Health disparities in the utilization of elective total joint replacement has been targeted as a priority area for additional research by NIAMS. The proposed study seeks to examine factors that may provide the basis for these health disparities and builds on two federally funded studies. The first examines ethnic differences in the management of osteoarthritis (OA) among male veterans. The second, the Study of Health Aging: Body Composition (Health ABC) study, is a NIA-funded longitudinal evaluation focusing on two population-based cohorts of individuals between the ages of 70 to 79 recruited from the Pittsburgh, PA and Memphis, TN metropolitan areas. The overall goal of this research is to better understand the reasons behind ethnic variations in the utilization of lower extremity total knee arthroplasty (TKA) or total hip arthroplasty (THA). The proposed study will examine the health beliefs, practices, preferences and perceptions of African American women and men, as well as white women and men with knee or hip OA and how these factors may influence consideration of TKA/THA. A cross-sectional study design will be utilized to examine the following Specific Aims: 1) To examine ethnic/gender differences in individuals' self-report of symptoms and functional status among individuals with OA of similar radiologic severity; 2) To examine ethnic/cultural differences in perceptions of the efficacy of specific treatment options for arthritis and willingness to have TKA/THA; 3) To examine gender differences in perceptions of specific treatment options for arthritis and willingness to have TKA/THA; and 4) To examine ethnic/gender differences in provider-level factors related to access to TKA/THA. The 518 individuals from the Health ABC study with symptomatic and radiographic knee OA and 271 with symptomatic and radiographic hip OA will be surveyed. Regarding Specific Aims 1 and 2, major variables that may confound the relationship between ethnicity or gender and willingness to have joint replacement include understanding the risks and benefits of joint replacement; pain coping strategies; perceptions of the efficacy of a specific treatment option such as prayer, and perceptions of health care. The proposed study is unique in that it will examine ethnic and gender differences in the management of OA across patients with varying disease severity, focusing on specific factors that may explain health disparities.
| Emejuaiwe, N; Jones, A C; Ibrahim, S A et al. (2007) Disparities in joint replacement utilization: a quality of care issue. Clin Exp Rheumatol 25:44-9 |
