Psychosocial

Abstract 1282: Racial Differences in Attitudes Toward Joint Replacement: the Health ABC Study

Background: Despite evidence that the prevalence of knee and hip OA is equal or perhaps greater among African-Americans (AA's) compared to whites, there are marked disparities in the frequency of total knee and hip replacement (TJR) between races. The reasons behind these disparities are unknown, however. Previous studies of men with OA suggested there may be race-related differences in willingness to consider undergoing TJR and outcome expectations.

Methods: The sample consisted of 586 elderly participants (60% women and 40% AA) with a mean age of 80 (± SD 2.8 years) in the Health ABC study who reported chronic knee or hip pain (i.e., on most days for at least one month in the past year) and had bilateral fixed-flexion knee or standing pelvis radiographs. Willingness to consider TJR was dichotomized (willing / not willing). Logistic regression analyses were performed initially adjusted for age, educational level, depressive symptoms (Center for Epidemiologic Studies -Depression scale) and disease severity (WOMAC), and then adjusted for JR outcome expectations

Results:

	Blacks	Whites
Willingness to consider surgery Males Females	38% 38%	57% 50%
Expectations after surgery
Prolonged hospitalization	22%	13%
Prolonged recovery	43%	20%
Moderate to severe pain	52%	42%
Moderate to severe walking difficulty	52%	44%
all p’s < .03

The adjusted odds ratio (OR) for willingness was 0.36 (95% CI 0.18 to 0.73) for AA men compared to white men and the adjusted OR was 0.60 (95% CI 0.38 to 0.95) for AA women compared to white women was. These differences persisted with further adjustment for racial differences in expectations of outcomes after TJR (adjusted OR = 0.35 (95% CI 0.17 to 0.72) for AA men compared to white men and adjusted OR=0.54 (95% CI 0.33 to 0.89) for AA women compared to white women.

Conclusion: This is the first study to investigate and demonstrate racial differences in TJR outcome expectations and willingness to consider JR in both AA men and women. AA’s were much less likely to consider TJR than whites, although racial differences in outcome expectations did not explain differences in willingness to undergo TJR.

Editorial: Minority groups are less likely to receive preventive, diagnostic, and medical or surgical interventions. Reasons for disparities remain largely unknown. Recently, investigators have focused on whether patient attitudes and beliefs differ by race and potentially contribute to differences in procedure rates. The current data suggest that racial differences in the outcomes expectations that were queried did not account for differences in willingness to have surgery, which at first glance seems contrary to expectations.

Why would more negative beliefs in AA not be play a significant role in their willingness to undergo surgery? There are likely to be many reasons for this. For instance, 80 year old black participants have had different life experience from 80 year old whites. Study eligibility may have also played an important role. The Health, Aging and Body Composition (Health ABC) study was a longitudinal cohort study of 3075 well-functioning older black and white men and women. Participants were identified from a random sample of white Medicare beneficiaries and all age-eligible community-dwelling black residents in certain ZIP codes of Memphis TN and Pittsburgh, PA. It is likely that 80 year old black participants had different life experiences from 80 year old whites. Also, participants were eligible if they reported no difficulty in either walking one quarter of a mile, going up 10 steps without resting, or performing any basic activity of daily living. Many participants may not have experienced knee or hip pain severe enough to warrant considering surgery, in which case outcomes expectancies would not be related to willingness. Finally, it may be that there are other expectations that were not assessed are more central to willingness to have TJR. Nevertheless, these data suggest that older African Americans tend to hold more negative personal health beliefs about TJR which can potentially be addressed through patient education and discussions to elicit individual concerns.

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.