title: Racial differences in expectations of joint replacement surgery outcomes.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Philadelphia VAMC, Philadelphia, PA 19104-4155, USA. peter.groeneveld@va.gov
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld
authors.forename: C Kent
authors.initials: CK
authors.lastname: Kwoh
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.forename: Cathleen J
authors.initials: CJ
authors.lastname: Appelt
authors.forename: Ming
authors.initials: M
authors.lastname: Geng
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Gutierrez
authors.forename: Damaris S
authors.initials: DS
authors.lastname: Wessel
authors.forename: Said A
authors.initials: SA
authors.lastname: Ibrahim
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000208:ethnology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000208:ethnology* / Q000601:surgery; D010342:Patient Acceptance of Health Care; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology*