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Philadelphia VAMC, Philadelphia, PA 19104-4155, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 05/2008; 59(5):730-7. DOI: 10.1002/art.23565
Source: PubMed


Prior studies have indicated racial differences in patients' expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a well-validated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust.
Detailed demographic, clinical, psychological, and social data were collected from 909 male patients (450 African American, 459 white) ages 50-79 years with moderate or severe osteoarthritis (OA) of the hip or knee receiving primary care at 2 veterans affairs medical centers. The previously validated Joint Replacement Expectations Survey was used to assess expectations for pain relief, functional improvement, and psychological well-being after joint replacement.
Among knee OA patients (n = 627), the unadjusted mean expectation score (scale 0-76) for African American patients was 48.7 versus 53.6 for white patients (mean difference 4.9, P < 0.001). For hip OA patients (n = 282), the unadjusted mean expectation score (scale 0-72) for African Americans was 45.4 versus 51.5 for whites (mean difference 6.1, P < 0.001). Multivariable adjustment for disease severity, socioeconomic factors, education, social support, literacy, and trust reduced these racial differences to 3.8 points (95% confidence interval [95% CI] 1.2, 6.3) among knee OA patients and 4.2 points (95% CI 0.4, 8.0) among hip patients.
Among potential candidates for joint replacement, African American patients have significantly lower expectations for surgical outcomes than white patients. This difference is not entirely explained by racial differences in demographics, disease severity, education, income, social support, or trust.

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Available from: Said A Ibrahim, Jan 13, 2014
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    • "In addition to genetic differences in AIS incidence and severity across different racial groups, there could also exist environmental explanations for these differences. Race and socioeconomic class have been shown to be independent factors that limit access to and utilization of care for many medical problems [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21]. Similarly, the rate of surgical procedures has been shown to differ between races [22] [23]. "
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    ABSTRACT: Ethnic disparities have been documented in the incidence and treatment of many diseases. Additionally, race and socioeconomic status (SES) have been shown to affect disease severity and access to care in the recent orthopedic literature. To assess the role, if any, that race, SES, and health insurance type play in disease severity and treatment decisions in patients with adolescent idiopathic scoliosis. Retrospective chart review. Pediatric patients seen in a single surgeon's practice over 6 years (2004-2009). Treatment modality (observation, bracing, or surgery). Data were obtained from 403 patients seen over 6 years (2004-2009). A patient-reported questionnaire was used to collect race, age, family income, and parent marital status data. Race was self-reported as "Asian," "black or African American," "Hispanic or Latino," "white or Caucasian," or "Other." Socioeconomic status was determined using family income and type of health insurance as indicators. Major curve magnitude and prescribed initial treatment (observation, brace, or surgery) were assessed from physician records. An independent sample t test was used to detect differences in curve magnitude of the different racial groups. A Pearson chi-square analysis was used to detect group differences for curves in surgical patients, defined as curves greater than 40°, and their initial treatment. Patients self-identified with one of the following racial groups: white (N=219), black (N=86), Hispanic (N=44), Asian (N=37), or Other (N=17). Mean curve magnitude was greater in black than in white patients (33° vs. 28°, p<.05). Black patients were more likely to present with curves in the surgical range (34% vs. 24%, p<.05) and were more likely to have surgery as their initial treatment than white patients (34% vs. 19%, p<.05). Black patients had more limited health care plans and lower incomes compared with whites (p<.001). Patients with higher access insurance plans presented at a younger age than patients with more limited access plans, irrespective of race (13.6 vs. 14.1, p<.05). There was no difference in Cobb angle at presentation by income or type of insurance. Curve magnitude and percentage of patients with curves in the surgical range were greater in black than in white patients. There was no difference in age on presentation or treatment offered across all racial groups. Black patients were more likely to have surgery as their initial treatment than white patients. While race did have an impact on disease severity in this single surgeon's practice, SES did not.
    The spine journal: official journal of the North American Spine Society 10/2013; 15(5). DOI:10.1016/j.spinee.2013.06.043 · 2.43 Impact Factor
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    • "We also sought to determine if African–American and white elders differ in self-management and whether such differences are consistent across mild and more severe osteoarthritis. Differences in selfmanagement would be consistent with recent evidence suggesting that African–Americans have lower expectations of receiving joint replacement surgery (Groeneveld et al. 2008). Other research suggests that African–American and white elders with osteoarthritis do not differ in health beliefs or care-seeking related to arthritis (Ang et al. 2008). "
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    ABSTRACT: The aim of this study was to examine optimal self-management in osteoarthritis and its association with patient-reported outcomes. We recruited a population-based sample of Medicare beneficiaries (n = 551) residing in Allegheny County, PA, USA and elicited an expanded set of self-management behaviors using open-ended inquiry. We defined optimal self-management according to clinical recommendations, including use of hot compresses on affected joints, alteration of activity, and exercise. Only 20% practiced optimal self-management as defined by two or more of these criteria. Optimal and suboptimal self-managers did not differ in sociodemographic features. Both white and African-Americans who practiced optimal self-management reported significantly less pain, but the benefit was greatest in severe disease for whites and for mild-moderate disease among African-Americans. This backdrop of naturally occurring self-management behaviors may be important to recognize in planning programs that seek to bolster self-management skills.
    Journal of Cross-Cultural Gerontology 11/2008; 23(4):349-60. DOI:10.1007/s10823-008-9085-3
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