Arthritis in the Regional Cultures of the American Nations: An Overlooked Component of a Larger Unhealthy Lifestyle Syndemic

Ross Arena; Nicolaas P Pronk; Elie Gertner; Kharma C Foucher; Colin Woodard

doi:10.1177/15598276241283762

Arthritis in the Regional Cultures of the American Nations: An Overlooked Component of a Larger Unhealthy Lifestyle Syndemic

Am J Lifestyle Med. 2024 Sep 12:15598276241283762. doi: 10.1177/15598276241283762. Online ahead of print.

Authors

Ross Arena^{1

2}, Nicolaas P Pronk^{2

3

4}, Elie Gertner^{3

5}, Kharma C Foucher^{1

6}, Colin Woodard⁷

Affiliations

¹ Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA (RA, KCF, CW).
² Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA (RA, NPP).
³ HealthPartners Institute, Minneapolis, MN, USA (NPP, EG).
⁴ Department of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA (NPP).
⁵ Section of Rheumatology, Regions Hospital, St Paul, MN and University of Minnesota Medical School, Minneapolis, MN, USA (EG).
⁶ Department of Kinesiology and Nutrition, College of Applied Science, University of Illinois, Chicago, IL, USA (KCF).
⁷ Nationhood Lab, Pell Center for International Relations and Public Policy, Salve Regina University, Newport, RI, USA (CW).

Abstract

Introduction: Health indices vary widely within the United States (U.S.), with clear "belts and epicenters" where the prevalence of unhealthy lifestyle behaviors, chronic disease, and disability are all high. Arthritis is a significant, well-established risk factor for developing chronic disease. In this paper, we hypothesize that the prevalence and patterns of arthritis in the U.S. will mirror that of other leading health issues across the country. Methods: We merged county-level data on arthritis, disability, and depression prevalence, the Lifestyle Health Index (LHI), the Social Vulnerability Index (SVI) and the American Nations regional cultures schematic. Results: Data was available from 3073 U.S. counties. We found age-adjusted arthritis prevalence has statistically significant and generally strong Pearson product correlations (r ≈ 0.70, P < 0.001) with (1) LHI sub scores and overall score; (2) Depression prevalence; (3) Disability prevalence; and (4) SVI. The geographic distribution of age-adjusted arthritis prevalence according to the American Nations regional cultures model demonstrated clear heterogeneity across regions. Conclusions: The status of population health in the U.S. is disconcerting and the current model of health care delivery, which is often approached from a siloed (condition-specific vs holistic care), reactionary, secondary prevention model, is inadequate to the challenge.

Keywords: arthritis; chronic disease; chronic pain; depression; public health; unhealthy lifestyle behaviors.