13 / 58
13
• Although the burden of serious OA is comparable in Blacks and Whites, multiple
U.S. studies indicate that Whites over age 65 undergo joint replacement at a
higher rate than Blacks.
11;28
◦
◦
In 2006, the rate of TKA among U.S. adults ages 65 years and older
was 39% lower in Blacks than in Whites (5.6 and 9.2 per 1,000 people,
respectively).
28
◦
◦
Several studies have shown that these racial differences persist even when
access to care is similar.
29
◦
◦
The disparities are not explained by varying risk for knee osteoarthritis.
12
◦
◦
Studies have found that, compared to White patients, Black patients tend
to report a poorer understanding of TJA; expect longer hospital stays,
more residual pain, and more difficulty walking after the procedure; are
less likely to believe in the efficacy of TJA; and are less willing to consider
it as an option for treating knee/hip osteoarthritis.
30-32
◦
◦
Recent studies have revealed, despite similar education, amount of
insurance coverage, number of comorbidities, and self-reported degree of
osteoarthritis severity, African Americans were nearly 50% less likely than
Whites to perceive the benefits of total joint arthroplasty
33;34
and 70% more
likely than Whites to recognize barriers to total joint arthroplasty.
34
• Clinic-based studies indicate that there may be greater unmet need for joint
replacement among women compared with men. However, to date, there is no
U.S. population-based evidence of this disparity.
11
It should be noted, however,
that the lack of population-based evidence may be due to how clinical research
is conducted. Novikoff and Saleh note that a number of factors might explain
sex and gender disparities observed in TJA, including underrepresentation in
clinical trials. “Even if women are represented, many studies do not provide
gender-specific analysis because either the study was not powered sufficiently
to allow for subgroup analysis or gender-specific analysis was not a part of the
hypothesis being tested.”
35
• Ethnic and race group differences have been reported in both clinical and
experimental pain, with Black Americans reporting increased pain. A 2012
study of 94 participants (74% women), including 45 Blacks and 49 Whites, with
symptomatic knee osteoarthritis indicated that Blacks had significantly lower
levels of vitamin D compared to Whites, demonstrated greater clinical pain,
and showed greater sensitivity to heat-induced and mechanically induced pain.
The authors concluded that it may be warranted that older Black Americans
with chronic widespread pain be screened for vitamin D deficiency to reduce
disparities in pain.
36
• A 2013 study by Colbert and associates
37
found that in 3,695 persons with or at
higher risk for knee OA, higher BMI and large waist circumference were each
associated with poor outcome over four years. Among women with high BMI