Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors

Abstract

Background: There is a marked difference between black patients and white patients in the utilization of joint replacement therapy. The reasons behind this disparity remain unknown.

Objectives: To examine how black and white potential candidates for joint replacement compare with respect to their overall familiarity with joint replacement as an option, as well as their perceptions of the risks/benefits of this procedure.

Methods: Cross-sectional survey of 596 elderly patients with symptomatic osteoarthritis of the knee or hip or both attending primary care clinics at Cleveland VAMC.

Results: Black (44%) and white (56%) patients in this cohort were comparable with respect to age and clinical factors. However, black patients were less likely to be employed (8% vs. 15%, P = 0.017) or to be married (39% vs. 56%, P = 0.000), but more likely to report an annual household income of less than $10,000 (41% vs. 20%, P = 0.000) and less than high school education (43% vs. 29%, P = 0.001). Black patients were less likely than white patients to have had family or friends who had had joint replacement (OR, 0.39 [0.26-0.61]), or to report a good understanding of joint replacement as a form of treatment (OR, 0.62 [0.42-0.92]). They were more likely than white patients to expect longer hospital course (OR, 4.09 [2.57-6.54]), moderate to extreme pain (OR, 2.61 [1.74-3.89]), and moderate to extreme difficulty walking after replacement surgery (OR, 2.76 [1.83-4.16]).

Conclusion: Black patients were less likely than white patients to be familiar with joint replacement surgery and more likely to express concerns about postsurgical pain and difficulty walking.