Kwoh CK, Burant CJ, Siminoff LA, Ibrahim SA; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Kent Kwoh, Associate Professor of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106-6033, Tel: 216-844-1011; Fax: 216-844-5172; E-mail: ckk@po.cwru.edu
Purpose: Previous studies have reported ethnic differences in utilization of joint replacement, with lower rates among African-Americans (AA) as compared to Whites, but the reasons for these differences remain unknown. We examined ethnic differences in older male African-American and White patients with chronic knee and/or hip pain regarding their awareness of joint replacement and its risks and benefits.Population Studied: A cohort of 285 veterans aged 50 or older (45% AA and 55% White) with moderate to severe knee and/or hip pain of more than six months duration seen in the Primary Care Clinics. Patients who had joint replacement were excluded.Study Design: Trained research assistants utilized structured questionnaires to survey patients with regard to their awareness of joint replacement (JR) and their understanding of its risks and benefits. Six questions were used assess the following topics: heard of JR for arthritis; knowing anyone who had JR, having a good understanding of what happens during JR; risk of death form JR; length recovery from JR; residual pain after JR; and residual walking difficulty after JR. Other measures we examined included severity of their arthritis (Lequense Scale); Arthritis-Specific Functional Health Status (WOMAC); Comorbidity (Charlson); and Fatalism (Powe). Crude and adjusted odds ratios were calculated using ordinal logistic regression.Principal Findings: AA and White patients in this cohort were comparable with respect to age (67 +/- 9 vs. 68 +/- 9, p=0.53), Lequense score (mean 11 vs. 12, p=0.09) and WOMAC score (mean 17 vs. 18, p=0.25), and Fatalism (mean score, 1.98 vs. 2.04, p=0.37). AAs were less likely than whites to have heard of JR (adjusted OR = 0.38, 95 CI 0.18 - 0.85), to have known someone who had this surgery (adjusted OR = 0.24, 95% CI 0.13 - 0.44), to have a good understanding of hip/knee replacement surgery (adjusted OR = 0.35, 95% CI 0.20 - 0.61). AAs were more likely to believe that there will be moderate to severe pain post-JR (adjusted OR = 1.96, 95% CI 1.14 - 3.39), and they were also more likely to believe moderate to severe difficulty in walking post-JR (adjusted OR = 3.07, 95% CI 1.73 - 5.45). Odds ratios were adjusted for age, educational level, income, disease severity, health status and other important clinical and psychosocial covariates. There were no differences between groups with regard to knowledge of risk of death or length of recovery post-JR.Conclusion: Overall, AAs, as compared to whites, were less likely to be aware of JR as an option for their arthritis. In addition, AAs were less likely to have a good understanding of the potential benefits of JR.Implication for Policy, Delivery or Practice: While AAs are less likely to utilized JR as an option for arthritis, these results suggest that lack of information about the benefits of JR may play a role in the disparities in utilization. Better educational programs for patients and physicians may be needed to overcome patients' lack of awareness and concerns about the procedure. Primary Funding Source: Department of Veterans Affairs, Health Services Research and Development
Publication Types:
Keywords:
- African Americans
- Animals
- Arthritis
- Arthroplasty, Replacement
- Arthroplasty, Replacement, Knee
- European Continental Ancestry Group
- Health Knowledge, Attitudes, Practice
- Humans
- Knowledge
- Male
- Odds Ratio
- Pain
- Pain Measurement
- Questionnaires
- Veterans
- surgery
- hsrmtgs
Other ID:
UI: 102272345
From Meeting Abstracts