Racial and ethnic disparities in utilization of total knee arthroplasty among older women

被引:47
作者
Cavanaugh, A. M. [1 ]
Rauh, M. J. [2 ,3 ]
Thompson, C. A. [3 ]
Alcaraz, J. [3 ]
Mihalko, W. M. [4 ]
Bird, C. E. [5 ]
Eaton, C. B. [6 ,7 ]
Rosal, M. C. [8 ]
Li, W. [9 ]
Shadyab, A. H. [10 ]
Gilmer, T. [10 ]
LaCroix, A. Z. [10 ]
机构
[1] Univ Calif San Diego, San Diego State Univ, Joint Doctoral Program Publ Hlth, La Jolla, CA 92093 USA
[2] San Diego State Univ, Doctor Phys Therapy Program, San Diego, CA 92182 USA
[3] San Diego State Univ, Grad Sch Publ Hlth, San Diego, CA 92182 USA
[4] Univ Tennessee, Campbell Clin, Dept Orthopaed Surg & Biomed Engn, Memphis, TN USA
[5] RAND Corp, Hlth Care Div, Santa Monica, CA USA
[6] Brown Univ, Dept Family Med, Warren Alpert Med Sch, Providence, RI 02912 USA
[7] Brown Univ, Sch Publ Hlth, Dept Epidemiol, Providence, RI 02912 USA
[8] Univ Massachusetts, Med Sch, Dept Populat & Quantitat Sci, Amherst, MA 01003 USA
[9] Univ Massachusetts, Sch Med, Dept Med, Worcester, MA USA
[10] Univ Calif San Diego, Dept Family Med & Publ Hlth, 9500 Gilman Dr,Mail Code 0725, La Jolla, CA 92103 USA
基金
美国国家卫生研究院;
关键词
Joint replacement; African American; Hispanic; Arthritis; Medicare; ELECTIVE JOINT REPLACEMENT; PATIENT RACE; HIP; OSTEOARTHRITIS; CONCORDANCE; PREVALENCE; PAIN; AGE; RECOMMENDATIONS; COMMUNICATION;
D O I
10.1016/j.joca.2019.07.015
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Objective: To evaluate racial and ethnic disparities in utilization of total knee arthroplasty (TKA) in relation to demographic, health, and socioeconomic status variables. Design: Prospective study of 102,767 Women's Health Initiative postmenopausal women initially aged 50-79, examining utilization rates of primary TKA between non-Hispanic Black/African American, non-Hispanic White, and Hispanic/Latina women (hereafter referred to as Black, White, and Hispanic). A total of 8,942 Black, 3,405 Hispanic, and 90,420 White women with linked Medicare claims data were followed until time of TKA, death, or transition from fee-for-service coverage. Absolute disparities were determined using utilization rates by racial/ethnic group and relative disparities quantified using multivariable hazards models in adjusting for age, arthritis, joint pain, mobility disability, body mass index, number of comorbidities, income, education, neighborhood socioeconomic status (SES), and geographic region. Results: TKA utilization was higher among White women (10.7/1,000 person-years) compared to Black (8.5/1,000 person-years) and Hispanic women (7.6/1,000 person-years). Among women with health indicators for TKA including diagnosis of arthritis, moderate to severe joint pain, and mobility disability, Black and Hispanic women were significantly less likely to undergo TKA after adjusting for age [Black: HR (95% confidence interval) = 0.70 (0.63-0.79); Hispanic: HR = 0.58 (0.44-0.77)]. Adjustment for SES modestly attenuated the measured disparity, but significant differences remained [Black: HR = 0.75 (0.67-0.89); Hispanic: HR = 0.65 (0.47-0.89)]. Conclusions: Compared to White women, Black and Hispanic women were significantly less likely to undergo TKA after considering need and appropriateness for TKA and SES. Further investigation into personal-level and provider-level factors that may explain these disparities is warranted. (C) 2019 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:1746 / 1754
页数:9
相关论文
共 52 条
[21]   Estimates of the prevalence of arthritis and other rheumatic conditions in the United States [J].
Helmick, Charles G. ;
Felson, David T. ;
Lawrence, Reva C. ;
Gabriel, Sherine ;
Hirsch, Rosemarie ;
Kwoh, C. Kent ;
Liang, Matthew H. ;
Kremers, Hilal Maradit ;
Mayes, Maureen D. ;
Merkel, Peter A. ;
Pillemer, Stanley R. ;
Reveille, John D. ;
Stone, John H. .
ARTHRITIS AND RHEUMATISM, 2008, 58 (01) :15-25
[22]   Race and Elective Joint Replacement: Where a Disparity Meets Patient Preference [J].
Ibrahim, Said A. ;
Franklin, Patricia D. .
AMERICAN JOURNAL OF PUBLIC HEALTH, 2013, 103 (04) :583-584
[23]   Defining Racial and Ethnic Disparities in THA and TKA [J].
Irgit, Kaan ;
Nelson, Charles L. .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2011, 469 (07) :1817-1823
[24]   Racial trends in the use of major procedures among the elderly [J].
Jha, AK ;
Fisher, ES ;
Li, ZH ;
Orav, EJ ;
Epstein, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (07) :683-691
[25]   Prevalence of Total Hip and Knee Replacement in the United States [J].
Kremers, Hilal Maradit ;
Larson, Dirk R. ;
Crowson, Cynthia S. ;
Kremers, Walter K. ;
Washington, Raynard E. ;
Steiner, Claudia A. ;
Jiranek, William A. ;
Berry, Daniel J. .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2015, 97A (17) :1386-1397
[26]   Determinants of patient preferences for total knee replacement: African-Americans and whites [J].
Kwoh, C. Kent ;
Vina, Ernest R. ;
Cloonan, Yona K. ;
Hannon, Michael J. ;
Boudreau, Robert M. ;
Ibrahim, Said A. .
ARTHRITIS RESEARCH & THERAPY, 2015, 17
[27]   The association of doctor-patient race concordance with health services utilization [J].
LaVeist, TA ;
Nuru-Jeter, A ;
Jones, KE .
JOURNAL OF PUBLIC HEALTH POLICY, 2003, 24 (3-4) :312-323
[28]   Do Patient Expectations About Arthroplasty at Initial Presentation for Hip or Knee Pain Differ by Sex and Ethnicity? [J].
Lavernia, Carlos J. ;
Contreras, Juan S. ;
Parvizi, Javad ;
Sharkey, Peter F. ;
Barrack, Robert ;
Rossi, Mark D. .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2012, 470 (10) :2843-2853
[29]   It's Not What You Say... - Racial disparities in communication between orthopedic surgeons and patients [J].
Levinson, Wendy ;
Hudak, Pamela L. ;
Feldman, Jacob J. ;
Frankel, Richard M. ;
Kuby, Alma ;
Bereknyei, Sylvia ;
Braddock, Clarence, III .
MEDICAL CARE, 2008, 46 (04) :410-416
[30]   Utilization of elective hip and knee arthroplasty by age and payer [J].
Matlock, Dan ;
Earnest, Mark ;
Epstein, Anne .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2008, 466 (04) :914-919