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

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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.

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Acknowledgements

This study was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service (IIR 04-137, PI: Said A. Ibrahim). Dr. Hausmann’s effort was supported by the Veterans Affairs Health Services Research and Development Career Development Program (RCD 06-287 and ER 0280-1). Dr. Ibrahim is a previous recipient of a VA Health Services Research Career Development Award and the Harold Amos Robert Wood Johnson Scholar Award. Dr. Ibrahim is also supported by a K24 Award (1K24AR055259-01) from the National Institutes of Musculoskeletal and Skin Disorders. The views expressed here are those of the authors and do not represent those of the Department of Veterans Affairs or the United States Government. The authors would like to thank project coordinator Margaret Kerr and members of the research staff: Elizabeth Flatley, Michael Hannon, Laura Johnson, Renee McDade, Matthew McShane, Rebecca Meiksin, Christine Schneider, Rebecca Siders, Lisa Stewart, and Sandra Truax. The authors would also like to thank Kim Hansen and Hilary Peterson for editorial input on this manuscript.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive (151C-H), Pittsburgh, PA, 15206, USA

    Leslie R. M. Hausmann PhD, Maria Mor PhD, Barbara H. Hanusa PhD, Susan Zickmund PhD, Bruce S. Ling MD & C. Kent Kwoh MD

  2. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Maria Mor PhD

  3. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Barbara H. Hanusa PhD

  4. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Susan Zickmund PhD, Peter Z. Cohen MD, Bruce S. Ling MD & C. Kent Kwoh MD

  5. Louis Stokes DVA Medical Center, Cleveland, OH, USA

    Richard Grant MD & Denise M. Kresevic RN, PhD

  6. University Hospitals Case Medical Center, Cleveland, OH, USA

    Richard Grant MD & Denise M. Kresevic RN, PhD

  7. Jesse Brown VA Medical Center, Center for Complex Chronic Care, Chicago, IL, USA

    Howard S. Gordon MD

  8. College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Howard S. Gordon MD

  9. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA

    Said A. Ibrahim MD, MPH

  10. School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Said A. Ibrahim MD, MPH

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  1. Leslie R. M. Hausmann PhD
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  11. Said A. Ibrahim MD, MPH
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Correspondence to Leslie R. M. Hausmann PhD.

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Hausmann, L.R.M., Mor, M., Hanusa, B.H. et al. The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting. J GEN INTERN MED 25, 982–988 (2010). https://doi.org/10.1007/s11606-010-1399-5

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  • DOI: https://doi.org/10.1007/s11606-010-1399-5

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