Original Research

Journal of General Internal Medicine

, Volume 25, Issue 9, pp 982-988

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

  • Leslie R. M. HausmannAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare System Email author 
  • , Maria MorAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare SystemGraduate School of Public Health, University of Pittsburgh
  • , Barbara H. HanusaAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare SystemDepartment of Psychiatry, University of Pittsburgh School of Medicine
  • , Susan ZickmundAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare SystemSchool of Medicine, University of Pittsburgh
  • , Peter Z. CohenAffiliated withSchool of Medicine, University of Pittsburgh
  • , Richard GrantAffiliated withLouis Stokes DVA Medical CenterUniversity Hospitals Case Medical Center
  • , Denise M. KresevicAffiliated withLouis Stokes DVA Medical CenterUniversity Hospitals Case Medical Center
  • , Howard S. GordonAffiliated withJesse Brown VA Medical Center, Center for Complex Chronic CareCollege of Medicine, University of Illinois at Chicago
  • , Bruce S. LingAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare SystemSchool of Medicine, University of Pittsburgh
    • , C. Kent KwohAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare SystemSchool of Medicine, University of Pittsburgh
    • , Said A. IbrahimAffiliated withCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare SystemCenter for Health Equity Research and Promotion, Philadelphia VA Medical CenterSchool of Medicine, University of Pennsylvania

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Abstract

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.

KEY WORDS

healthcare disparities total joint replacement orthopedic surgery osteoarthritis patient preference