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Arthritis Among Veterans — United States, 2011–2013

Please note: An erratum has been published for this article. To view the erratum, please click here.

Louise B. Murphy, PhD1, Charles G. Helmick, MD1, Kelli D. Allen, PhD2, Kristina A. Theis, MPH1, Nancy A. Baker, ScD1, Glen R. Murray3, Jin Qin, PhD1, Jennifer M. Hootman, PhD1, Teresa J. Brady, PhD1, Kamil E. Barbour, PhD1 (Author affiliations at end of text)

Arthritis is among the most common chronic conditions among veterans and is more prevalent among veterans than nonveterans (1,2). Contemporary population-based estimates of arthritis prevalence among veterans are needed because previous population-based studies predate the Persian Gulf War (1), were small (2), or studied men only (2) despite the fact that women comprise an increasing proportion of military personnel and typically have a higher prevalence of arthritis than men (1,3). To address this knowledge gap, CDC analyzed combined 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System (BRFSS) data among all adults aged ≥18 years, by veteran status, to estimate the total and sex-specific prevalence of doctor-diagnosed arthritis overall and by sociodemographic categories, and the state-specific prevalence (overall and sex-specific) of doctor-diagnosed arthritis. This report summarizes the results of these analyses, which found that one in four veterans reported that they had arthritis (25.6%) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories, including sex (prevalence among male and female veterans was 25.0% and 31.3%, respectively). State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia. Veterans comprise a large and important target group for reducing the growing burden of arthritis. Those interested in veterans' health can help to improve the quality of life of veterans by ensuring that they have access to affordable, evidence-based, physical activity and self-management education classes that reduce the adverse effects of arthritis (e.g., pain and depression) and its common comorbidities (e.g., heart disease and diabetes).

BRFSS is an annual, cross-sectional, random-digit–dialed telephone (landline and cell phone) survey of the 50 U.S. states, territories, and the District of Columbia (DC). BRFSS is designed to collect data that are representative of the noninstitutionalized adult civilian population in each state. All analyses used combined 2011, 2012, and 2013 BRFSS data. Median state-specific BRFSS response rates, based on American Association for Public Opinion Research definition no. 4, were 49.7% in 2011, 45.2% in 2012, and 45.9% in 2013.* BRFSS respondents were defined as having arthritis if they responded "yes" to the question, "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?" Veterans were defined as those who responded "yes" to the question, "Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military Reserve unit? Active duty does not include training for the Reserves or National Guard, but does include activation, for example, for the Persian Gulf War."

CDC estimated annualized crude and age-specific prevalence of doctor-diagnosed arthritis stratified by veteran status and sex, age-standardized overall and sex-specific prevalence by veteran status across categories of race/ethnicity, highest educational attainment, employment status, income, and body mass index (under/normal weight, overweight, and obese), age-standardized prevalence overall and by sex among veterans for the 50 states, DC, Guam, and Puerto Rico. Data were analyzed using software that accounted for the complex sampling design, including application of sampling weights so that estimates were representative of the noninstitutionalized adult civilian population in each state. Variance was estimated with 95% confidence intervals (CIs) that accounted for the clustered design using the Taylor series linearization method. The 2000 U.S. Projected Population, in three age groups (18–44, 45–64, and ≥65 years) was used for age-standardization.

Veterans had a higher overall prevalence of reported arthritis than nonveterans, 25.6% (CI = 25.2%–26.1%) versus 23.6% (CI = 23.4%–23.7%). For both men and women, arthritis prevalence was higher among veterans than nonveterans (Table 1). Among male veterans (compared with male nonveterans) arthritis prevalence was higher for all age groups, and age-standardized arthritis prevalence was ≥5 percentage points higher across most of the sociodemographic categories examined (race/ethnicity, education, income, employment status, and body mass index) (Table 1). Among female veterans (compared with female nonveterans) arthritis prevalence was higher for young (18–44 years) and middle aged (44–64 years) women; age-standardized arthritis prevalence was ≥5 percentage points higher across most of the sociodemographic categories examined (Table 1). Of the estimated 9.0 million veterans with arthritis, 8.3 million were men and 670,000 were women.

Among the 50 states and DC, the median state-specific arthritis prevalence among veterans was 25.4% (range = 19.7% in DC to 32.7% in West Virginia) (Table 2, Figure). Among male veterans, the median state-specific prevalence was 24.7% (range = 18.4% in Hawaii to 32.7% in West Virginia); among women the median was 30.3% (range = 22.4% in Hawaii to 42.7% in Oregon) (Table 2). In each state, veterans comprised a substantial proportion of all persons with arthritis (median = 15.9%; range = 12.6% in Illinois and New Jersey to 22.2% in Alaska) (Table 2).

Discussion

Veterans reported arthritis frequently and more often than nonveterans among both men and women and across all sociodemographic groups. Although a high level of physical fitness and good health are required for entry into military service, traumatic and overuse injuries are common during active duty (4). A recent study found that the incidence of osteoarthritis (a condition that represents the largest portion of arthritis cases and for which musculoskeletal injuries are a potent risk factor) was higher among an active duty sample than osteoarthritis incidence reported in civilian populations (5).

One of the few previous population-based studies of arthritis prevalence among veterans was a small study based on 2010 BRFSS data from men in five states (Indiana, Mississippi, South Carolina, West Virginia, and Wisconsin) (2). In that study, 44.8% (unadjusted) had arthritis, whereas in the current study, arthritis prevalence in these same five states was lower, ranging from 32.7% in West Virginia to 22.0% in Wisconsin. Two changes in the BRFSS methodology since 2011 might account for this difference. First, cell phone users are now sampled. Inclusion of cell phones captures younger adults who might be missed with previous landline-only data collection; the latter is more likely to capture age groups (middle aged and older adults) with a higher prevalence of arthritis. Second, sampling weights, which are applied to make estimates representative of each states' population, are now calculated using iterative proportional fitting (raking) methods, whereas before 2011, sampling weights were derived using post-stratification procedures.§

Arthritis prevalence was consistently higher among female veterans than their male counterparts. A previously reported estimate among women using U.S. Department of Veterans Affairs (VA) health system services indicated that three in four (77.6% in 2008) had arthritis (6). Although this estimate is considerably higher than the estimate for women overall in the current study (31.3%), VA health system consumers represent a subset of veterans who are more likely to have military service–associated disability (7). In the current study, arthritis prevalence among women veterans who reported being unable to work (67.9%) was almost as high as that in the previous study. This subgroup might be most similar to VA system users.

Although the prevalence of arthritis was higher among women, the relative differences in prevalence between veterans and nonveterans was higher for men than women. Patterns across age were also noteworthy. Arthritis was not only highly prevalent among middle aged (45–64 years) veterans (40.3% among women and 36.0% among men) but also among younger veterans (prevalences of 17.3% and 11.6% among women and men aged 18–44 years, respectively) indicating that arthritis and its effects need to be addressed among male and female veterans of all ages. Reducing the impact of arthritis among younger adults might help to stem its debilitating effects in later life.

The findings in this report are subject to at least five limitations. First, arthritis was based on self-report. Although recall bias is possible, a validation study among health plan enrollees found that this definition had a positive predictive value of 74.9% among persons aged 45–64 years and a 91.0% positive predictive value among persons ages ≥65 years (8) and is acceptable for public health surveillance of arthritis. Second, there was insufficient sample size to estimate state-specific arthritis prevalence across the same sociodemographic categories as for the overall estimates (Table 1). Nevertheless, BRFSS collection of veteran status in 2011, 2012, and 2013 allowed analysis of arthritis prevalence across finer sociodemographic categories than previously possible, which was especially important in calculating sex-specific estimates. Third, similar to civilian jobs, there is considerable heterogeneity in military occupations, ranging from sedentary office jobs to physically demanding roles, including combat. BRFSS did not collect information about duration of active duty and work-related risk factors for arthritis during service (e.g., trauma/injury versus physical work demand), and therefore arthritis prevalence across these groups cannot be determined. Fourth, data are cross-sectional and not longitudinal, and therefore, attributing onset of arthritis to veteran status is not appropriate; furthermore, arthritis among veterans might be unrelated to service and attributable instead to risk factors for arthritis (e.g., obesity for osteoarthritis or smoking for rheumatoid arthritis). Finally, results might be subject to selection bias because the median BRFSS response rates were <50% in all three survey years. Nevertheless, the population-based estimates for veterans overall and across sociodemographic categories in this study demonstrate that arthritis among veterans is an important public health concern.

The contemporary, state-specific arthritis prevalence estimates provided in this report indicate that veterans with arthritis represented a sizeable portion (with a median of approximately one in six) of adults with arthritis in each state. Because most veterans use health systems other than the VA system (9), strategies for managing arthritis that are accessible to all veterans are essential. Fortunately, multiple self-management strategies have been proven to decrease the adverse effects of arthritis and improve the quality of life of persons with arthritis. These include courses that teach persons with arthritis how to achieve recommended levels of physical activity (e.g., Walk with Ease and EnhanceFitness) and those that teach skills for better managing arthritis and other chronic conditions, including diabetes, heart disease, and chronic lung diseases (e.g., self-management education classes such as the Chronic Disease Self-Management Program).** Although these courses are increasingly available in communities across the United States, even greater availability is needed to ensure they are readily available for the large and growing number of adults with arthritis, including veterans (10). General community offerings of these programs might not appeal to some veterans or accommodate their specific needs or preferences. The high prevalence of arthritis among veterans, coupled with the large absolute number of veterans affected, suggests that dedicated veterans' service organizations in the community and other settings are well-positioned to offer these evidence-based programs to the veteran population. Additionally, health care professionals can have a meaningful impact on improving veterans' quality of life and function by recommending these programs to their patients with arthritis.

1Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Health Services Research and Development Service, U.S. Department of Veterans Affairs Medical Center, Durham, North Carolina, and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; 3Geographic Information Systems Laboratory, University of West Georgia (Corresponding author: Louise B. Murphy, lmurphy1@cdc.gov, 770-488-5464)

Acknowledgment

Karen Wooten, MA, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

  1. Dominick KL, Golightly YM, Jackson GL. Arthritis prevalence and symptoms among US non-veterans, veterans, and veterans receiving Department of Veterans Affairs Healthcare. J Rheumatol 2006;33:348–54.
  2. Hoerster KD, Lehavot K, Simpson T, McFall M, Reiber G, Nelson KM. Health and health behavior differences: U.S. military, veteran, and civilian men. Am J Prev Med 2012;43:483–9.
  3. CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010–2012. MMWR 2013;62:869–73.
  4. Hauret KG, Jones BH, Bullock SH, Canham-Chervak M, Canada S. Musculoskeletal injuries description of an under-recognized injury problem among military personnel. Am J Prev Med 2010;38(1 Suppl):S61–70.
  5. Cameron KL, Hsiao MS, Owens BD, Burks R, Svoboda SJ. Incidence of physician-diagnosed osteoarthritis among active duty United States military service members. Arthritis Rheum 2011;63:2974–82.
  6. Yoon J, Scott JY, Phibbs CS, Frayne SM. Trends in rates and attributable costs of conditions among female VA patients, 2000 and 2008. Womens Health Issues 2012;22:e337–44.
  7. Friedman SA, Phibbs CS, Schmitt SK, Hayes PM, Herrera L, Frayne SM. New women veterans in the VHA: a longitudinal profile. Womens Health Issues 2011;21(4 Suppl):S103–11.
  8. Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA. Validation of a surveillance case definition for arthritis. Journal Rheumatol 2005;32:340–7.
  9. Copeland LA, Zeber JE, Bingham MO, et al. Transition from military to VHA care: psychiatric health services for Iraq/Afghanistan combat-wounded. J Affect Disord 2011;130:226–30.
  10. Ory MG, Smith ML, Patton K, Lorig K, Zenker W, Whitelaw N. Self-management at the tipping point: reaching 100,000 Americans with evidence-based programs. J Am Geriatr Soc 2013;61:821–3.

* Additional information available at http://www.cdc.gov/brfss/annual_data/annual_data.htm.

Additional information available at http://www.cdc.gov/nchs/data/statnt/statnt20.pdf.

§ Post-stratified weights are calculated by aligning each individual characteristic (e.g., sex and age) of the sample with the target population; iterative proportional fitting (raked weights) are calculated by iteratively aligning each specific combination of characteristics (e.g., women aged 18–25 years). Additional information available at http://www.cdc.gov/brfss/annual_data/2013/pdf/weighting_data.pdf.

Additional information available at http://www.cdc.gov/arthritis/interventions/physical_activity.htm.

** Additional information available at http://www.cdc.gov/arthritis/interventions/self_manage.htm.


What is already known on this topic?

Arthritis is a common chronic condition among veterans, and at least two population-based studies have reported a higher prevalence of arthritis among veterans compared with nonveterans. These arthritis prevalence studies of veterans were conducted before the Persian Gulf War, were small, or examined men only.

What is added by this report?

To assess the prevalence of doctor-diagnosed arthritis among male and female veterans, CDC analyzed Behavioral Risk Factor Surveillance System survey data from 2011, 2012, and 2013. The analysis found that 25.6% of veterans reported having arthritis (25.0% among men and 31.3% among women) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories. State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia.

What are the implications for public health practice?

The high prevalence of arthritis, combined with the large number of persons affected, indicate that strategies are needed to reduce the adverse effects of arthritis. Interventions to improve the quality of life of persons with arthritis include providing access to affordable physical activity and self-management education classes.


TABLE 1. Crude, age-specific, and age-standardized* estimated prevalence of arthritis among veterans and nonveterans, by sex and selected sociodemographic characteristics — United States, 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System surveys

Characteristic

Sex-specific

Overall (N = 1,464,060)

Men (n = 586,401)

Women (n = 875,889)

Nonveterans
(n = 417,572)

Veterans
(n = 168,829)

Nonveterans
(n = 860,024)

Veterans
(n = 15,865)

Nonveterans
(n = 1,277,596)

Veterans
(n = 111,934)

No.

%

95% CI

No.

%

95% CI

No.

%

95% CI

No.

%

95% CI

No.

%

95% CI

No.

%

95% CI

Overall

Crude

98,604

17.6

(17.4 – 17.8)

66,723

35.0

(34.6 – 35.4)

324,533

28.9

(28.7 – 29.1)

6,037

31.3

(29.9 – 32.7)

423,137

24.0

(23.8 – 24.1)

72,760

34.7

(34.3 – 35.1)

Age-standardized

98,103

19.5

(19.3 – 19.7)

66,385

25.0

(24.5 – 25.4)

321,422

26.1

(26.0 – 26.3)

5,963

31.3

(29.9 – 32.7)

419,525

23.6

(23.4 – 23.7)

72,348

25.6

(25.2 – 26.1)

Age group (yrs)

18–44

12,309

6.9

(6.7–7.2)

2,473

11.6

(10.9–12.4)

24,859

9.8

(9.6–10.0)

813

17.3

(15.3–19.5)

37,168

8.4

(8.3–8.6)

3,286

12.6

(11.9–13.3)

45–64

52,662

27.4

(27.0–27.8)

19,514

36.0

(35.3–36.8)

126,332

36.8

(36.5–37.2)

2,942

40.3

(38.1–42.4)

178,994

32.7

(32.5–33.0)

22,456

36.4

(35.7–37.1)

≥65

33,132

44.5

(43.8–45.3)

44,398

47.1

(46.5–47.7)

170,231

58.2

(57.9–58.6)

2,208

58.9

(55.8–61.8)

203,363

54.6

(54.3–54.9)

46,606

47.4

(46.8–48.0)

Race/Ethnicity§

White, non-Hispanic

78,495

21.2

(21.0–21.5)

55,836

25.1

(24.6–25.7)

258,029

27.2

(27.0–27.4)

4,549

31.8

(30.2–33.4)

336,524

24.9

(24.7–25.0)

60,385

25.7

(25.2–26.2)

Black, non-Hispanic

6,934

19.5

(18.8–20.3)

4,031

25.1

(23.6–26.6)

30,127

28.1

(27.6–28.6)

738

27.7

(24.0–31.7)

37,061

24.9

(24.5–25.3)

4,769

25.8

(24.4–27.3)

Hispanic

5,536

14.3

(13.6–15.0)

2,057

21.9

(20.3–23.6)

17,350

22.7

(22.1–23.2)

245

28.8

(23.6–34.7)

22,886

18.9

(18.5–19.3)

2,302

22.7

(21.1–24.4)

Other, non-Hispanic

6,002

16.2

(15.2–17.2)

3,602

28.4

(26.4–30.4)

14,791

23.0

(22.1–23.9)

414

33.5

(28.1–39.3)

20,793

20.2

(19.6–20.9)

4,016

29.1

(27.2–31.1)

Highest educational attainment§

Less than high school

13,840

22.9

(22.3–23.6)

4,806

31.7

(28.5–35.0)

39,011

31.2

(30.7–31.8)

52,851

27.4

(27.0–27.9)

4,941

32.9

(29.4–36.6)

High school or equivalent

31,252

20.7

(20.4–21.1)

21,041

25.0

(24.2–25.9)

110,453

27.8

(27.4–28.1)

1,163

30.1

(27.2–33.1)

141,705

25.0

(24.8–25.2)

22,204

25.3

(24.5–26.1)

Technical degree/Some college

22,770

20.4

(20.0–20.9)

19,939

26.1

(25.3–26.8)

92,571

26.7

(26.4–27.0)

2,386

33.2

(31.0–35.5)

115,341

24.5

(24.3–24.7)

22,325

26.9

(26.2–27.7)

College degree or higher

30,421

15.0

(14.7–15.3)

20,775

21.5

(20.7–22.3)

81,415

20.9

(20.7–21.2)

2,339

28.5

(26.7–30.3)

111,836

18.4

(18.3–18.6)

23,114

22.4

(21.7–23.2)

Employment status§

Working

44,285

15.7

(15.4–16.0)

16,092

20.5

(19.9–21.0)

89,980

21.3

(21.1–21.6)

1,986

24.8

(22.7–27.0)

134,265

18.7

(18.5–18.9)

18,078

20.9

(20.3–21.4)

Not working

6,261

19.3

(18.2–20.4)

2,209

27.3

(25.1–29.6)

14,569

27.7

(27.0–28.5)

326

35.6

(29.7–41.9)

20,830

24.2

(23.6–24.8)

2,535

28.2

(26.2–30.3)

Homemaker/student

791

18.6

(15.7–21.8)

291

22.5

(18.6–26.9)

33,544

22.9

(22.4–23.3)

447

30.2

(26.6–33.9)

34,335

22.2

(21.8–22.6)

738

25.8

(23.2–28.6)

Retired

31,111

33.4

(28.4–38.8)

41,535

37.3

(32.5–42.3)

136,637

33.5

(29.9–37.3)

167,748

34.3

(31.0–37.8)

43,801

38.8

(34.3–43.5)

Unable to work

15,746

44.3

(42.9–45.8)

6,341

54.1

(50.5–57.8)

48,246

58.3

(57.2–59.4)

982

67.9

(60.6–74.5)

63,992

52.9

(52.0–53.7)

7,323

56.5

(53.2–59.8)

Annual household income§

<$15,000

13,544

25.1

(24.4–25.8)

5,274

32.7

(30.4–35.1)

53,074

34.4

(33.9–35.0)

740

42.7

(37.9–47.6)

66,618

31.0

(30.5–31.4)

6,014

33.9

(31.8–36.0)

$15,000 to <$25,000

16,443

22.5

(21.9–23.1)

11,629

30.5

(29.1–32.0)

65,049

30.0

(29.6–30.5)

1,071

35.9

(32.0–40.1)

81,492

27.1

(26.8–27.4)

12,700

31.1

(29.8–32.5)

$25,000 to <$50,000

22,202

19.5

(19.0–19.9)

19,869

25.6

(24.7–26.5)

73,142

26.5

(26.1–26.8)

1,572

31.0

(28.6–33.6)

95,344

23.7

(23.4–24.0)

21,441

26.1

(25.2–26.9)

≥$50,000

36,178

17.1

(16.8–17.4)

22,271

22.3

(21.6–22.9)

74,785

21.9

(21.6–22.2)

1,874

28.0

(25.8–30.4)

110,963

19.8

(19.6–20.0)

24,145

22.9

(22.3–23.6)

Body mass index§

Underweight/Normal weight (<25)

19,994

15.5

(15.1–15.8)

14,741

19.9

(19.1–20.7)

97,371

20.5

(20.3–20.7)

1,792

25.1

(23.0–27.3)

117,365

19.0

(18.8–19.2)

16,533

20.8

(20.1–21.6)

Overweight (25 to <30)

39,025

18.0

(17.7–18.3)

28,729

23.0

(22.3–23.6)

95,942

25.6

(25.3–25.9)

1,863

31.6

(29.2–34.2)

134,967

22.0

(21.8–22.2)

30,592

23.6

(23.0–24.3)

Obese (≥30)

38,114

26.0

(25.6–26.4)

22,537

32.4

(31.4–33.4)

109,627

35.5

(35.2–35.9)

2,039

39.9

(36.9–43.0)

147,741

31.5

(31.3–31.8)

24,576

33.0

(32.0–34.0)

Abbreviation: CI = confidence interval.

* Age-standardized to 2000 U.S. projected population (age groups 18–44, 45–64, and ≥65 years); includes only those for whom age was reported.

Number of respondents (unweighted) who reported having arthritis.

§ Weighted to noninstitutionalized U.S. civilian population using sampling weights provided in Behavioral Risk Factor Surveillance System survey data.

Estimates not presented if number of respondents was <50 or relative standard error was ≥30 because estimate might be unreliable.


TABLE 2. State-specific, age-standardized* estimated prevalence of arthritis among veterans, by sex — United States, 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System surveys (N = 1,464,060)

State

Sex-specific

All veterans

Veterans with arthritis as % of all persons in state with arthritis

Men

Women

No.

No. (1,000s)§

%§

95% CI§

No.

No. (1,000s)§

%§

95% CI§

No.

No. (1,000s)§

%§

95% CI§

Alabama

1,233

165

26.8

(24.4–29.2)

149

16

34.1

(28.7–39.9)

1,382

182

27.8

(25.7–30.0)

15.4

Alaska

612

24

26.6

(24.1–29.4)

65

2

26.4

(19.8–34.3)

677

26

26.6

(24.2–29.1)

22.2

Arizona

1,061

194

23.9

(21.1–27.0)

102

24

40.0

(29.7–51.2)

1,163

218

25.9

(22.9–29.2)

18.5

Arkansas

746

89

25.6

(22.5–29.0)

78

9

34.5

(26.3–43.7)

824

98

26.7

(23.8–29.8)

14.9

California

1,694

754

23.6

(21.7–25.5)

158

58

34.4

(28.9–40.4)

1,852

811

24.7

(22.9–26.6)

13.8

Colorado

1,941

141

24.7

(23.0–26.5)

176

14

31.1

(26.5–36.1)

2,117

155

25.4

(23.8–27.1)

17.7

Connecticut

905

87

24.9

(21.6–28.4)

66

5

27.6

(20.9–35.6)

971

92

25.0

(22.0–28.2)

14.1

Delaware

777

30

23.5

(20.5–26.7)

94

3

30.1

(23.4–37.7)

871

33

24.3

(21.6–27.2)

17.6

District of Columbia

420

10

19.9

(16.8–23.4)

§

§

§

§

468

10

19.7

(16.9–22.8)

10.3

Florida

3,276

639

23.8

(21.8–25.8)

313

60

34.4

(27.7–41.8)

3,589

699

25.0

(23.0–27.1)

17.5

Georgia

1,110

263

24.1

(22.0–26.3)

155

31

30.4

(25.5–35.7)

1,265

294

24.8

(22.9–26.9)

16.8

Hawaii

866

33

18.4

(16.5–20.5)

77

2

22.4

(17.6–28.2)

943

36

18.8

(17.0–20.7)

17.1

Idaho

891

50

28.9

(24.7–33.5)

76

3

30.1

(22.8–38.6)

967

53

28.7

(24.8–33.0)

18.7

Illinois

721

284

25.1

(21.4–29.3)

53

17

29.9

(22.0–39.3)

774

301

25.4

(22.0–29.1)

12.6

Indiana

1,182

171

27.3

(24.6–30.2)

90

10

31.0

(24.6–38.2)

1,272

181

27.3

(24.8–30.0)

13.3

Iowa

956

81

22.8

(20.3–25.4)

64

4

27.5

(19.4–37.4)

1,020

86

23.2

(20.8–25.9)

14.8

Kansas

2,497

80

26.2

(24.5–27.9)

223

7

33.8

(29.0–39.0)

2,720

87

26.9

(25.3–28.6)

17.2

Kentucky

1,417

134

30.2

(27.7–32.8)

133

7

29.3

(23.1–36.4)

1,550

141

30.2

(27.9–32.6)

12.9

Louisiana

1,018

117

23.4

(21.1–25.9)

88

9

31.1

(24.2–39.0)

1,106

126

24.4

(22.1–26.9)

13.7

Maine

1,678

52

28.7

(26.3–31.2)

125

3

28.1

(22.8–34.2)

1,803

55

28.5

(26.3–30.8)

17.5

Maryland

1,590

150

24.5

(22.2–27.1)

234

18

28.2

(24.2–32.6)

1,824

168

24.9

(22.8–27.1)

15.9

Massachusetts

2,159

159

23.6

(21.2–26.2)

188

12

33.1

(26.4–40.6)

2,347

171

24.9

(22.6–27.4)

13.9

Michigan

1,737

301

31.5

(28.3–34.8)

107

15

30.0

(23.5–37.5)

1,844

316

31.2

(28.3–34.2)

13.3

Minnesota

1,500

127

22.6

(20.0–25.5)

123

8

25.9

(19.5–33.5)

1,623

135

22.7

(20.2–25.4)

16.1

Mississippi

1,057

84

30.0

(26.9–33.4)

97

7

31.5

(25.2–38.5)

1,154

90

30.1

(27.2–33.1)

13.6

Missouri

1,058

190

28.4

(25.3–31.7)

86

13

33.5

(26.1–41.7)

1,144

203

28.7

(25.8–31.8)

15.3

Montana

1,585

37

26.4

(24.1–28.9)

127

3

32.0

(26.5–38.2)

1,712

40

26.9

(24.8–29.2)

19.0

Nebraska

2,946

53

25.7

(23.6–28.0)

212

4

39.5

(33.2–46.2)

3,158

57

26.8

(24.8–29.0)

17.0

Nevada

793

80

24.6

(21.2–28.2)

65

4

22.6

(17.1–29.2)

858

84

23.9

(20.9–27.1)

18.1

New Hampshire

1,077

44

28.1

(24.7–31.8)

92

3

29.2

(22.8–36.4)

1,169

48

27.8

(24.7–31.0)

17.3

New Jersey

1,524

179

21.6

(19.5–23.8)

120

10

23.8

(18.3–30.3)

1,644

190

22.0

(20.1–24.0)

12.6

New Mexico

1,225

56

23.9

(21.8–26.2)

131

5

28.1

(23.0–33.8)

1,356

61

24.2

(22.3–26.3)

16.1

New York

714

365

22.7

(20.0–25.8)

55

18

31.8

(24.4–40.1)

769

384

23.5

(20.8–26.3)

10.3

North Carolina

1,508

277

24.2

(22.3–26.2)

132

19

23.2

(18.9–28.1)

1,640

297

24.1

(22.4–25.9)

15.5

North Dakota

763

19

24.3

(21.8–27.0)

58

1

27.4

(20.6–35.4)

821

21

24.7

(22.3–27.3)

15.5

Ohio

1,566

351

26.7

(24.5–29.0)

115

20

30.9

(24.9–37.6)

1,681

372

27.2

(25.1–29.4)

14.2

Oklahoma

1,258

120

29.2

(26.6–31.9)

104

8

29.6

(24.5–35.3)

1,362

129

28.9

(26.7–31.3)

16.3

Oregon

864

120

27.6

(24.4–31.2)

93

12

42.7

(32.4–53.6)

957

133

29.1

(25.8–32.5)

16.1

Pennsylvania

2,014

384

28.4

(26.0–30.8)

159

24

35.0

(27.0–43.9)

2,173

409

29.1

(26.8–31.6)

14.1

Rhode Island

905

33

28.7

(25.3–32.5)

68

2

24.5

(18.4–31.9)

973

35

28.2

(25.0–31.6)

15.6

South Carolina

1,994

154

27.3

(25.2–29.6)

192

14

35.7

(30.5–41.2)

2,186

169

28.3

(26.3–30.3)

16.1

South Dakota

1,078

25

26.3

(22.7–30.2)

82

1

29.4

(22.8–36.9)

1,160

27

26.2

(22.9–29.7)

17.8

Tennessee

818

203

25.8

(22.2–29.7)

85

20

33.6

(24.3–44.4)

903

223

26.8

(23.4–30.4)

16.6

Texas

1,441

573

23.8

(21.7–26.0)

167

65

32.1

(25.4–39.6)

1,608

637

24.9

(22.9–27.0)

16.3

Utah

1,332

49

22.5

(20.5–24.5)

86

3

32.3

(25.4–40.0)

1,418

53

23.3

(21.4–25.3)

13.5

Vermont

891

19

24.4

(21.6–27.3)

61

1

32.8

(24.1–42.9)

952

20

25.4

(22.8–28.3)

14.8

Virginia

1,043

243

22.6

(20.7–24.6)

151

32

26.9

(22.9–31.3)

1,194

275

23.0

(21.2–24.8)

17.3

Washington

2,109

207

23.8

(22.0–25.6)

257

22

29.9

(25.4–34.8)

2,366

229

24.4

(22.8–26.1)

17.6

West Virginia

916

73

32.7

(29.8–35.8)

65

4

34.7

(27.6–42.6)

981

76

32.7

(30.0–35.6)

14.5

Wisconsin

742

154

22.0

(19.1–25.1)

55

10

28.5

(20.5–38.1)

797

164

22.4

(19.8–25.3)

14.8

Wyoming

1,054

18

24.7

(22.0–27.5)

85

1

28.1

(20.4–37.3)

1,139

20

25.0

(22.4–27.8)

18.3

Median

24.7

30.3

25.4

15.9

Guam

131

18.6

(15.3–22.3)

**

**

**

145

18.2

(15.2–21.6)

16.3

Puerto Rico

330

20.9

(18.0–24.1)

**

**

**

368

22.6

(19.1–26.5)

5.9

* Age-standardized to 2000 U.S. projected population (age groups 18–44, 45–64, and ≥65 years); includes only those for whom age was reported.

Number of respondents (unweighted) who reported having arthritis.

§ Weighted to noninstitutionalized U.S. civilian population using sampling weights provided in Behavioral Risk Factor Surveillance System survey data.

Number of veterans with arthritis / total number of adults in state with arthritis.

** Estimates not presented if number of respondents was <50 or relative standard error was ≥30 because estimate might be unreliable.


FIGURE. State-specific, age-standardized estimated prevalence of arthritis among veterans — United States, 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System surveys

The figure is a map showing state-specific, age-standardized estimated prevalence of arthritis among veterans in the United States in 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System surveys. Among the 50 states and the District of Columbia, the median state-specific arthritis prevalence among veterans was 25.4% (range = 19.7% in the District of Columbia to 32.7% in West Virginia).

Abbreviations: GU = Guam; PR = Puerto Rico.

Alternate Text: The figure above is a map showing state-specific, age-standardized estimated prevalence of arthritis among veterans in the United States in 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System surveys. Among the 50 states and the District of Columbia, the median state-specific arthritis prevalence among veterans was 25.4% (range = 19.7% in the District of Columbia to 32.7% in West Virginia).



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