title: Ethnic Barriers to Utilization of Total Joint Arthroplasty Among Chinese Immigrants in the United States.
abstract: Previous studies have documented disparities in total joint arthroplasty (TJA) utilization among African American and Hispanic patients, but utilization among non-English-speaking Chinese patients in the United States has not been studied.
  
  
  
  To quantify the utilization rate and detect ethnic factors effecting TJA utilization in non-English-speaking Chinese patients, data were gathered prospectively from the practice of a single fellowship-trained Caucasian surgeon from October 2012 to February 2013. A customized survey was drafted and validated in collaboration with a social scientist. Questions assessed demography, lifestyle factors, socioeconomic status, language skills, cultural beliefs, and prior experience with surgery. Surveys were administered in patients' native language and were collected in a blinded fashion.
  
  
  
  Overall, 269 patients were surveyed (157 Caucasian and 65 Chinese), 85 of which were recommended surgery (42 Caucasian and 26 Chinese). Seventy-six percent of Caucasian patients elected surgery, compared to 35% of Chinese patients. A multivariate logistic regression showed Chinese ethnicity to be a significant predictor of surgical decision after controlling for age, gender, socioeconomic status, and education. Several questions drafted to detect cultural differences in the aforementioned 6 categories were answered significantly differently (P < .05, chi-square).
  
  
  
  Language, lack of familiarity with surgery, lack of TJA knowledge, family members' role in decision making, and preference for a doctor of the same race may contribute to decreased utilization of TJA in this population. We believe a better understanding of the cultural beliefs and behaviors of Chinese patients will help physicians provide more optimal care to this patient population.
authors.affiliation: Class of 2018, Albany Medical College, Albany, New York.
authors.forename: Maxwell C
authors.initials: MC
authors.lastname: Alley
authors.affiliation: Class of 2018, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Mason
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: David J
authors.initials: DJ
authors.lastname: Tybor
authors.affiliation: Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Pevear
authors.affiliation: Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Baratz
authors.affiliation: Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D044466:Asian People / Q000706:statistics & numerical data*; D003657:Decision Making; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010820:Physicians; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
keywords: Chinese; cultural; ethnic barriers; health disparities; total joint arthroplasty; utilization