title: Racial disparities in joint replacement use among older adults.
abstract: BACKGROUND
  Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.
  
  
  OBJECTIVE
  This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.
  
  
  METHODS
  Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.
  
  
  METHODS
  National probability sample of US community-dwelling older adults.
  
  
  METHODS
  AHEAD participants (n = 6159) aged 69 to 103 years.
  
  
  METHODS
  The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).
  
  
  RESULTS
  Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).
  
  
  CONCLUSIONS
  These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.
authors.affiliation: Institute for Health Services Research and Policy Studies, the Femberg School of Medicine, Northwestern University, Chicago, Illinois 60208, USA. ddunlop@northwestern.edu
authors.forename: Dorothy D
authors.initials: DD
authors.lastname: Dunlop
authors.forename: Jing
authors.initials: J
authors.lastname: Song
authors.forename: Larry M
authors.initials: LM
authors.lastname: Manheim
authors.forename: Rowland W
authors.initials: RW
authors.lastname: Chang
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D010003:Osteoarthritis / Q000453:epidemiology / Q000601:surgery; D012494:Sampling Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data*