Analysis of Risk and Protective Factors for Arthritis Status and Severity Using Survey Data

Authors

  • Masaru Teramoto Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
  • Sheniz Moonie School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA

DOI:

https://doi.org/10.6000/1929-6029.2013.02.03.3

Keywords:

Rao-Scott χ2 test, logistic regression, Behavioral Risk Factor Surveillance System, cigarette smoking, alcohol consumption, obesity, physical activity, odds ratio

Abstract

This study looked at how cigarette smoking, alcohol consumption, obesity, and physical activity are associated with the prevalence and severity of arthritis among adults living in Delaware, U.S. through the analysis of survey data. We examined data from the 2009 Delaware Behavioral Risk Factor Surveillance System (BRFSS). Weighted percentages were calculated for the arthritis-related factors above by arthritis status and activity limitation due to arthritis/joint symptoms, and were analyzed using the Rao-Scott χ2 test. A multiple logistic regression analysis was performed to determine an odds ratio (OR) while adjusting for gender, age, race/ethnicity, and education. Adult Delawareans self-reporting arthritis were more likely to be former and current smokers than those without self-reported arthritis (p < 0.001; OR = 1.58 for former smokers vs. non-smokers; OR = 1.52 for current smokers vs. non-smokers). Moderate and heavy alcohol consumption was associated with lower severity of arthritis (p < 0.001; OR = 0.66 for moderate drinking vs. no drinking; OR = 0.50 for heavy drinking vs. no drinking). There was a significant relationship of obesity to both arthritis status (p < 0.001; OR = 2.13 for obesity vs. not overweight/obesity) and severity (p < 0.008; OR = 1.67 for obesity vs. not overweight/obesity). Furthermore, people having arthritis-related activity limitation were more likely to not meet the current physical activity recommendations (p = 0.013; OR = 1.46). It appears that smoking and obesity have a negative impact on the risk and severity of arthritis, whereas alcohol consumption and physical activity may be protective against arthritis. A proper analysis of survey data is essential to truly understand how human behavior impacts people’s health.

Author Biographies

Masaru Teramoto, Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA

Department of Health Sciences, College of Nursing and Health Professions

Sheniz Moonie, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA

School of Community Health Sciences

References

Arthritis Foundation, Association of State and Territorial Health Officials, Centers for Disease Control and Prevention. National arthritis action plan: a public health strategy. 1999 [cited 2013 Jul 1]: Available from: http://www.arthritis.org/ media/Delia/NAAP_full_plan.pdf

Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation — United States, 2007-2009. MMWR 2010; 59(39): 1261-5.

Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006; 54(1): 226-9. http://dx.doi.org/10.1002/art.21562 DOI: https://doi.org/10.1002/art.21562

Brault MW, Hootman JM, Helmick CG, Theis KA, Armour BS. Prevalence and most common causes of disability among adults — United States, 2005. MMWR 2009; 58(16): 421-6.

Yelin E, Cisternas M, Foreman A, Pasta D, L. M, Helmick CG. National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions — United States, 2003. MMWR 2007; 56(1): 4-7. DOI: https://doi.org/10.1002/art.22565

Albano SA, Santana-Sahagun E, Weisman MH. Cigarette smoking and rheumatoid arthritis. Semin Arthritis Rheum 2001; 31(3): 146-59. http://dx.doi.org/10.1053/sarh.2001.27719 DOI: https://doi.org/10.1053/sarh.2001.27719

Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L. The impact of obesity on the musculoskeletal system. Int J Obes 2008; 32(2): 211-22. http://dx.doi.org/10.1038/sj.ijo.0803715 DOI: https://doi.org/10.1038/sj.ijo.0803715

Maxwell JR, Gowers IR, Moore DJ, Wilson AG. Alcohol consumption is inversely associated with risk and severity of rheumatoid arthritis. Rheumatology 2010; 49(11): 2140-6. http://dx.doi.org/10.1093/rheumatology/keq202 DOI: https://doi.org/10.1093/rheumatology/keq202

Manninen P, Riihimaki H, Heliovaara M, Suomalainen O. Physical exercise and risk of severe knee osteoarthritis requiring arthroplasty. Rheumatology 2001; 40(4): 432-7. http://dx.doi.org/10.1093/rheumatology/40.4.432 DOI: https://doi.org/10.1093/rheumatology/40.4.432

Behavioral Risk Factor Surveillance System. Atlanta, GA: Centers for Disease Control and Prevention; [updated 2013 Mar 19; cited 2013 Jul 1]: Available from: http://www.cdc. gov/brfss/

BRFSS Frequently Asked Questions (FAQs). Centers for Disease Control and Prevention; [updated 2013 Mar 19; cited 2013 Jul 1]: Available from: http://www.cdc.gov/brfss/ about/brfss_faq.htm

Centers for Disease Control and Prevention. 2009 BRFSS Overview. [cited 2013 Jul 1]: Available from: http://www.cdc.gov/brfss/technical_infodata/surveydata/2009/overview_09.rtf

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office 2010.

Alcohol and Public Health: Frequently Asked Questions. Atlanta, GA: Centers for Disease Control and Prevention; [updated 2012 Nov 7; cited 2013 Jul 1]: Available from: http://www.cdc.gov/alcohol/faqs.htm

World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO Consultation. WHO Technical Report Series. Vol. 894. Geneva, Switzerland: World Health Organization; 2000.

Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116(9): 1081-93. http://dx.doi.org/10.1161/CIRCULATIONAHA.107.185649 DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.185649

Barrett EM, Scott DG, Wiles NJ, Symmons DP. The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. Rheumatology (Oxford) 2000; 39(12): 1403-9. http://dx.doi.org/10.1093/rheumatology/39.12.1403 DOI: https://doi.org/10.1093/rheumatology/39.12.1403

Bennett JA. Mediator and moderator variables in nursing research: conceptual and statistical differences. Res Nurs Health 2000; 23(5): 415-20. http://dx.doi.org/10.1002/1098-240X(200010)23:5<415::AID-NUR8>3.0.CO;2-H DOI: https://doi.org/10.1002/1098-240X(200010)23:5<415::AID-NUR8>3.0.CO;2-H

Fairchild AJ, MacKinnon DP. A general model for testing mediation and moderation effects. Prev Sci 2009; 10(2): 87-99. http://dx.doi.org/10.1007/s11121-008-0109-6 DOI: https://doi.org/10.1007/s11121-008-0109-6

Stolt P, Bengtsson C, Nordmark B, et al. Quantification of the influence of cigarette smoking on rheumatoid arthritis: results from a population based case-control study, using incident cases. Ann Rheum Dis 2003; 62(9): 835-41. http://dx.doi.org/10.1136/ard.62.9.835 DOI: https://doi.org/10.1136/ard.62.9.835

Nyhall-Wahlin BM, Jacobsson LT, Petersson IF, Turesson C. Smoking is a strong risk factor for rheumatoid nodules in early rheumatoid arthritis. Ann Rheum Dis 2006; 65(5): 601-6. http://dx.doi.org/10.1136/ard.2005.039172 DOI: https://doi.org/10.1136/ard.2005.039172

Mili F, Helmick CG, Zack MM. Prevalence of arthritis: analysis of data from the US Behavioral Risk Factor Surveillance System, 1996-99. J Rheumatol 2002; 29(9): 1981-8.

Harrison BJ. Influence of cigarette smoking on disease outcome in rheumatoid arthritis. Curr Opin Rheumatol 2002; 14(2): 93-7. http://dx.doi.org/10.1097/00002281-200203000-00003 DOI: https://doi.org/10.1097/00002281-200203000-00003

Tuomi T, Heliovaara M, Palosuo T, Aho K. Smoking, lung function, and rheumatoid factors. Ann Rheum Dis 1990; 49(10): 753-6. http://dx.doi.org/10.1136/ard.49.10.753 DOI: https://doi.org/10.1136/ard.49.10.753

Jonsson T, Thorsteinsson J, Valdimarsson H. Does smoking stimulate rheumatoid factor production in non-rheumatic individuals? APMIS 1998; 106(10): 970-4. http://dx.doi.org/10.1111/j.1699-0463.1998.tb00247.x DOI: https://doi.org/10.1111/j.1699-0463.1998.tb00247.x

Kallberg H, Jacobsen S, Bengtsson C, et al. Alcohol consumption is associated with decreased risk of rheumatoid arthritis: results from two Scandinavian case-control studies. Ann Rheum Dis 2009; 68(2): 222-7. http://dx.doi.org/10.1136/ard.2007.086314 DOI: https://doi.org/10.1136/ard.2007.086314

Sharma L, Lou C, Cahue S, Dunlop DD. The mechanism of the effect of obesity in knee osteoarthritis: the mediating role of malalignment. Arthritis Rheum 2000; 43(3): 568-75. http://dx.doi.org/10.1002/1529-0131(200003)43:3<568::AID-ANR13>3.0.CO;2-E DOI: https://doi.org/10.1002/1529-0131(200003)43:3<568::AID-ANR13>3.0.CO;2-E

Neidhart M, Hauser N, Paulsson M, DiCesare PE, Michel BA, Hauselmann HJ. Small fragments of cartilage oligomeric matrix protein in synovial fluid and serum as markers for cartilage degradation. Br J Rheumatol 1997; 36(11): 1151-60. http://dx.doi.org/10.1093/rheumatology/36.11.1151 DOI: https://doi.org/10.1093/rheumatology/36.11.1151

Mouritzen U, Christgau S, Lehmann HJ, Tanko LB, Christiansen C. Cartilage turnover assessed with a newly developed assay measuring collagen type II degradation products: influence of age, sex, menopause, hormone replacement therapy, and body mass index. Ann Rheum Dis 2003; 62(4): 332-6. http://dx.doi.org/10.1136/ard.62.4.332 DOI: https://doi.org/10.1136/ard.62.4.332

Dumond H, Presle N, Terlain B, et al. Evidence for a key role of leptin in osteoarthritis. Arthritis Rheum 2003; 48(11): 3118-29. http://dx.doi.org/10.1002/art.11303 DOI: https://doi.org/10.1002/art.11303

Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 1992; 116(7): 535-9. http://dx.doi.org/10.7326/0003-4819-116-7-535 DOI: https://doi.org/10.7326/0003-4819-116-7-535

Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage 2005; 13(1): 20-7. http://dx.doi.org/10.1016/j.joca.2004.10.008 DOI: https://doi.org/10.1016/j.joca.2004.10.008

Caspersen CJ, Pereira MA, Curran KM. Changes in physical activity patterns in the United States, by sex and cross-sectional age. Med Sci Sports Exerc 2000; 32(9): 1601-9. http://dx.doi.org/10.1097/00005768-200009000-00013 DOI: https://doi.org/10.1097/00005768-200009000-00013

Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services 2008.

Felson DT. Risk factors for osteoarthritis: understanding joint vulnerability. Clin Orthop Relat Res 2004; 427(Suppl): S16-S21. http://dx.doi.org/10.1097/01.blo.0000144971.12731.a2 DOI: https://doi.org/10.1097/01.blo.0000144971.12731.a2

Rosenbaum PR, Donald BR. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70(1): 41-55. http://dx.doi.org/10.1093/biomet/70.1.41 DOI: https://doi.org/10.1093/biomet/70.1.41

Rosenbaum PR, Donald BR. Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc 1984; 79(387): 516-24. http://dx.doi.org/10.1080/01621459.1984.10478078 DOI: https://doi.org/10.1080/01621459.1984.10478078

Downloads

Published

2013-07-30

How to Cite

Teramoto, M., & Moonie, S. (2013). Analysis of Risk and Protective Factors for Arthritis Status and Severity Using Survey Data. International Journal of Statistics in Medical Research, 2(3), 192–199. https://doi.org/10.6000/1929-6029.2013.02.03.3

Issue

Section

General Articles