A recent government report's finding that arthritis and rheumatism account for much of the disability in Americans may be an underestimate. The estimated percentage of Americans reporting a disability increased by 7.7% (from 44.1 million to 47.5 million) during 1999-2005, with arthritis and rheumatism the most common causes of physical problems that interfere with daily life, according to a report issued by the Centers for Disease Control and Prevention. Almost 22% of the adult population reported a physical disability in 2005, Dr. Chad Helmick and his coauthors wrote (MMWR 2009;58:421-6). Although the percentage hasn't changed since the last disability survey in 1999, the number represents an absolute increase of 7.7%—probably because of an increase in the number of older people as baby boomers age, wrote Dr. Helmick, an epidemiologist for the CDC and a coauthor of the study. The most commonly reported causes of disability were arthritis and rheumatism (8.6 million), followed by back or spine problems (7.6 million) and cardiac problems (3 million), the report said. Dr. John Klippel, president and chief executive officer of the Arthritis Foundation, said the survey might underestimate the true impact of arthritis and rheumatic disease. “I believe that many people who report disability due to back pain have arthritis as the underlying cause of that pain,” Dr. Klippel said in an interview. “If you add those two together, then the overwhelming reason for disability in America would be arthritis and musculoskeletal diseases.” The data were extracted from the 2005 Survey of Income and Program Participation, conducted by the U.S. Census Bureau. The survey included interviews with 70,312 noninstitutionalized people aged 18 years or older from 37,400 households (representing 83% of eligible households). Disability was defined as a “yes” answer to one of three categories: the required use of an assistive device (cane, crutches, walker, or wheelchair); difficulty performing activities of daily living or specified functional activities; and a limitation in the ability to work around the house or at a job or business. Respondents then chose the cause of their disability from a list of 30 disorders. National estimates were extrapolated from the completed survey. The survey concluded that most of those reporting a disability were aged 65 years or older (52%) and that disability was significantly higher in women than in men (24% vs. 19%, respectively). The most commonly reported functional disabilities were difficulty walking three or more blocks (10%; 22 million people) and difficulty climbing a flight of stairs (10%). Of those with a disability, 19% (an estimated 9 million people) identified arthritis or a rheumatic disease as the cause. These disorders were also the most common cause of disability for women, affecting 24%. (See box.) Back and spine problems affected 17% of the population, and were the leading cause of disability for men (17%). Cardiac disorders affected 7% overall (8% of men and 5% of women). The authors note that disability will become more common as Americans age, and that rheumatologists might bear the brunt of that flood. “After baby boomers enter the 65 and older age group, which has a much higher risk for disability, the absolute number of persons affected likely will increase substantially. The added number of persons reporting disabilities is likely to place more demands on healthcare providers trained in musculoskeletal conditions.”
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