title: Gender Disparities in Osteoarthritis-Related Health Care Utilization Before Total Knee Arthroplasty.
abstract: Women older than 50 years have higher prevalence of knee osteoarthritis (OA) and experience greater functional disability than men. No studies have examined large populations to identify knee OA-related health care utilization differences. The purpose of this investigation was to evaluate gender differences in the utilization of OA-related health care resources in the 12 months preceding total knee arthroplasty (TKA).
  
  
  
  Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefit databases were reviewed from 2005 to 2012. Subjects were included if they underwent TKA, had associated diagnosis of lower leg OA, and were continuously in the database for 12 months preceding TKA. Patient-specific OA-related health care utilization was identified. Multivariate logistic regression analysis controlling for age, region, and Charlson Comorbidity Index was performed to isolate the influence of gender.
  
  
  
  A total of 244,059 patients with a mean age of 64.8 years consisting of 61.2% women were included. Multivariate logistic regression adjusted odds ratios showed that when compared to men, women were 30%, 20%, 31%, 18%, 19%, 29%, and 39%, more likely to receive a narcotic analgesic, nonnarcotic analgesics, corticosteroid injection, hyaluronic acid injection, knee magnetic resonance imaging, a physical therapy evaluation, and occupational therapy evaluation in the 12 months preceding TKA, respectively.
  
  
  
  Women have a significantly higher utilization of knee OA-related health care in the 12 months preceding TKA. Although the precise cause for this discrepancy in care cannot be determined from this study, it highlights a potential bias in management of advanced knee OA and directions for further investigation.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine Division of Biological Sciences, Chicago, Illinois.
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Bawa
authors.affiliation: Pritzker School of Medicine, University of Chicago Division of Biological Sciences, Chicago, Illinois.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Weick
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine Division of Biological Sciences, Chicago, Illinois.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Dirschl
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D008297:Male; D006278:Medicare; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States
chemical_list: D006820:Hyaluronic Acid
keywords: gender differences; health care utilization; intra-articular corticosteroid injection; intra-articular hyaluronic acid injection; total knee arthroplasty