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. 2023 Dec 18;24(1):976.
doi: 10.1186/s12891-023-07096-0.

Healthcare disparities: patients' perspectives on barriers to joint replacement

Susan M Goodman  1   2 , Insa Mannstadt  3 , J Alex B Gibbons  4 , Mangala Rajan  5 , Anne Bass  3 , Linda Russell  3 , Bella Mehta  5   3 , Mark Figgie  6 , Michael L Parks  6 , Shilpa Venkatachalam  7 , W Benjamin Nowell  7 , Collin Brantner  8 , Geyanne Lui  9 , Andrea Card  5 , Peggy Leung  5 , Henry Tischler  10 , Sarah R Young  11 , Iris Navarro-Millán  5   3
Affiliations

Healthcare disparities: patients' perspectives on barriers to joint replacement

Susan M Goodman et al. BMC Musculoskelet Disord. .

Abstract

Objective: Racial and ethnic disparities in arthroplasty utilization are evident, but the reasons are not known. We aimed to identify concerns that may contribute to barriers to arthroplasty from the patient's perspective.

Methods: We identified patients' concerns about arthroplasty by performing a mixed methods study. Themes identified during semi-structured interviews with Black and Hispanic patients with advanced symptomatic hip or knee arthritis were used to develop a questionnaire to quantify and prioritize their concerns. Multiple linear and logistic regression analyses were conducted to determine the association between race/ethnicity and the importance of each theme. Models were adjusted for sex, insurance, education, HOOS, JR/KOOS, JR, and discussion of joint replacement with a doctor.

Results: Interviews with eight participants reached saturation and provided five themes used to develop a survey answered by 738 (24%) participants; 75.5% White, 10.3% Black, 8.7% Hispanic, 3.9% Asian/Other. Responses were significantly different between groups (p < 0.05). Themes identified were "Trust in the surgeon" "Recovery", "Cost/Insurance", "Surgical outcome", and "Personal suitability/timing". Compared to Whites, Blacks were two-fold, Hispanics four-fold more likely to rate "Trust in the surgeon" as very/extremely important. Blacks were almost three times and Hispanics over six times more likely to rate "Recovery" as very/extremely important.

Conclusion: We identified factors of importance to patients that may contribute to barriers to arthroplasty, with marked differences between Blacks, Hispanics, and Whites.

Keywords: Access to care; Arthroplasty; Mixed methods; Race/ethnicity; Surveys.

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Conflict of interest statement

I.N.M receives advisory board honoraria from Sobi (Swedish Orphan Biovitrum AB). S.V. is employed by Global Healthy Living Foundation (GHLF), a nonprofit that has received research funding from various pharmaceutical companies including AbbVie, Amgen, BMS, Eli Lilly, and Pfizer. GHLF receives grants and sponsorships from multiple organizations, and a full list of funders is available on their website. S.M.G., I.M., J.A.B.G, M.R., A.B., L.R., B.M., M.F., M.L.P, W.B.N., C.B., G.L., A.C., P.L, H.T., and S.R.Y. declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Racial and Ethnic differences in proportion of Very/Extremely important ratings to the identified concerns to arthroplasty. Statistical significance markers: p < 0.1; * p < 0.05; ** p < 0.01; *** p < 0.001; ****p < 0.0001
See this image and copyright information in PMC

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