Former research studies have delved into the influence of sedentary conduct and physical exertion on osteoarthritis4,17, studies that explore the multifaceted nature of contributing elements and incorporate large sample analyses are relatively uncommon. In our study, we executed an exhaustive analysis on the distribution of arthritis across various demographic segments. The outcomes indicated a remarkably elevated arthritis prevalence in females, older adults, non-Hispanic whites, moderate alcohol consumers, active smokers, overweight individuals, and those diagnosed with diabetes. Interestingly, the amplified arthritis prevalence in females aligns with the findings of Podcasy and Epperson, They suggested that women typically experience higher rates of persistent ailments, potentially due to hormonal fluctuations and lifestyle determinants18.
We also noted an evident age gradient, with the most significant arthritis prevalence within the age group of 65 and above. This can possibly be ascribed to the escalated physiological deterioration of joints with aging, resonating with the observations of Andersen’s research 19. In relation to racial disparities, our findings revealed the highest arthritis prevalence in non-Hispanic whites. Conversely, Stefan20 offered a contrasting viewpoint. Their research pointed to a higher chronic disease prevalence in Asian Indian populations, suggesting the possible influence of diverse research methodologies and sample selections on racial discrepancy findings.
Income-wise, our data portrayed an elevated arthritis prevalence in lower-income brackets. This can potentially be attributed to the challenges faced by those in lower socioeconomic tiers in maintaining healthy lifestyles and accessing medical aid, thereby enhancing their arthritis risk. This parallels Brennan-Olsen's findings, which reported higher arthritis prevalence in lower and middle-income individuals in less affluent nations21. Further, Callahan established that even after considering other health conditions, community poverty and individual socioeconomic standing significantly affected the physical health of arthritis patients22.
In relation to educational attainment, the study's findings propose that education might have an influential role in managing disease and shaping treatment results for individuals with arthritis. The prevalence of arthritis was found to correlate with age and level of education. It was more common for adults with lesser educational qualifications to experience coexisting health conditions23. Furthermore, the extent of a patient's understanding of their illness could also affect disease management and treatment results, as a study focused on rheumatoid arthritis patients in Bangladesh indicated24. These suggest the potential influence of educational attainment on arthritis prevalence and treatment outcomes.
As far as alcohol consumption is concerned, our analysis presented a higher prevalence of arthritis among people without drinking, while moderate drinkers showed a lower prevalence. This contrasts with some former research, and such inconsistency may have multiple explanations. Primarily, the origins of arthritis are complex and could be influenced by numerous factors. The effect of alcohol on immune function and inflammatory processes isn't straightforward and might involve dose and duration effects. Going beyond a certain level of alcohol consumption might lead to a weakened immune system, diminishing inflammatory responses and thus decreasing arthritis risk. Secondary, potential confounding elements or interactions might be involved. For instance, drinkers, compared to non-drinkers, might partake in additional health-oriented behaviors, such as adequate sleep and increased physical activity, which could be defensive against arthritis. Specific rationales would necessitate further investigation for verification and thorough examination. One study discovered a link between smoking, alcohol, and disease activity, and functional status in patients with rheumatoid arthritis25. Additionally, alcohol intake has been found to suppress the response of T follicular helper (TFH) cells, thus inhibiting the development of autoimmune arthritis26. These results suggest the potential influence of alcohol consumption on arthritis prevalence and disease activity.
The research also indicated a correlation between smoking habits and arthritis prevalence. Smoking might contribute to arthritis development by amplifying the body's inflammatory response. Chemicals present in tobacco might stimulate the immune system, leading to increased inflammation in the joints. Moreover, smoking might lead to diminished blood flow, which could adversely affect joint nutrition and waste removal, resulting in joint degradation and discomfort. These elements collectively raise the risk of arthritis, echoing the findings of Podcasy and Epperson18.
In relation to body mass, our study indicated a notably increased prevalence of arthritis among individuals with obesity. This could be a result of the heightened strain that excess body mass exerts on the joints, thereby escalating the risk of arthritis. This aligns with the observations of Agrawal, who pinpointed obesity as a considerable risk contributor to arthritis27. Additionally, our data pointed to a greater prevalence of arthritis among individuals with diabetes, potentially due to the impact of diabetes on joint health and subsequently increasing arthritis risk. This echoes the findings of Stefan, who identified diabetes as a contributing factor for arthritis20.
Physical activity contributes to improving joint stability, flexibility, enhancing muscle strength, and promoting joint lubrication and recuperation28. The interaction between physical activity, sedentary behavior, and arthritis indicated that physically active individuals exhibited a reduced arthritis prevalence compared to inactive ones. Furthermore, we found that individuals participating in Transportation MVPA and leisure time MVPA showcased lower arthritis prevalence than those abstaining from such activities. This observation aligns with the study conducted by Master et al., suggesting moderate physical activity could aid in managing body weight, reducing joint stress, and consequently mitigating arthritis risk29. Sedentary behavior is considered a detrimental factor contributing to arthritis incidence. Sedentary behavior, whether screen-related or non-screen-related, could adversely affect joint health. Long time sedentary behavior might result in joint instability, muscle weakness, and stiffness, thus elevating arthritis risk. Individuals exhibiting higher non-screen time sedentary behavior had a higher arthritis prevalence compared to those exhibiting lesser sedentary behavior. These observations imply that physical activity might be beneficial in warding off arthritis, possibly due to its role in preserving joint health and flexibility and mitigating arthritis risk, which aligns with Wanner's findings30. Extended sedentary behavior might elevate joint pressure, thereby raising the risk of arthritis. Furthermore, sedentary behavior could be tied to other unhealthy lifestyle aspects, such as poor dietary habits and lack of exercise, which could augment arthritis risk. This resonates with the study conducted by Wu31.
In the multivariate logistic regression assessment, we found that a general lack of total physical activity is associated with an increased incidence of arthritis. This observation aligns with earlier research findings, suggesting a lower probability of arthritis manifestation in populations with more physical activity. Contrarily, a surprising revelation is that populations lacking in work-oriented MVPA display a diminished incidence of arthritis. This could be attributed to the monotonous nature of work-associated physical tasks, potentially instigating joint overuse and subsequently escalating arthritis risk, a notion supported by Urquhart's research that advocates for moderate physical activity as a pathway to enhanced joint function and possibly a reduced arthritis susceptibility32. Diving into the realm of sedentary habits, our analysis unveils an association between long-lasting sedentary behaviors and an uptick in arthritis incidence. This link can be rationalized considering that extended sedentary activities might induce joint rigidity and muscle wasting, thereby heightening arthritis vulnerability33,34. However, after adjusting for covariates, the association between total physical activity, Transportation MVPA, leisure time MVPA, and Screen time sedentary behavior with arthritis is no longer significant. This might be reflective of confounding factors such as age, sex, ethnicity, PIR, BMI, alcohol intake, smoking, and diabetes presence playing significant roles in the physical activity-arthritis interplay.
Accounting for potential confounding factors is vital in examining the relationship between physical activity and arthritis. In clinical scenarios, encouraging moderate physical activity and reducing sedentary behavior are likely effective approaches for the prevention and management of arthritis35. For those diagnosed with arthritis, the choice and intensity of physical activity should be tailored based on their unique health conditions and guided by their physician's advice.
This study's limitations stem from its cross-sectional design, which hinders the establishment of causal relationships, and the possibility that the sample might not entirely represent the broader population. Future research should leverage longitudinal designs to more accurately evaluate the causal relationship between physical activity, sedentary behavior, and arthritis. Moreover, further studies should investigate the impact of diverse types and intensities of physical activity on joint health, and tailor physical activity guidelines based on individual health conditions and risk factors. In summary, this study offers comprehensive insights into the epidemiological characteristics and potential risk factors of arthritis, highlighting the significance of physical activity and reducing sedentary behavior in managing arthritis. However, additional research is necessary to fully understand these relationships and propose more effective strategies for the prevention and management of arthritis.