title: Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors.
abstract: BACKGROUND
  There is a marked difference between black patients and white patients in the utilization of joint replacement therapy. The reasons behind this disparity remain unknown.
  
  
  OBJECTIVE
  To examine how black and white potential candidates for joint replacement compare with respect to their overall familiarity with joint replacement as an option, as well as their perceptions of the risks/benefits of this procedure.
  
  
  METHODS
  Cross-sectional survey of 596 elderly patients with symptomatic osteoarthritis of the knee or hip or both attending primary care clinics at Cleveland VAMC.
  
  
  RESULTS
  Black (44%) and white (56%) patients in this cohort were comparable with respect to age and clinical factors. However, black patients were less likely to be employed (8% vs. 15%, P = 0.017) or to be married (39% vs. 56%, P = 0.000), but more likely to report an annual household income of less than $10,000 (41% vs. 20%, P = 0.000) and less than high school education (43% vs. 29%, P = 0.001). Black patients were less likely than white patients to have had family or friends who had had joint replacement (OR, 0.39 [0.26-0.61]), or to report a good understanding of joint replacement as a form of treatment (OR, 0.62 [0.42-0.92]). They were more likely than white patients to expect longer hospital course (OR, 4.09 [2.57-6.54]), moderate to extreme pain (OR, 2.61 [1.74-3.89]), and moderate to extreme difficulty walking after replacement surgery (OR, 2.76 [1.83-4.16]).
  
  
  CONCLUSIONS
  Black patients were less likely than white patients to be familiar with joint replacement surgery and more likely to express concerns about postsurgical pain and difficulty walking.
authors.affiliation: Louis Stokes Department of VAMC, University Hospitals of Cleveland, Ohio, USA. Said.Ibrahim2@med.va.gov
authors.forename: Said A
authors.initials: SA
authors.lastname: Ibrahim
authors.forename: Laura A
authors.initials: LA
authors.lastname: Siminoff
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Burant
authors.forename: C Kent
authors.initials: CK
authors.lastname: Kwoh
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D010003:Osteoarthritis / Q000601:surgery*; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D014728:Veterans / Q000145:classification / Q000523:psychology* / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data