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. 2019 Dec;27(12):1746-1754.
doi: 10.1016/j.joca.2019.07.015. Epub 2019 Aug 9.

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

A M Cavanaugh  1 , M J Rauh  2 , C A Thompson  3 , J Alcaraz  4 , W M Mihalko  5 , C E Bird  6 , C B Eaton  7 , M C Rosal  8 , W Li  9 , A H Shadyab  10 , T Gilmer  11 , A Z LaCroix  12
Affiliations

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

A M Cavanaugh et al. Osteoarthritis Cartilage. 2019 Dec.

Abstract

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.

Keywords: African American; Arthritis; Hispanic; Joint replacement; Medicare.

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Conflict of interest statement

Competing interest statement: The authors have no competing interests to report.

Figures

Figure 1.
Figure 1.
Study population determination flow chart
Figure 2.
Figure 2.
Risk quintiles determined through predicted probabilities of TKA determined through Cox hazards regression with independent variables of age, diagnosis of OA, RA, joint pain, mobility disability, BMI, and number of comorbidities. Failure curves through Kaplan-Meier method used to determine proportion of women undergoing TKA in each quintile.
See this image and copyright information in PMC

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