Original Research

How Common Is Hip Pain Among Older Adults?

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Results From the Third National Health and Nutrition Examination Survey


 

References

ABSTRACT

OBJECTIVE: To determine the incidence of self-reported significant hip pain using a nationally representative sample of older adults in the United States.

STUDY DESIGN: Subjects were interviewed to determine their leisure time physical activity levels and whether they experienced severe hip pain. Sampling weights were calculated to account for unequal selection probabilities. The impact of race, age, and physical activity status was examined as influential factors affecting hip pain.

POPULATION: We interviewed 6596 adults aged 60 years and older as part of the third National Health and Nutrition Examination Survey (NHANES III).

OUTCOME MEASURED: We measured the prevalence of hip pain.

RESULTS: A total of 14.3% of participants aged 60 years and older reported significant hip pain on most days over the past 6 weeks. Men reported hip pain less frequently than women. Age did not influence self-reported hip pain in men. The lowest prevalence of hip pain was found in women aged 60 to 70 years. Sixteen percent of non-Hispanic white women reported hip pain, compared with 14.8% of black women and 19.3% of Mexican American women. Among non-Hispanic white men, 12.4% reported hip pain, a proportion no different from that of their black and Mexican American male counterparts. Among older US adults, 18.4% of those who had not participated in leisure time physical activity during the previous month reported severe hip pain; 12.6% of those who did engage in physical activity reported hip pain.

CONCLUSIONS: Self-reported hip pain has increased since NHANES I (1971-1975). Further studies are needed to identify individuals at highest risk for severe hip pain and to identify optimal treatment of hip pain.

KEY POINTS FOR CLINICIANS
  • Self-reported hip pain has increased in older adults since surveys conducted from 1971 to 1975.
  • A total of 14.3% of older adults report significant hip pain; men report hip pain less frequently than women.
  • Sex, age, and race are important determinants of hip pain in older adults.

According to a report by the National Arthritis Data Workgroup based on data from the first National Health and Nutrition Examination Survey (NHANES I), the prevalence of symptomatic hip osteoarthritis (OA) is 0.7% in both adult women and men; 0.5% have moderate or severe symptoms.1 The incidence of symptomatic hip OA was higher in women than in men, and increased with age in both sexes until age 80 years, with a slight decline beyond that age.2 In a study of patients in a health maintenance organization, the incidence of symptomatic hip OA in elderly women was 239 per 100,000 person-years at ages 60 to 69 years, 583 per 100,000 person-years at ages 70 to 79 years, and 441 per 100,000 person-years for women older than 80 years. The corresponding rates for elderly men per 100,000 person-years were 158, 445, and 264, respectively.

In contrast, the prevalence of radiographic hip OA is 3.1%; risk factors for the development of radiographic changes appear different in women and men.3 As has been demonstrated in the knee, radiographic hip OA is more prevalent than symptomatic disease. Only 61% of older individuals with confirmed radiologic hip OA reported pain at the hip, while 11% without radiologic changes of OA had significant hip pain, presumably of nonarticular etiology. Factors that affect patients’ reporting of symptoms of hip pain, both from OA and from nonarticular sources, have not yet been fully elucidated.

We are not aware of any current nationally representative reports on the sex-specific and race-specific prevalence of hip pain in older adults. Therefore, the purpose of our investigation was to examine the age-specific prevalence of hip pain using a current nationally representative sample of older US adults. We will also describe the prevalence of self-reported hip pain among older adults from 2 of the largest minority groups in the United States: non-Hispanic blacks and Mexican Americans.

Methods

Sample design

The Third National Health and Nutrition Examination Survey (NHANES III) was conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics. The plan and operation of NHANES III have been described elsewhere.5,6 Briefly, the survey was designed to produce a nationally representative sample of the civilian noninstitutionalized US population. One of the main goals of this survey was to estimate the national prevalence of selected health conditions and risk factors.

The NHANES III represents a 6-year study that was conducted from 1988 through 1994 consisting of 2 phases lasting 3 years each: phase I, 1988 through 1992, and phase II, 1991 through 1994. The survey was designed so that each phase was a nationally representative sample. Information presented in this report reflect data from phases I and II combined. The NHANES III oversampled Mexican Americans, non-Hispanic blacks, and older adults to ensure weighted, reliable estimates from these groups.

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