Racial, ethnic disparities found in imaging, treatment of hip, knee OA
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Results showed African American, Asian and Hispanic patients with hip and knee osteoarthritis had significant disparities in the utilization of imaging, administration of injections and total joint arthroplasty compared with white patients.
Mark Wu, MD, current resident at Duke University, and colleagues collected age, sex, race/ethnicity, insurance status, geographic location and income of patients 40 years of age or older diagnosed with hip or knee osteoarthritis from 2013 to 2021. Researchers identified patients who underwent an X-ray, MRI or CT scan, injection and primary total joint arthroplasty.
“Of note, we had five distinct racial or ethnic groups. These included non-Hispanic whites, non-Hispanic Black patients, Asians, Hispanics and Native Americans, and this was based off of prior literature,” Wu said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
After adjusting for baseline demographic factors, multivariate logistic regression analyses showed Asian patients had a significantly decreased odds of undergoing hip X-ray, as well as knee injection, compared with white patients. Wu noted African American patients had significantly decreased odds of undergoing a knee MRI and knee X-ray compared with white patients. However, he added there were no significant associations between race and hip injections.
“For total hip arthroplasty, we found that African American, Hispanic and Asian patients all had significant decreased odds of undergoing a total hip compared to Caucasians and we found similar findings for total knee arthroplasty,” Wu said.
Patients in higher income quartiles were more like to receive an MRI, according to Wu. Compared with women, men were less likely to receive an injection but more likely to undergo TJA. Wu also noted patients with Medicaid or self-paid insurance were less likely to undergo TJA.
“In the future, it’d be great to look at some race- and ethnicity-specific studies analyzing patient- and provider-level barriers and facilitators to osteoarthritis-related care and then, using this knowledge, come up with real interventions to improve the equity and care that we provide,” Wu said.
Perspective
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Unconscious bias is being addressed more frequently. Mark Wu, MD, and colleagues have presented interesting data that stimulate further discussion. They presented a retrospective study over a period of 8 years with over 140,000 patients enrolled, of which 70% were white, 25.8% were African American, 2% were Hispanic, 1.5% Asian and 0.6% were Native American. The percentages of non-white patients are relatively small. However, even after the authors adjusted for sociodemographic factors, non-white patients were less likely to have advanced imaging studies or undergo arthroplasty. The factors for these disparities are likely multifactorial. Everyone holds unconscious biases. In addition, patients may have preconceived notions and not want to seek interventions in orthopedic care. They may be hesitant to speak up and advocate strongly for themselves. This may require the orthopedic surgeon/team to be proactive in gauging patients’ needs.
This study highlights that, regardless of reasons, there are disparities in the delivery of care to total joint-eligible patients that may have some basis in race. Awareness is critical for us to dedicate ourselves in addressing patients’ needs and making them feel comfortable in pursuing necessary joint replacement.
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Wu M, et al. Paper 12. Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 11-14, 2021; Dallas (hybrid meeting).
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