0 (31.5–36.6) 38.0 (32.7–43.7)
Georgia 1,890,000 573,000 34.1 (30.8–37.4) 31.2 (25.7–37.4)
Hawaii 211,000 41,000 21.7 (19.0–24.7) 23.6 (18.9–29.2)
Idaho 309,000 59,000 21.8 (19.1–24.9) 21.9 (17.4–27.3)
Illinois 2,308,000 576,000 27.4 (24.6–30.5) 24.4 (20.2–29.3)
Indiana 1,390,000 302,000 25.5 (22.8–28.4) 26.0 (20.6–32.2)
Iowa 619,000 122,000 22.3 (20.0–24.8) 24.3 (19.7–29.6)
Kansas 536,000 121,000 25.7 (24.4–27.1) 26.2 (23.8–28.6)
Kentucky 1,087,000 349,000 36.3 (33.5–39.1) 36.7 (32.0–41.7)
Louisiana 989,000 356,000 41.1 (37.8–44.4) 41.2 (35.8–46.9)
Maine 332,000 69,000 23.9 (21.6–26.3) 30.3 (25.6–35.4)
Maryland 1,096,000 249,000 26.1 (23.3–29.1) 28.5 (22.8–35.0)
Massachusetts 1,300,000 310,000 28.0 (25.4–30.8) 28.4 (24.1–33.2)
Michigan 2,305,000 605,000 28.7 (26.7–30.8) 30.5 (27.1–34.1)
Minnesota 907,000 181,000 21.8 (20.1–23.5) 23.3 (19.9–27.1)
Mississippi 647,000 270,000 45.5 (42.5–48.5) 46.0 (40.8–51.3)
Missouri 1,372,000 375,000 30.1 (27.6–32.8) 34.0 (29.2–39.2)
Montana 216,000 47,000 23.2 (20.5–26.1) 24.3 (19.7–29.6)
Nebraska 334,000 67,000 21.6 (19.9–23.5) 22.8 (19.4–26.6)
Nevada 477,000 130,000 30.6 (25.6–36.1) 30.2 (22.3–39.3)
New Hampshire 282,000 58,000 23.0 (20.7–25.6) 26.6 (21.6–32.3)
New Jersey 1,590,000 424,000 30.0 (27.5–32.6) 33.6 (28.9–38.7)
New Mexico 386,000 110,000 32.2 (29.3–35.2) 32.7 (27.4–38.5)
New York 3,629,000 821,000 30.9 (28.6–33.3) 32.3 (27.8–37.2)
North Carolina 2,089,000 687,000 35.8 (33.2–38.6) 34.5 (30.3–38.9)
North Dakota 134,000 21,000 19.2 (16.3–22.4) 23.4 (17.8–30.2)
Ohio 2,547,000 695,000 30.4 (28.1–32.8) 30.1 (25.8–34.6)
Oklahoma 813,000 259,000 35.0 (32.3–37.9) 36.9 (32.2–41.9)
Oregon 838,000 178,000 24.3 (21.6–27.2) 25.7 (21.2–30.8)
Pennsylvania 2,937,000 723,000 28.1 (25.5–30.9) 28.7 (23.9–34.0)
Rhode Island 226,000 59,000 29.9 (27.1–33.0) 34.7 (28.6–41.4)
South Carolina 1,105,000 361,000 36.1 (34.0–38.2) 36.7 (32.9–40.7)
South Dakota 158,000 36,000 24.1 (20.9–27.6) 27.3 (21.4–34.2)
Tennessee 1,630,000 481,000 34.2 (31.1–37.4) 35.3 (30.1–40.8)
Texas 4,055,000 1,138,000 33.3 (30.5–36.3) 32.0 (27.5–36.9)
Utah 407,000 77,000 21.2 (19.4–23.2) 20.3 (17.7–23.2)
Vermont 136,000 29,000 23.2 (20.8–25.9) 25.5 (21.0–30.7)
Virginia 1,513,000 381,000 27.5 (25.2–29.9) 26.7 (23.0–30.7)
Washington 1,346,000 282,000 23.0 (21.3–24.6) 22.7 (19.6–26.1)
West Virginia 557,000 204,000 39.8 (37.5–42.1) 41.6 (37.9–45.3)
Wisconsin 1,104,000 232,000 24.0 (21.3–27.0) 23.7 (19.1–28.9)
Wyoming 116,000 22,000 20.7 (17.7–24.2) 22.7 (17.3–29.3)
Median (Range)** 28.4 (19.2–45.5) 29.7 (20.3–46.0)
Guam 17,000 5,000 31.3 (24.0–39.6) 27.0 (19.8–35.8)
Puerto Rico 635,000 340,000 56.0 (52.9–59.0) 58.2 (52.1–64.1)

Abbreviation: CI = confidence interval.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Respondents with arthritis who answered 7, 8, 9, or 10 to the question “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. During the past 30 days, how bad was your joint pain on average? Please answer on a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.” Severe joint pain was defined as a pain level of 7–10.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Estimates with a relative standard error ≥30% or unweighted denominator <50 were suppressed as unreliable.
** Median and range were calculated from estimates for the 50 states and the District of Columbia.

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Return to your place in the textFIGURE 4. Age-standardized prevalence of arthritis-attributable severe joint pain* among adults aged ≥18 years with arthritis, by state† — Behavioral Risk Factor Surveillance System, United States, 2015
Map of the United States indicates prevalence of arthritis-attributable severe joint pain among adults aged 18 years and older with arthritis, by state. The data source is the 2015 Behavioral Risk Factor Surveillance System.

Abbreviations: DC = District of Columbia; NA = not applicable; Q = quartile.

* Respondents with arthritis who answered 7, 8, 9, or 10 to the question “Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. During the past 30 days, how bad was your joint pain on average? Please answer on a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.” Severe joint pain was defined as a pain level of 7–10.

† Estimate for one state (Alaska) with a relative standard error >30% or unweighted denominator <50 was suppressed as unreliable.

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TABLE 13. Unadjusted* and age-standardized† percentages of adults aged ≥18 years with arthritis§ reporting they attended a self-management education course for their arthritis, by selected state — Behavioral Risk Factor Surveillance System, 13 states,** 2015Return to your place in the text
State No. of respondents with arthritis Weighted population with arthritis and attendance at self-management education course (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized % (95% CI)
California 2,803 818,000 15.4 (11.5–20.3) 13.6 (9.3–19.6)
Kansas 7,320 53,000 11.2 (9.9–12.7) 11.9 (9.5–14.8)
Kentucky 3,565 110,000 11.5 (9.9–13.3) 12.2 (9.5–15.5)
Michigan 3,224 259,000 12.2 (10.4–14.1) 12.5 (9.3–16.5)
Minnesota 4,666 116,000 14.2 (12.9–15.5) 15.3 (12.7–18.4)
Missouri 2,808 157,000 13.5 (11.7–15.5) 14.5 (11.2–18.7)
Montana 2,123 29,000 14.5 (12.2–17.0) 19.0 (14.4–24.6)
New York 3,921 323,000 10.6 (8.7–12.8) 9.1 (6.9–11.9)
Oregon 1,828 130,000 17.2 (13.8–21.3) 18.1 (12.4–25.5)
Pennsylvania 2,059 294,000 11.9 (10.0–14.1) 15.1 (11.3–20.0)
Rhode Island 2,244 21,000 10.8 (9.1–12.8) 10.6 (7.7–14.4)
South Carolina 4,405 126,000 12.9 (11.4–14.5) 16.5 (13.2–20.4)
Utah 2,929 60,000 16.6 (13.9–19.8) 18.0 (13.5–23.5)
Median (Range)†† 12.9 (10.6–17.2) 14.5 (9.1–19.0)

Abbreviation: CI = confidence interval.
* The numerator was the estimated number of adults with arthritis who reported ever having taken an educational course or class to learn to manage their arthritis. The denominator was the estimated number of adults with arthritis.
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Respondents who answered yes to the question “Have you ever taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?”
** States that administered the Behavioral Risk Factor Surveillance System (BRFSS) arthritis management module: California, Kansas, Kentucky, Michigan, Minnesota, Missouri, Montana, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, and Utah.
†† Median and range were calculated from estimates for the 13 states that administered the BRFSS arthritis management module.

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TABLE 14. Unadjusted* and age-standardized† percentages of overweight or obesity§ among adults aged ≥18 years with arthritis reporting health care provider counseling to lose weight to help with their arthritis or joint symptoms,** by selected state — Behavioral Risk Factor Surveillance System, 13 states,†† 2015Return to your place in the text
State No. of respondents with arthritis No. of respondents who are overweight or obese Weighted population with arthritis who are overweight or obese (rounded to 1,000s) Weighted population with arthritis who are overweight or obese reporting counseling to lose weight (rounded to 1,000s) Unadjusted % (95% CI) Age-standardized %* (95% CI)
California 2,803 504 5,719,000 1,762,000 48.9 (41.5–56.4) 40.1 (30.9–50.1)
Kansas 7,320 2,127 536,000 133,000 41.6 (39.0–44.1) 39.9 (35.7–44.3)
Kentucky 3,565 2,289 1,087,000 339,000 48.4 (44.9–52.0) 52.7 (46.6–58.7)
Michigan 3,224 1,375 2,305,000 734,000 48.6 (45.3–52.0) 49.4 (43.5–55.3)
Minnesota 4,666 2,885 907,000 246,000 43.0 (40.7–45.3) 44.3 (39.7–49.0)
Missouri 2,808 1,751 1,372,000 384,000 47.7 (44.4–51.0) 49.8 (43.0–56.6)
Montana 2,123 1,304 216,000 50,000 39.3 (35.6–43.0) 35.1 (28.7–42.1)
New York 39,21 1,112 3,629,000 1,118,000 52.9 (48.7–57.0) 53.2 (45.2–61.1)
Oregon 1,828 528 838,000 245,000 47.8 (42.0–53.7) 47.5 (36.7–58.5)
Pennsylvania 2,059 1,268 2,937,000 801,000 44.6 (41.1–48.2) 42.4 (35.7–49.4)
Rhode Island 2,244 1,271 226,000 64,000 49.9 (46.2–53.6) 41.5 (34.7–48.6)
South Carolina 4,405 2,812 1,105,000 327,000 46.6 (44.0–49.2) 47.6 (42.9–52.4)
Utah 2,929 919 407,000 114,000 45.6 (41.2–50.2) 44.5 (37.6–51.5)
Median (Range)§§ 47.7 (39.3–52.9) 44.5 (35.1–53.2)

Abbreviation: CI = confidence interval.
* The numerator was the estimated number of adults with arthritis who reported being told by their doctor to exercise or get physical activity. The denominator was the estimated number of adults with arthritis.
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Overweight: body mass index 25.0–29.9; obese: body mass index ≥30; calculated from self-reported height and weight.
Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
** Respondents who were overweight or obese who answered yes to the question “Has a doctor or other health professional ever suggested losing weight to help your arthritis or joint symptoms?”
†† States that administered the Behavioral Risk Factor Surveillance System (BRFSS) arthritis management module: California, Kansas, Kentucky, Michigan, Minnesota, Missouri, Montana, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, and Utah.
§§ Median and range were calculated from estimates for the 13 states that administered the BRFSS arthritis management module.

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TABLE 15. Unadjusted* and age-standardized† percentages of adults aged ≥18 years with arthritis§ reporting health care provider counseling for physical activity or exercise, by selected state — Behavioral Risk Factor Surveillance System, 13 states,** 2015Return to your place in the text
State No. of respondents with arthritis Weighted population with arthritis reporting counseling for physical activity or exercise (rounded to 1,000s) Unadjusted % (95% CI) Age standardized %* (95% CI)
California 2,803 3,022,000 57.0 (50.9–62.9) 57.8 (48.2–66.9)
Kansas 7,320 247,000 52.6 (50.4–54.7) 52.3 (48.4–56.1)
Kentucky 3,565 514,000 53.8 (50.8–56.8) 53.6 (48.3–58.8)
Michigan 3,224 1,242,000 59.0 (56.2–61.7) 61.5 (56.5–66.3)
Minnesota 4,666 462,000 57.1 (55.2–59.0) 58.1 (54.4–61.7)
Missouri 2,808 668,000 57.8 (54.9–60.6) 57.0 (51.1–62.8)
Montana 2,123 112,000 55.5 (52.3–58.6) 57.8 (52.0–63.4)
New York 3,921 1,925,000 63.4 (60.1–66.5) 61.9 (55.1–68.2)
Oregon 1,828 445,000 59.6 (54.6–64.4) 61.7 (52.9–69.9)
Pennsylvania 2,059 1,439,000 58.5 (55.4–61.4) 59.8 (54.0–65.4)
Rhode Island 2,244 115,000 60.9 (57.8–63.8) 59.6 (53.0–65.8)
South Carolina 4,405 586,000 60.4 (58.3–62.6) 61.2 (57.1–65.1)
Utah 2,929 207,000 58.2 (54.4–61.8) 58.5 (52.5–64.3)
Median (Range)†† 58.2 (52.6–63.4) 58.5 (52.3–61.9)

Abbreviation: CI = confidence interval.
* The numerator was the estimated number of adults with arthritis who report being told by their health care provider to exercise or get physical activity. The denominator was the estimated number of adults with arthritis.
† Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
§ Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
Respondents who answered yes to the question “Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?”
** States that administered the Behavioral Risk Factor Surveillance System (BRFSS) arthritis management module: California, Kansas, Kentucky, Michigan, Minnesota, Missouri, Montana, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, and Utah.
†† Median and range were calculated from estimates for the 13 states that administered the BRFSS arthritis management module.

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TABLE 16. Estimates of adults aged ≥18 years with arthritis and age-standardized* percentages of arthritis health-related characteristics among adults with arthritis,† by quartile§ of state-level prevalence of arthritis — Behavioral Risk Factor Surveillance System, United States, 2015Return to your place in the text
Estimate/Characteristic Q1 (17.2%–21.5%)
% (95% CI)		 Q2 (21.5%–22.7%)
% (95% CI)		 Q3 (23.0%–25.4%)
% (95% CI)		 Q4 (25.7%–33.6%)
% (95% CI)		 p-trend
No. of respondents with arthritis 36,278 43,596 29,347 36,929 —
Weighted population with arthritis 21,702,000 12,741,000 10,866,000 15,694,000 —
Arthritis-attributable activity limitations 48.7 (46.7–50.6) 47.8 (46.1–49.5) 49.1 (47.1–51.2) 52.9 (51.3–54.4) <0.001
Arthritis-attributable severe joint pain 31.3 (29.5–33.2) 26.6 (25.2–28.1) 29.5 (27.7–31.5) 35.4 (33.9–36.8) <0.001
Arthritis-attributable social participation restriction 20.1 (18.5–21.8) 17.4 (16.2–18.6) 20.5 (18.9–22.1) 23.7 (22.5–25.1) <0.001
≥14 physically unhealthy days during past 30 days 27.3 (25.6–29.0) 26.2 (24.7–27.7) 27.0 (25.3–28.8) 30.2 (28.9–31.5) <0.006
≥14 mentally unhealthy days during past 30 days 22.6 (21.0–24.3) 22.1 (20.7–23.5) 24.0 (22.2–25.9) 25.7 (24.4–27.1) 0.001
Obesity 37.4 (35.6–39.3) 39.5 (37.8–41.2) 40.3 (38.4–42.4) 45.0 (43.6–46.5) <0.001
Leisure-time physical inactivity 33.8 (32.0–35.8) 31.4 (29.8–33.0) 35.0 (33.0–37.0) 38.4 (37.0–39.9) <0.001
Leisure-time walking 48.2 (46.3–50.1) 49.5 (47.8–51.2) 48.0 (46.0–50.1) 45.1 (43.6–46.6) 0.001

Abbreviations: CI = confidence interval; Q = quartile.
* Age standardized to the 2000 U.S. projected population, using three age groups: 18–44, 45–64, and ≥65 years.
† Doctor-diagnosed arthritis was defined as a yes response to the question “Has a doctor, nurse, or other health professional ever told you that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
§ Quartiles (Q1–Q4) were calculated from age-standardized prevalences of arthritis for the 50 states and the District of Columbia. Q1 (lowest): Hawaii, California, Minnesota, Texas, the District of Columbia, Nevada, New Jersey, Utah, Alaska, Nebraska, Maryland, New York, Florida, and Illinois. Q2: Virginia, North Dakota, Connecticut, Colorado, South Dakota, Arizona, Massachusetts, Wisconsin, New Mexico, Washington, and Kansas. Q3: New Hampshire, Iowa, Idaho, Vermont, Georgia, Montana, Wyoming, Rhode Island, Oregon, Delaware, North Carolina, Ohio, and Indiana. Q4 (highest): Pennsylvania, Oklahoma, Louisiana, South Carolina, Maine, Mississippi, Missouri, Michigan, Arkansas, Kentucky, Tennessee, Alabama, and West Virginia.
p-value for test of linear trend in age-standardized prevalence estimates across quartiles. Bonferroni-corrected alpha level of 0.006 (α = 0.05/8) to adjust for testing multiple characteristics. Quadratic terms were applied to the test of trend to improve fit and were statistically significant at the alpha level of 0.006 for three characteristics (arthritis-attributable severe joint pain, arthritis-attributable social participation restriction, and leisure-time physical inactivity).

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Suggested citation for this article: Barbour KE, Moss S, Croft JB, et al. Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management — United States, 2015. MMWR Surveill Summ 2018;67(No. SS-4):1–28. DOI: http://dx.doi.org/10.15585/mmwr.ss6704a1.

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