Ethnic and Racial Disparities in Diagnosis, Treatment, and Follow-up Care

ArticleinThe Journal of the American Academy of Orthopaedic Surgeons 15 Suppl 1:S8-12 · February 2007with5 Reads
DOI: 10.5435/00124635-200700001-00004 · Source: PubMed
Abstract
Studies from four areas of musculoskeletal health care disparities were reviewed to determine the root causes of the disparities and gain insight into measurable interventions. The areas of musculoskeletal health were total joint arthroplasty, amputation for patients with diabetes, rehabilitation of and impairment in patients with stroke, and morbidity associated with unintentional injuries. The Jenkins Model on Health Disparities was used to investigate and rank the contributing causes (socioeconomic status, sociocultural beliefs, racism, biology) of the health care disparities. No single root cause was found for any of the conditions. Thus, all contributing factors must be considered when planning meaningful interventions.
    • "Many factors such as demographics, socioeconomic status, cultural beliefs, patient preferences, knowledge and expectations , and physician preferences may contribute to racial disparities in TJA utilization and outcomes, and as expected, no single cause can explain the racial differences in the utilization and outcomes of joint arthroplasties [90]. Improvement in physician-patient interactions and more effective communication might improve patient perception and knowledge and set realistic expectations of surgery [55, 56]. "
    [Show abstract] [Hide abstract] ABSTRACT: Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient’s perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity.
    Full-text · Article · Apr 2016
    • "There is dear and convincing evidence that racial and ethnic differences both in access to health care and health care outcomes are consistently present across a wide range of illnesses [4,[6][7][8][9]15,17,30,33,[37][38][39]. Furthermore, these differences have been documented even after statistically correcting for variables such as insurance status, income, age, co-morbid conditions, and clinical presentation. "
    [Show abstract] [Hide abstract] ABSTRACT: To compare the prevalence of pressure ulcer (PU) and barriers to treatment in the event of PU development as a function of race-ethnicity in persons with spinal cord injury (SCI). Interview data were collected from three rehabilitation hospitals each of which was designated as a model SCI system of care by the United States Department of Education. There were 475 participants with similar portions of each racial-ethnic group (African-American n = 121, American-Indian n = 105, Caucasians n = 127, Hispanics n = 122). The lowest prevalence rates for pressure ulcers were reported by Hispanics followed by Caucasians. Logistic regression revealed racial-ethnic differences in the odds of developing a PU within the past 12 months. Social support and injury severity were also associated with risk of PU while age, gender, years since injury, and education were not. Significant racial-ethnic differences were also observed in 5 of 9 barriers to the treatment of PUs. Results suggest that variability in social support and barriers to treatment may contribute to the racial-ethnic differences in prevalence rates for PU that were observed. Future research in this area could lead to the development of strategies to enhance prevention and treatment targeted at the elimination of any racial-ethnic disparities.
    Article · Feb 2009
  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate sociodemographic influences on utilization and outcomes of endovascular abdominal aortic repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA). Secondary data analysis of the State Inpatient Databases for New Jersey. Between 2001 and 2006, a total of 6227 adult subjects (mean [SD] age, 73.3 [8.3] years; 77.6% male) underwent AAA repair (3167 EVAR and 3060 open surgery [OS]). Patients receiving EVAR were older than those undergoing OS (mean [SD] age, 74.2 [8.0] vs 72.4 [8.6] years) (P < .001). Men were 1.60 (95% confidence interval [CI], 1.39-1.77) times more likely to receive EVAR than women. White subjects had the same odds of undergoing EVAR as black subjects, and white subjects had 1.60 (95% CI, 1.29-2.06) times higher odds of receiving EVAR than Hispanics. Subjects with Medicare coverage were 3.90 (96% CI, 2.28-6.59) times more likely to receive EVAR than uninsured subjects. Logistic regression analysis demonstrated that older age, male sex, and Medicare coverage were significantly associated with increased utilization of EVAR and that uninsured subjects and Hispanics are less likely to receive EVAR. Octogenarians and black subjects (odds ratios: 3.69 CI: 2.31-5.91, and 2.59 CI: 1.47-4.54 respectively) had significantly greater likelihood of death after elective AAA repair. For AAA repair, significant sociodemographic disparities exist in the use of endovascular technology and in mortality. The risk of death after elective AAA repair was significantly greater for black subjects. Further analysis is warranted to delineate inequalities of vascular care for AAA and to assist in formulating policy to address these disparities.
    Full-text · Article · Aug 2008
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