title: Racial and Ethnic Differences in Total Knee Arthroplasty in the Veterans Affairs Health Care System, 2001-2013.
abstract: To examine black-white and Hispanic-white differences in total knee arthroplasty from 2001 to 2013 in a large cohort of patients diagnosed with osteoarthritis (OA) in the Veterans Affairs (VA) health care system.
  
  
  
  Data were from the VA Musculoskeletal Disorders cohort, which includes data from electronic health records of more than 5.4 million veterans with musculoskeletal disorders diagnoses. We included white (non-Hispanic), black (non-Hispanic), and Hispanic (any race) veterans, age ≥50 years, with an OA diagnosis from 2001-2011 (n = 539,841). Veterans were followed from their first OA diagnosis until September 30, 2013. As a proxy for increased clinical severity, analyses were also conducted for a subsample restricted to those who saw an orthopedic or rheumatology specialist (n = 148,844). We used Cox proportional hazards regression to examine racial and ethnic differences in total knee arthroplasty by year of OA diagnosis, adjusting for age, sex, body mass index, physical and mental diagnoses, and pain intensity scores.
  
  
  
  We identified 12,087 total knee arthroplasty procedures in a sample of 473,170 white, 50,172 black, and 16,499 Hispanic veterans. In adjusted models examining black-white and Hispanic-white differences by year of OA diagnosis, total knee arthroplasty rates were lower for black than for white veterans diagnosed in all but 2 years. There were no Hispanic-white differences regardless of when diagnosis occurred. These patterns held in the specialty clinic subsample.
  
  
  
  Black-white differences in total knee arthroplasty appear to be persistent in the VA, even after controlling for potential clinical confounders.
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, and University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Leslie R M
authors: LRM
authors: Hausmann
authors: VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Medicine, New Haven, Connecticut.
authors: Cynthia A
authors: CA
authors: Brandt
authors: Yale School of Medicine, New Haven, Connecticut.
authors: Constance M
authors: CM
authors: Carroll
authors: VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Public Health, New Haven, Connecticut.
authors: Brenda T
authors: BT
authors: Fenton
authors: Corporal Michael J. Crescenz VA Medical Center, Center for Health Equity Research and Promotion, and University of Pennsylvania, Philadelphia.
authors: Said A
authors: SA
authors: Ibrahim
authors: VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Medicine, New Haven, Connecticut.
authors: William C
authors: WC
authors: Becker
authors: Minneapolis VA Healthcare System, Center for Chronic Disease Outcomes Research and University of Minnesota, Minneapolis.
authors: Diana J
authors: DJ
authors: Burgess
authors: Walter Reed National Military Medical Center, Bethesda, Maryland.
authors: Laura D
authors: LD
authors: Wandner
authors: Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis.
authors: Matthew J
authors: MJ
authors: Bair
authors: VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Medicine, New Haven, Connecticut.
authors: Joseph L
authors: JL
authors: Goulet
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000639:trends*; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D057286:Electronic Health Records / Q000639:trends; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000208:ethnology; D014481:United States / Q000208:ethnology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans; D044465:White People / Q000208:ethnology*; D001741:Black or African American