Open AccessRacial differences in expectations of joint replacement surgery outcomes
Author(s) -
Groeneveld Peter W.,
Kwoh C. Kent,
Mor Maria K.,
Appelt Cathleen J.,
Geng Ming,
Gutierrez Jennifer C.,
Wessel Damaris S.,
Ibrahim Said A.
Publication year - 2008
Publication title -
arthritis care & research
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.23565
Subject(s) - medicine , socioeconomic status , physical therapy , confidence interval , veterans affairs , demography , osteoarthritis , joint replacement , arthroplasty , surgery , population , alternative medicine , environmental health , pathology , sociology
Abstract Objective 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. Methods 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. Results 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. Conclusion 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.