Abstract 741: Racial/ Ethnic Disparities in Unmet Social support Need among Total Knee Replacement Candidates
Authors
M Huisingh-Scheetz, RW Chang, D Dunlop, A Chung, HJ Chang.
Background
Health services research indicates that racial/ ethnic differences in utilization of surgical procedures occur in the United States, including joint replacement surgery. The reasons which account for these observed differences in surgical utilization are however unclear. The authors examined whether differences in unmet social support might explain part of this observation.
Methods
The authors examined baseline data from a prospective cohort comprised of 193 non-Hispanic white and 185 non-Hispanic black candidates who were referred for total knee replacement surgery. The authors next collected information regarding four dimension of social support. These included financial, tangible, informational and emotional parameters. The primary outcome of interest was “unmet social support”, defined as a participant who expressed need for a specific type of social support within the preceding 30 day period, but who did not receive the needed support. Using this prospective cohort and these measures of social support, the author undertook an analysis to evaluate whether unmet need differed by racial/ethnic groups.
Results
Overall, 20% of the participants conveyed that they experienced at least one unmet dimension of social support. While the frequency of an unmet social support dimension was greater in the black compared to the white study participants, in adjusted analyses the one dimension of unmet social support that was statistically significantly different between the two groups, in being more prevalent among the blacks than in the white participants, was financial support [odds ratio 3.1; 95% confidence interval 1.1 – 8.6]. These results were adjusted for age, gender, martial status, education, income and measures of depression and functional status.
Conclusions
The authors conclude that unmet social support, particularly as applied to finances, are greater among black than white patients referred for knee replacement surgery. They further advocate that additional research, including of larger sample size, ought to further address how such unmet social need might influence the decision to pursue versus to defer joint replacement surgery.
Editorial Comment
Whereas racial and ethnic differences have been previously studied in fields outside arthritis and musculoskeletal disorders, such as open heart bypass surgery, there is increasing interest in such health services research as applied to knee and hip replacement. Given the observation that such differences in arthroplasty rates do in fact existent, it is of much interest to understand why. Given how successful and life-changing joint replacement is for the patient with advanced osteoarthritis of a lower extremity joint (e.g. hip, knee), it ought be a societal priority to eradicate any barriers to equal delivery of such surgical care to all racial and ethnic groups. It would also be o f interest to follow a large cohort of patients referred for replacement surgery, and to assess over time if outcomes following surgery vary by race in addition to age and gender groups.
