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Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.
Med Care. 2008 Feb; 46(2):200-8.MC

Abstract

BACKGROUND

Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.

OBJECTIVE

This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries.

DESIGN

Longitudinal (1998-2004) Health and Retirement Study.

SETTING

National probability sample of US community-dwelling adults.

SAMPLE

A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older.

MEASUREMENTS

The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population.

RESULTS

Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences.

CONCLUSIONS

These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation.

Authors+Show Affiliations

Institute for Healthcare Studies, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. ddunlop@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18219249

Citation

Dunlop, Dorothy D., et al. "Age and Racial/ethnic Disparities in Arthritis-related Hip and Knee Surgeries." Medical Care, vol. 46, no. 2, 2008, pp. 200-8.
Dunlop DD, Manheim LM, Song J, et al. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Med Care. 2008;46(2):200-8.
Dunlop, D. D., Manheim, L. M., Song, J., Sohn, M. W., Feinglass, J. M., Chang, H. J., & Chang, R. W. (2008). Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Medical Care, 46(2), 200-8. https://doi.org/10.1097/MLR.0b013e31815cecd8
Dunlop DD, et al. Age and Racial/ethnic Disparities in Arthritis-related Hip and Knee Surgeries. Med Care. 2008;46(2):200-8. PubMed PMID: 18219249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. AU - Dunlop,Dorothy D, AU - Manheim,Larry M, AU - Song,Jing, AU - Sohn,Min-Woong, AU - Feinglass,Joseph M, AU - Chang,Huan J, AU - Chang,Rowland W, PY - 2008/1/26/pubmed PY - 2008/3/21/medline PY - 2008/1/26/entrez SP - 200 EP - 8 JF - Medical care JO - Med Care VL - 46 IS - 2 N2 - BACKGROUND: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed. OBJECTIVE: This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries. DESIGN: Longitudinal (1998-2004) Health and Retirement Study. SETTING: National probability sample of US community-dwelling adults. SAMPLE: A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older. MEASUREMENTS: The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population. RESULTS: Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences. CONCLUSIONS: These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/18219249/Age_and_racial/ethnic_disparities_in_arthritis_related_hip_and_knee_surgeries_ L2 - https://doi.org/10.1097/MLR.0b013e31815cecd8 DB - PRIME DP - Unbound Medicine ER -