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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.