This literature from national studies on the costs of arthritis documents a burden of great magnitude, showing that arthritis exacts substantial national tolls. Economic costs of arthritis represent 1.5-2.5% of the GNP and total health care expenditures among those with arthritis approach 3% of the GNP. People with arthritis are substantial users of health care services, averaging 9-10 physician visits and 0.2-0.3 hospital admissions annually. In the US alone, it was the primary listed diagnosis for 44 million ambulatory visits and 3.8 million hospital days in 1997. Finally, people with arthritis experience significant time loss; more than half with work disabilities and as many as 60% with activity limitations attributable to arthritis. However, the relevance of these findings on the costs of arthritis for policy purposes is limited because the most recent results, based on national data, are largely from the early 1990s. The latest estimates of economic costs are based on 1987-1996 data sets. Recent findings relating medical utilization on the individual level used 1995 data and on the national level used 1997 data. Even the most recent 1997 medical utilization estimates were based on US data that predated the effects of the US 1997 Balanced Budget Act on US health care (47,48). Documentation of work and activity restrictions utilized data from 1990 or earlier. Findings on disability among people with arthritis analyzed data prior to 1995. The most recent estimates of the costs and burden of arthritis are generally based on national data sets that are 5-10 years old. This deficiency points to the need for contemporary estimates that reflect current treatments and current health care systems. It is also notable that national population-based studies reviewed almost exclusively evaluate the US and Canadian experience, with a heavy predominance of US data. This demonstrates a need for current information from the international community related to the impact of arthritis at national levels, to promote public policies that are responsive to the needs of all people with arthritis. Finally, to facilitate a public health response to reduce the high costs and burden of arthritis, risk factors that predicted functional deterioration among older people with arthritis were identified. Older Hispanic adults with arthritis were at greatest risk of functional deterioration. However, this disparity is modified by health behaviors, which are amenable to intervention. Specifically, vigorous exercise could provide an absolute reduction of 5-10% in the progression of functional deterioration among older adults with arthritis. Public health policies, health education, and prevention efforts to maintain functional abilities in people with arthritis should target Hispanics, particularly those with less education. Prevention should include vigorous exercise and medical intervention for health needs. In older adults, weight maintenance should also be promoted.
