Differences in expectations of outcome mediate African American/white patient differences in "willingness" to consider joint replacement

Objective. Joint replacement therapy is an effective treatment option for end-stage osteoarthritis (OA) of the knee and/or hip. There are marked racial/ethnic disparities in the utilization of this procedure. The reasons for these disparities are not known. We sought to determine whether African American patients differ from white patients in their "willingness" to consider joint replacement and to determine the factors that influence this relationship. Methods. We performed a cross-sectional survey of 596 elderly, male, African American or white patients with moderate-to-severe symptomatic knee or hip OA who were receiving primary care at the Department of Veterans Affairs outpatient clinics. Results. The groups were similar with respect to age, severity of arthritis measured by the Lequesne Scale and the Western Ontario and McMaster Universities Osteoarthritis-Index, and scores on the Charlson Comorbidity Index and Geriatric Depression Scale. Compared with whites, African Americans were less likely to be employed or married or to have attained a high school education, but were more likely to report a median annual household income of <$10,000. They were also less likely than whites to be familiar with joint replacement and more likely to expect a longer duration of hospital course, pain, and functional disability following replacement surgery. African American patients were less "willing" than white patients to consider joint replacement (odds ratio 0.50, 95% confidence interval 0.30-0.84). However, this difference was explained by the between-group differences in expectations. Conclusion. African American patients were less likely than white patients to express "willingness" to consider joint replacement if the procedure was needed and recommended. This difference was explained by differences between the groups in their expectations of hospital course, pain, and function following replacement surgery.