Association of Burden and Prevalence of Arthritis With Disparities in Social Risk Factors, Findings From 17 US States.



Social risks previously have been associated with arthritis prevalence and costs. Although social risks often cluster among individuals, no studies have examined associations between multiple social risks within the same individual. Our objective was to determine the association between individual and multiple social risks and the prevalence and burden of arthritis by using a representative sample of adults in 17 US states.


Data are from the 2017 Behavioral Risk Factor Surveillance System. Respondents were 136,432 adults. Social risk factors were food insecurity, housing insecurity, financial insecurity, unsafe neighborhoods, and health care access hardship. Weighted χ2 and logistic regression analyses, controlling for demographic characteristics, measures of socioeconomic position, and other health conditions examined differences in arthritis prevalence and burden by social risk factor and by a social risk index created by summing the social risk factors.


We observed a gradient in the prevalence and burden of arthritis. Compared with those reporting 0 social risk factors, respondents reporting 4 or more social risk factors were more likely to have arthritis (adjusted odds ratio [AOR], 1.92; 95% CI, 1.57-2.36) and report limited usual activities (AOR, 2.97; 95% CI, 2.20-4.02), limited work (AOR, 2.72; 95% CI, 2.06-3.60), limited social activities (AOR, 3.10; 95% CI, 2.26-4.26), and severe joint pain (AOR, 1.86; 95% CI, 1.44-2.41).


Incremental increases in the number of social risk factors were independently associated with higher odds of arthritis and its burden. Intervention efforts should address the social context of US adults to improve health outcomes.





Published Version (Please cite this version)


Publication Info

Rethorn, Zachary D, Timothy J Rethorn, Chad E Cook, Jason A Sharpe, S Nicole Hastings and Kelli D Allen (2022). Association of Burden and Prevalence of Arthritis With Disparities in Social Risk Factors, Findings From 17 US States. Preventing chronic disease, 19. p. E08. 10.5888/pcd19.210277 Retrieved from

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Zachary D. Rethorn

Instructor, Medical Center in the Department of Orthopaedic Surgery

Dr. Zachary D. Rethorn is a board-certified orthopedic physical therapist and certified health coach with clinical and research expertise in musculoskeletal pain conditions, physical activity, and health promotion. He earned his undergraduate degree in Exercise Science from Belmont University followed by his DPT degree from the University of Tennessee at Chattanooga. Dr. Rethorn completed a residency in orthopedic physical therapy through Benchmark Rehab Institute, a faculty development residency through Duke University, and a PhD in health promotion and wellness at Rocky Mountain University of Health Professions. Dr. Rethorn is a postdoctoral fellow at the Durham VA Health Care System Center for Innovation to ADAPT where his research focuses on improving access, equity, and outcomes for musculoskeletal conditions through attending to behavioral and social determinants of health. He has presented at national and international conferences on topics related to musculoskeletal conditions, health equity, and health promotion. 


Chad E. Cook

Professor in Orthopaedic Surgery

Dr. Cook is a clinical researcher, physical therapist, and profession advocate with a long-term history of clinical care excellence and service. His passions include refining and improving the patient examination process and validating tools used in day-to-day physical therapist practice. Dr. Cook has authored or co-authored 3 textbooks, has published over 315 peer reviewed manuscripts and lectures internationally on orthopedic examination and treatment.

Jason Sharpe

Instructor, Medical Center in the Department of Orthopaedic Surgery

Susan Nicole Hastings

Professor of Medicine

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