title: Disparity in total hip replacement affecting Hispanic Medicare beneficiaries.
abstract: OBJECTIVE
  To compare the utilization of total hip replacement (THR) between Hispanic persons and non-Hispanic persons in a sample with health insurance.
  
  
  METHODS
  Case-control study using Medicare claims data.
  
  
  METHODS
  The cases were Medicare beneficiaries from Arizona, Illinois, New Mexico, or Texas who underwent a primary THR. The controls were Medicare beneficiaries who did not receive a THR, matched by age, sex, and county of residence.
  
  
  METHODS
  Beneficiary surnames and the race indicator in Medicare records were used to classify beneficiaries' probability of being Hispanic. Conditional logistic regression was used to estimate the odds of receiving of THR, adjusting for Medicaid eligibility.
  
  
  RESULTS
  Six thousand four hundred thirty-seven recipients of a primary THR were matched to 12,874 controls. According to the Medicare race indicator, 1% of recipients of THR and 3.3% of controls were Hispanic (P < or =0.001). The odds of THR decreased as the probability of Hispanic ethnicity increased, from an odds ratio (OR) of 1.00 among beneficiaries with non-Hispanic surnames, to an OR of 0.36 among those with heavily Hispanic surnames (95% CI, 0.31, 0.43). Poverty, as reflected by eligibility for Medicaid, did not modify the low odds of THR among Hispanic persons (OR, 0.25 among Medicaid-eligible Hispanic persons; 95% CI, 0.19, 0.33; and OR, 0.30 among Hispanic persons not Medicaid eligible; 95% CI, 0.24, 0.38).
  
  
  CONCLUSIONS
  Hispanic persons with Medicare receive THR at lower rates than do non-Hispanic persons. Because Medicare covers THR, our findings suggest that under utilization of THR by Hispanic persons cannot be attributed to lack of health insurance alone.
authors.affiliation: Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Texas Health Science Center at San Antonio, 78229, USA. escalante@uthscsa.edu
authors.forename: Agustín
authors.initials: A
authors.lastname: Escalante
authors.forename: Jane
authors.initials: J
authors.lastname: Barrett
authors.forename: Inmaculada
authors.initials: I
authors.lastname: del Rincón
authors.forename: John E
authors.initials: JE
authors.lastname: Cornell
authors.forename: Charlotte B
authors.initials: CB
authors.lastname: Phillips
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010003:Osteoarthritis / Q000453:epidemiology / Q000601:surgery; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology