Healthy People 2020
defines a health disparity as “a particular type of health difference that
is closely linked with social, economic, and/or environmental disadvantage. Health disparities
adversely affect groups of people who have systematically experienced greater obstacles
to health based on their racial or ethnic group; religion; socioeconomic status; gender; age;
mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity;
geographic location; or other characteristics historically linked to discrimination or exclusion.”
Many factors contribute to racial, ethnic, and socioeconomic health disparities, including
inadequate access to care, poor quality of care, community features (such as poverty and
violence) and personal behaviors. These factors often are associated with underserved racial
and ethnic minority groups, individuals who have experienced economic obstacles, those with
disabilities and individuals living within medically underserved communities. Consequently,
individuals living in both urban and rural areas may experience health disparities.
Examples of Musculoskeletal Disparities
Disparities extend to musculoskeletal
conditions, including osteoarthritis (OA).
Osteoarthritis is the most common form of
arthritis, is the leading cause of disability
in the United States, and is the main
indication for total joint arthroplasty (TJA).
Examples of disparities are illustrated in
the following studies:
• Losina and colleagues found that in
persons free of knee OA at age 40, the
lifetime risk of diagnosed symptomatic
knee OA ranged from 10% among White
males to 17% among Black females. The
20-year risk of diagnosed symptomatic knee OA ranged from about 6% in males
(race/ethnicity did not affect the rate meaningfully) to 8% in Black females. By
age 65, 11.3%, 10.5%, and 10% of Black, Hispanic/Latina, and White females,
free of knee OA at age 40, will be diagnosed with symptomatic knee OA. Lifetime
need for total Knee Arthroplasty (TKA) ranged from 3.8% for Hispanic/Latino
males to 6.8% for Black females. The authors noted that high obesity rates in the
Black female population impacted these risks.
• A number of studies document lower rates of arthritis-related hip/knee surgeries
for older Black adults versus White adults age 65 or above. However, utilization
rates for Black versus White under age 65 do not differ. Lower utilization among
Hispanics/Latinos versus Whites in both age groups is largely explained by
medical access factors.
• Even after adjusting for insurance and health access, Hispanics/Latinos and
Blacks are almost 50% less likely to undergo TKA than Whites.
health disparity — between
any two people or groups of
people — is the observed difference
in health status or risk, due to social,
economic or environmental factors.