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  • CDC: 1 in 3 Rural Residents Has Arthritis; Over 50% of Those Experience Activity Limitations

    In brief:

    • Survey of 426,361 adults across US asked about arthritis and arthritis-attributable activity limitations (AAALs); responses were divided according to 6 categories of population descriptors, from rural to urban
    • Nearly 1 in 3 rural residents reported arthritis; rate was 1 in 5 for urban residents, 22.7% for the US overall
    • More than half (55.3%) of rural residents with arthritis reported AAAL; rate was 49.7% in urban areas
    • Higher incidence among rural residents applied to all age groups studies
    • Researchers believe interventions in rural areas may be hampered by lack of activity-friendly infrastructure

    America has an arthritis problem, and rural America is being hit especially hard—that's the finding of a report from the US Centers for Disease Control and Prevention (CDC) that estimates nearly 1 in 3 rural residents in the US has some form of arthritis, with more than half of those with arthritis experiencing activity limitations.

    The latest study, which appears in CDC's May 25 Morbidity and Mortality Weekly Report, describes the results of a detailed study of the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a survey of 426,361 noninstitutionalized adults across the 50 states and the District of Columbia. Researchers asked respondents, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?" If the answer was "yes," respondents were then asked, "Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?"

    Once data were collected, researchers organized responses according to where respondents lived, assigning them to 1 of 6 categories developed by the National Center for Health Statistics: city, large fringe metropolitan, medium metropolitan, small metropolitan, micro metropolitan, and rural. Here's what they found:

    • Overall, more than 1 in 5 respondents reported arthritis (22.7%), with 43% of those reporting arthritis-attributable activity limitation (AAAL).
    • Major differences were discovered in arthritis and AAAL rates between urban and rural residents, with the rate of arthritis among rural residents at 31.8%, compared with a 20.5% rate among urban residents. AAAL prevalence was also worse in rural areas, where 55.3% of respondents with arthritis reported limitations, compared with 49.7% in the most urban areas.
    • Arthritis prevalence was higher among rural residents for nearly all age groups studied.
    • Although rates tended to increase as population density decreased, the overall correlations to demographic, health, and behavioral patterns were similar for each population area, with women, older adults, smokers, adults with less education, adults who are less physically active, and adults with higher body mass index reporting higher rates of arthritis within each population grouping.
    • AAAL rates were particularly high for rural residents who also reported a functional or work disability, with 56.7% reporting activity limitations. That rate was 42.3% among urban residents.
    • Authors speculate that the higher rates may be due to a higher prevalence of recognized risk factors in rural areas—particularly older age, obesity, and lower socioeconomic status.

    While they write that "wider use of evidence-based interventions including physical activity and self-management education in rural areas might help reduce the impact of arthritis and AAAL," authors also acknowledge that may be easier said than done. Using walking as an example of a "low impact, accessible activity proven to reduce pain and improve quality of life," they describe how lower-density environments make this more difficult through limited pedestrian infrastructure, lack of sidewalks, long distances between destinations, and sometimes even a lack of a destination itself.

    But even without plentiful pedestrian-friendly environments, the physical activity levels of rural residents could be increased if health care providers would simply suggest self-management programs and recommend that their patients be more active, they assert.

    "The higher prevalence of arthritis and AAAL among rural US residents highlights the need for evidence-based intervention approaches such as physical activity, self-management education, and vocational rehabilitation programs," authors write. "Health care providers and community organizations can help residents participate in these helpful interventions."

    APTA offers multiple resources on arthritis management through community-based programs, including an overview of evidence-based programs, and a decision aid to help physical therapists choose an appropriate program for the patient. Additionally, the US Bone and Joint Initiative (USBJI) offers a series of free public education programs aimed at helping providers increase community awareness of osteoarthritis treatment. APTA is a founding member of USBJI.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • What about the obvious demographic of work experience? the stereotypes about rural people don't always fit. I live and work in a rural area and many of the people I know and treat have been manual labors, farm laborers, etc. Having significant arthritis may stop someone from manual labor, but not necessarily from going to the office. Also, what about cultural belief patterns regarding everything from pain education to participation in youth sports? I think there are more variables than what was studied.

      Posted by sarah rice on 6/1/2017 3:22 PM

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