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Arthritis of all types in the U.S. carried an economic burden of $303.5 billion in 2013, nearly 1% of the gross domestic product that year, according to a CDC analysis.
An estimated $139.8 billion in medical bill payments and $163.7 billion in lost wages were attributed to arthritis in 2013, their report stated. The percentage of people with arthritis who worked was 7.2 percentage points lower than that of people without arthritis (76.8%, 95% CI 75.0%-78.6%, versus 84.0%, 95% CI 82.5%-85.5%) after adjustment for sociodemographics and chronic conditions, Louise B. Murphy, PhD, of the CDC's Division of Population Health, and colleagues reported online in Arthritis Care and Research.
All-cause medical expenditures among adults with arthritis represented 51% of the $1.2 trillion national medical expenditures among all adults in 2013, they added.
"High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function," they wrote. "The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared with those without, signaling the need for interventions that keep people with arthritis in the work force."
Previous reports of medical care expenditures and earnings losses illustrated the sharply rising toll of arthritis and other rheumatic conditions, showing that costs nearly doubled from $65 billion in 1997 to $128 billion in 2003. Aging population, changes in medical management of arthritis, and the introduction of Medicare Part D have affected medical expenses and earnings losses since 2003, the authors noted.
For this analysis, researchers used 2013 Medical Expenditure Panel Survey (MEPS) data to generate updated estimates of the economic significance of arthritis, looking at medical expenditures of adults over 18 and arthritis-attributable earnings losses of adults ages 18 to 64. MEPS is an ongoing national survey that includes medical conditions, costs and payment sources and demographics, looking at households from the previous year's National Health Interview Survey (NHIS). This study included 24,762 individuals representing an estimated 66 million adults with arthritis in the MEPS database.
Murphy and colleagues revised the definition of arthritis in this study. Previous analyses used a broader set of ICD-9-CM codes for conditions treated by a rheumatologist or were considered rheumatic. This time, researchers used a subset of the original codes -- ICD-9-CM 274, 710, 712-716, 719, and 729 -- with 716 and 719 included because osteoarthritis often is misclassified to these codes in MEPS. These codes span rheumatoid arthritis, osteoarthritis, gout, and certain other inflammatory joint disorders (but not spondylopathies).
To measure medical expenditures -- the amounts paid to providers, not their nominal charges -- the team looked at MEPS data when available, or Agency for Healthcare Research and Quality (AHRQ) imputed expenditures derived from supplemental surveys of medical care providers. They estimated two types of medical expenditures: arthritis-attributable and all-cause. Arthritis-attributable expenditures were adjusted for comorbidities, socio-demographics and other characteristics. All-cause expenditures were the costs to treat all chronic conditions incurred by adults with arthritis.
The analysts also looked at personal earnings losses among adults ages 18 to 64 who had ever worked for pay, restricting their study to this group to prevent lost wages from being overestimated. They calculated the percentage of people who worked in 2013, the average annual earnings stratified by arthritis status, and the difference in average earnings between those with and without arthritis.
Results showed that the average arthritis-attributable medical expenditures were $2,117 (95% CI 1,268-2,966) per person, for a national aggregate of $139.8 billion. The highest average cost was for ambulatory care at $983 (95% CI $697-$1,269), followed by prescriptions at $474 (95% CI $173-$775).
In the MEPS database, adults with arthritis had the highest all-cause medical cost per person ($9,233). Total all-cause expenditures for people with arthritis were $609.8 billion, or 51% of all medical expenditures in MEPS. Payers and policy makers use all-cause medical expenditure information to identify populations with the greatest need for interventions, the authors noted.
Wage losses attributed to arthritis were $4,040 per person (95% CI $2,101-$5,979) in 2013, for a national total of $163.7 billion. Among adults ages 18 to 64 years old who had ever worked, the average per-person earnings for individuals with arthritis were 9% less than for those without arthritis ($34,193 versus $37,554 per year). After adjusting for differences in socio-demographic characteristics and chronic conditions, the percentage of working-age adults with arthritis who worked was 7.2 points lower than it was for those without arthritis.
The authors noted their conclusions might be conservative because MEPS methodology might contribute to underestimated costs. Their study might be limited because arthritis was self-reported in MEPS and NHIS, they added. Although the sensitivity of self-reported specific conditions like osteoarthritis is low, most types of arthritis probably were captured within their broad definition, they stated.