Ambulatory Medical Care Visits by Adults for Arthritis and Other Rheumatic Conditions (aorc) are Increasing, United States, 2002-2004 Vs. 1997

Purpose: Examine the change in impact of AORC on the ambulatory health care system from 1997 to 2002-2004.
Methods: Average annual 2002-2004 estimates in combined and separate (physician offices, outpatient, emergency department) settings for ambulatory care visits were estimated from two nationally representative sources: the National Ambulatory Medical Care Surveys (office visits) and the National Hospital Ambulatory Medical Care Surveys (outpatient and emergency department visits). These were compared with previously published estimates for 1997 that used the same methods. AORC was defined using National Arthritis Data Workgroup ICD-9-CM codes; specific conditions were defined as done previously. Only conditions reported as the primary diagnosis for the visit were counted; injury-related AORC visits were excluded. Both prevalence proportion and numbers affected for the U.S. population were estimated using SUDAAN to account for the complex survey design.
Results: For AORC, there were 42.9 million combined visits (20.2 per 100 U.S. adults) in 2002-2004, up from 36.5 million in 1997. Compared with 1997, AORC visits increased in all 3 settings: physician offices (32.6 to 38.6 million), outpatient (2.6 to 2.7 million), and emergency department (1.4 to 1.6 million). Among AORC visits to offices, there was an increase for orthopedic surgeons (6.4 to 10.6 million) and those in primary care (17.3 to 18.5 million), but a drop among rheumatologists (5.4 to 2.8 million). Also among AORC visits to offices, there was an increase in those seen by midlevel practitioners (physician assistants & nurse practitioners)(0.8 to 3.5 million).
For specific conditions, visits rose for OA (7.1 to 10.4 million), soft tissue disorders (9.3 to 10.0 million), joint pain/effusion/other (7.0 to 9.8 million), carpal tunnel syndrome (1.6 to 3.0 million) and gout (1.1 to 1.2 million), but fell for RA (4.0 to 2.3 million) and diffuse connective tissue diseases (1.5 to 1.1 million).
Conclusions: AORC is having a growing impact on the ambulatory health care system, consistent with previously projected increases in arthritis prevalence and recent estimates of AORC costs ($86 to 128 billion) for the same time period. With the projected future increase in arthritis prevalence, this impact can be expected to continue growing.

 C. Helmick, None; J. Hootman, None; Y. Luo, None.