Osteoarthritis is widespread and costly – both to individuals and to the nation.

There is limited osteoarthritis (OA)-specific cost data and the majority of cost estimates reflect the total cost of all forms of arthritis.  However, OA, which affects an estimated 32.5 million adults, is the most common form of the more than 100 different rheumatic conditions that comprise arthritis.2  The number of adults with OA is expected to increase as baby boomers age, because older adults have a higher prevalence of arthritis and OA.3  By 2040, the number of adults with arthritis is projected to increase to 78.4 million, most of whom will have OA.3  It is estimated that two-thirds of adults with obesity will develop knee OA at some point in their life, so rates of OA will increase with the obesity epidemic.15


How the Cost of OA Affects the Nation

OA has a significant economic impact due to the effects of disability, comorbid disease, and the expense of treatment.4

Economic Impact

The United States Bone and Joint Initiative (USBJI) highlights the enormous economic impact of OA in their Burden of Musculoskeletal Diseases5 report:

  • From 2013-2015, adults with arthritis reported 180.9 million total lost work days, which constituted 34% of reported lost work days for any medical condition.
  • Incremental mean health care expenditures for arthritis-related conditions doubled from 1996 to 2014. Per-person medical costs attributed to OA averaged $11,052 per-year between 2008 to 2014.
  • In 2013, there were 20.78 million ambulatory care visits and approximately 2.95 million inpatient hospitalizations for people with OA and allied disorders.
  • Despite a decline in length of hospital stay (mean of 8.9 days in 1992 to 3.4 days in 2013), USBJI reports that total “hospitalization charges for both types of knee replacements have increased by five times over (in constant 2013 dollars) from $8.4 billion in 1998 to $41.7 billion in 2013”
  • Annual all-cause costs (both direct and indirect) attributed to OA and allied disorders averaged $486.4 billion nationally between 2008 and 2014.

Social Impact

  • OA disproportionately affects women and minorities. More women than men have OA, particularly after age 50. Documented disparities include significantly greater adverse effects (activity limitation, work limitation, and severe pain) due to OA among African American compared to non-Hispanic white populations, despite equivalent OA prevalence between the two groups. Of increased concern, African Americans receive 39% fewer total knee replacements than whites despite similar levels of severe OA.16

How the Cost of Arthritis Affects the States

The most recently reported costs of arthritis by state are from 2003.  Total costs of arthritis ranged from $226 million in the District of Columbia to $12.1 billion in California.

The states with the highest cost attributable to arthritis:

  1. California, $12.1 billion
  2. New York, $8.7 billion
  3. Texas, $8.7 billion
  4. Florida, $7.6 billion
  5. Pennsylvania, $6.5 billion
  6. Ohio, $5.7 billion
  7. Michigan, $5.5 billion
  8. North Carolina, $4.1 billion
  9. Georgia, $3.9 billion
  10. New Jersey, $3.5 billion

More than a decade later, arthritis is still an expensive medical condition and major cause of disability.  A Behavioral Risk Factor Surveillance System Survey (BRFSS) examined state-level differences between survey respondents who reported having doctor-diagnosed arthritis.  A few notable rankings can be seen below:

The states with the highest prevalence of people with doctor-diagnosed arthritis in 2016:

  1.  West Virginia, 34.4%
  2. Arkansas, 31.6%
  3. Kentucky. 31.1%
  4. Alabama, 31%
  5. Mississippi, 29.4%
  6. Maine, 29.2%
  7. Michigan, 29.1%
  8. Tennessee, 28.4%
  9. Missouri, 28%
  10. Ohio, 27.6%

You can view the full rankings here.

The states and U.S. territories with the most work limitations attributable to arthritis in 2015:

  1. Puerto Rico, 55.4%
  2. Alabama, 54.6%
  3. Arkansas, 54.2%
  4. Kentucky, 51.5%
  5. Guam, 49.6%
  6. Oklahoma, 49.3%
  7. District of Columbia, 48.9%
  8. South Carolina, 48.6%
  9. North Carolina, 47.9%
  10. Nevada, 46.5%

You can view the full rankings here.

THE OA ACTION ALLIANCE’S STATE FACT SHEETS FOR OSTEOARTHRITIS

We have developed fact sheets for each state in America about the burden of osteoarthritis. This can be a tool to advocate for osteoarthritis with your legislators, administrators, and others. Click here to download your state’s fact sheet.

How the Cost of OA Affects the Employer

While OA is more common among employees in certain occupations such as mining, construction, agriculture, and sectors of the service industry, OA can interfere with the ability to be productive while on any job.7,8

  • From 2013-2015, adults with arthritis reported 180.9 million total lost work days, which constituted 34% of reported lost work days for any medical condition.
  • In 2013, 7.2% fewer people with arthritis worked when compared to those without arthritis.
  • Between 2013 and 2015, 6.4 million adults indicated that arthritis was the reason they were limited in, or unable to, work.  This constitutes 23% of the 28.1 million adults in the US who reported work limitations.  As the most common form of arthritis, it is likely that OA accounts for a large portion of those with work limitations.
  • OA severely limits productivity. From 2013-2015, approximately 30% of adults aged 18-64 years with doctor-diagnosed arthritis report an arthritis-attributable work limitation, including working less or not working at all. Much of this is due to OA.
  • Total national arthritis-attributable lost wages were $164 billion in 2013.  That amounts to $4,040 less pay for an adult with arthritis compared with an adult without arthritis.

FURTHER RESOURCES ON THE BURDEN OF OA

References

  1. Barbour KE, Helmick CG, Boring M, Brady TJ. Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2013–2015. MMWR Morb Mortal Wkly Rep 2017;66:246–253. DOI: http://dx.doi.org/10.15585/mmwr.mm6609e1.
  2. Cisternas MG, Murthy L, Sacks JJ, Solomon DH, Pasta DJ, Helmick CG. Alternative Methods for Defining Osteoarthritis and the Impact on Estimating Prevalence in a US Population-Based Survey. Arthritis Care Res (Hoboken). 2016 May;68(5):574-80.
  3. Hootman, J. M., Helmick, C. G., Barbour, K. E., Theis, K. A. and Boring, M. A. (2016), Updated Projected Prevalence of Self-Reported Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation Among US Adults, 2015–2040. Arthritis & Rheumatology, 68: 1582–1587. doi:10.1002/art.39692
  4. Bitton, R. (2009). The economic burden of osteoarthritis. Am J Manag Care, 15(8 Suppl), S230-S235.
  5. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS),  Fourth Edition, Forthcoming Rosemont, IL. Available at http://www.boneandjointburden.org. Accessed 10/15/2018
  6. http://www.cdc.gov/arthritis/data_statistics/state-data-current.htm. Accessed 10/15/2018
  7. Yucesoy B, Charles LE, Baker B, Burchfiel CM. Occupational and genetic risk factors for osteoarthritis: a review. Work 2015; 50(2):261-273.
  8. Silverwood,V., Blagojevic-Bucknall,M., Jinks,C., Jordan,J.L., Protheroe,J., & Jordan,K.P. (2015). Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage, 23(4), 507-515.
  9. A. Hawker, L. Stewart, M.R. French, J. Cibere, J.M. Jordan, L. March, et al. Understanding the pain experience in hip and knee osteoarthritis–an OARSI/OMERACT initiative. Osteoarthritis Cartilage, 16 (2008), pp. 415–422
  10. Vos,T et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859), 2163-2196.
  11. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73(7):1323-1330.
  12. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: Arthritis data from the Third National Health and Nutrition Examination Survey 1991-1994. J Rheumatol, 2006;33(11):2271-2279.
  13. Bolen J, Hootman J, Helmick CG, Murphy L, Langmaid G, Caspersen CJ. Arthritis as a potential barrier to physical activity among adults with diabetes – United States, 2005 and 2007. Morbidity and Mortality Weekly Report 2008;57(18):486-489. http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5718a3.htm
  14. Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM et al. Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? Arthritis Rheum 2011; 63(11):3372-3382.
  15. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis & Rheumatism 2008:59(9):1207-1213.
  16. Cisternas MG, Murphy L, Croft JB, Helmick CG. Racial disparities in total knee replacement among Medicare enrollees–United States 2000-2006. Morbidity and Mortality Weekly Report2009;58(6):133-138.
  17. Theis KA, Hootman JM, Helmick CG, Yelin E. Prevalence and correlates of arthritis-attributable work limitation in the US population among persons ages 18-64: 2002 National Health Interview Survey Data. Arthritis Care & Research 2007;57(3):355-363
Updated March 11, 2019