Racial differences in expectations of joint replacement surgery outcomes

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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