Journal Article

The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting

Cohen, Peter Z., Mor, Maria, Ling, Bruce S., Hausmann, Leslie R. M., Grant, Richard, Kresevic, Denise M., Hanusa, Barbara H., Kwoh, C. Kent, Ibrahim, Said A., Gordon, Howard S., Zickmund, Susan

2010

Overview

BACKGROUND The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored. OBJECTIVE To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment. DESIGN Prospective, observational study. PARTICIPANTS African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics. MAIN MEASURES Patients completed surveys that assessed socio-demographic and clinical variables that could influence osteoarthritis treatment. Orthopedic surgeons’ notes were reviewed to determine whether patients had been recommended for TJR and whether they underwent the procedure within 6 months of study enrollment. RESULTS Rate of TJR recommendation was 19.5%. Odds of receiving a TJR recommendation were lower for AA than white patients of similar age and disease severity (OR = 0.46, 95% CI = 0.26–0.83; P = 0.01). However, this difference was not significant after adjusting for patient preference for TJR (OR = 0.69, 95% CI = 0.36–1.31, P = 0.25). Overall, 10.3% of patients underwent TJR within 6 months. TJR was less likely for AA patients than for white patients of similar age and disease severity (OR = 0.41, 95% CI = 0.16–1.05, P = 0.06), but this difference was reduced after adjusting for whether patients had received a recommendation for the procedure at the index visit (OR = 0.57, 95% CI = 0.21–1.54, P = 0.27). CONCLUSIONS In this study, race differences in patient preferences for TJR appeared to underlie race differences in TJR recommendations, which led to race differences in utilization of the procedure. Our findings suggest that patient treatment preferences play an important role in racial disparities in TJR utilization in the orthopedic setting.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: African Americans / Aged / Arthritis / Arthroplasty, Replacement, Hip - utilization / Arthroplasty, Replacement, Knee - utilization / Biological and medical sciences / Diseases of the osteoarticular system / European Continental Ancestry Group / Female / General aspects / Health services utilization / Healthcare Disparities - ethnology / Hospitals, Veterans / Humans / Internal Medicine / Joint surgery / Male / Medical sciences / Medical treatment / Medicine / Medicine & Public Health / Middle Aged / Odds Ratio / Original Research / Orthopedic surgery / Orthopedics / Osteoarthritis / Osteoarthritis, Hip - ethnology / Osteoarthritis, Hip - surgery / Osteoarthritis, Knee - ethnology / Osteoarthritis, Knee - surgery / Outpatient Clinics, Hospital / Patient Preference - ethnology / Prospective Studies / Race / Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases