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Donnelly KM, Theriot HG, Bourgeois JP, Chapple AG, Krause PC, Dasa V. Lack of Demographic Information in Total Hip Arthroplasty/Total Knee Arthroplasty Randomized Controlled Trial Publications. J Arthroplasty 2023; 38:573-577. [PMID: 36257508 DOI: 10.1016/j.arth.2022.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The impact of social determinants of health (SDOH) has been documented in orthopaedic literature. However, there is a lack of data on the inclusion of these variables in orthopaedic studies. Our aim was to investigate how many total hip arthroplasties and total knee arthroplasties randomized controlled trials report SDOH variables such as race, ethnicity, insurance, income, and education within the manuscript. METHODS A systematic review was conducted on a PubMed search for randomized controlled trials published from 2017 to 2019 in the Journal of Bone and Joint Surgery, Journal of Arthroplasty, Clinical Orthopaedics and Related Research, and Osteoarthritis and Cartilage. Data collected included publication year, type of surgery, and the inclusion of race, ethnicity, insurance, income, and education. RESULTS Of the 72 manuscripts included in the study, 5.6% of the manuscripts mentioned race, 4.2% included race within the demographic table, and 1.4% included ethnicity in the demographic table. Overall, only 5 studies discussed any one of the variables studied and none included any SDOH variables in their multivariable regressions. There were no statistically significant differences on inclusion across journal year (P value = .78), journal name (P value = 1.00), or surgery type (P value = .555). CONCLUSION Our findings identify a major shortcoming in the inclusion of SDOH variables in total knee arthroplasty/total hip arthroplasty publications. Their exclusion may be indirectly perpetuating disparities if research that does not use representative patient samples is used in creating health policies and national standards. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | | | | | - Andrew G Chapple
- Biostatistics Program, School of Public Health, LSUHSC, New Orleans, Louisiana; Department of Orthopaedics, LSUHSC, New Orleans, Louisiana
| | - Peter C Krause
- Department of Orthopaedics, LSUHSC, New Orleans, Louisiana
| | - Vinod Dasa
- Department of Orthopaedics, LSUHSC, New Orleans, Louisiana
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MacFarlane LA, Kim E, Cook N, Lee IM, Iversen MD, Katz JN, Costenbader KH. Racial Variation in Total Knee Replacement in a Diverse Nationwide Clinical Trial. J Clin Rheumatol 2018; 24:1-5. [PMID: 29232323 PMCID: PMC5741516 DOI: 10.1097/rhu.0000000000000613] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Racial variation in total knee replacement (TKR) utilization in the United States has been reported in administrative database studies. We investigated racial variation in TKR procedures in a diverse cohort with severe knee pain followed in an ongoing clinical trial. METHODS VITAL (VITamin D and OmegA-3 TriaL) is a nationwide, randomized controlled trial of 25,874 adults, 20% of whom are black. We identified a subgroup highly likely to have knee osteoarthritis based on severity of knee pain, physician-diagnosed knee osteoarthritis, and inability to walk 2 to 3 blocks without pain. Participants completed a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and self-reported incident TKR annually in follow-up. Using Cox regression, we analyzed the association of black versus white race with TKR, adjusting for demographic and socioeconomic characteristics, comorbidities, and WOMAC pain and function. RESULTS Among 1070 participants who met the inclusion criteria, black participants reported worse baseline WOMAC pain (45 vs. 32, P < 0.001) and worse function (45 vs. 32, P < 0.001). During a median of 3.6 years (interquartile range, 3.2, 3.8 years) of follow-up, TKRs were reported by 180 participants. Black participants were less likely to undergo TKR (11% vs. 19%). After adjustment, the hazard ratio for TKR for black versus white participants was 0.51 (95% confidence interval, 0.32-0.81). Lower use of TKR among black participants was observed across all levels of income and education. CONCLUSIONS Despite worse baseline knee pain and function, black participants had much lower adjusted risk of having TKR than white participants, demonstrating persistent racial disparity in TKR utilization.
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Affiliation(s)
- Lindsey A. MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
| | - Eunjung Kim
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Nancy Cook
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Maura D Iversen
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Karen H. Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Shahid H, Singh JA. Racial/Ethnic Disparity in Rates and Outcomes of Total Joint Arthroplasty. Curr Rheumatol Rep 2016; 18:20. [PMID: 26984804 DOI: 10.1007/s11926-016-0570-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient's perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity.
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Affiliation(s)
- Hania Shahid
- Department of Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan.,Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jasvinder A Singh
- Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Merry B, Campbell CM, Buenaver LF, McGuire L, Haythornthwaite JA, Doleys DM, Edwards RR. Ethnic Group Differences in the Outcomes of Multidisciplinary Pain Treatment. ACTA ACUST UNITED AC 2010; 19:24-30. [PMID: 21731407 DOI: 10.3109/10582452.2010.538821] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES: The aim of this prospective investigation was to evaluate ethnic group differences in pain-related outcomes following multidisciplinary chronic pain treatment. A prospective pre- and post-treatment assessment design was employed to investigate the effects of ethnicity on changes in pain-related variables following completion of a multidisciplinary pain treatment program. METHODS: One hundred fifty five chronic pain patients participating in a multidisciplinary pain treatment program completed measures of pain and mood both prior to and following the four-week treatment. Primary outcome variables included pain severity, pain-related interference, and depressive symptoms. RESULTS: Baseline differences between African-Americans and Whites were observed for depressive symptoms, but not for pain severity or pain-related interference. Following multidisciplinary pain treatment, both White and African-American patients displayed post-treatment reductions in depressive symptoms and pain-related interference. However, White patients also reported reduced pain severity while African-Americans did not. CONCLUSIONS: The treatment approach used in the present study appeared to be less effective in reducing self-reported pain severity in African-American versus White patients, though both groups benefited in terms of reduced depressive symptoms and pain-related interference. Moreover, the observation that improvements in functioning occurred without reductions in pain severity in African-American patients suggests that differences may exist in treatment processes as a function of ethnic group, and will consequently be an important area for future research.
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Affiliation(s)
- Brian Merry
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine
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Huddleston JI, Maloney WJ, Wang Y, Verzier N, Hunt DR, Herndon JH. Adverse events after total knee arthroplasty: a national Medicare study. J Arthroplasty 2009; 24:95-100. [PMID: 19577884 DOI: 10.1016/j.arth.2009.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/05/2009] [Indexed: 02/01/2023] Open
Abstract
Adverse events from 2033 total knee arthroplasty patients were documented by nonphysician abstractors. The annual rate of adverse events from 2002 to 2004 was 9.2%, 6.4%, and 5.8%, respectively. Congestive heart failure (odds ratio, 2.1; 95% confidence interval, 1.2-3.5; P < .01) and chronic obstructive pulmonary disease (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) were associated with a significantly increased risk of experiencing any adverse event during the index hospitalization. The 30-day postprocedure rate of readmission for all causes was 5.5%. Experiencing an adverse event during the index hospitalization increased the length of stay (P < .001). The rate of symptomatic venous thromboembolism 30 days postprocedure was 1.7%. The 30-day postprocedure mortality rate was 0.3%. Experiencing any adverse event was associated with an increased 30-day postprocedure mortality (P < .001). Compared with previous studies of Medicare claims, these data reveal a substantial decrease in the mortality rate, an increased readmission rate, and no substantial change in the rate of venous thromboembolism.
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Affiliation(s)
- James I Huddleston
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California 94305-5341, USA
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Daaleman TP, Williams CS, Preisser JS, Sloane PD, Biola H, Zimmerman S. Advance care planning in nursing homes and assisted living communities. J Am Med Dir Assoc 2009; 10:243-51. [PMID: 19426940 DOI: 10.1016/j.jamda.2008.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/27/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the prevalence and characteristics of advance care planning (ACP) among persons dying in long-term care (LTC) facilities, and to examine the relationship between respondent, facility, decedent, and family characteristics and ACP. DESIGN After-death interviews of family members of decedents and facility liaisons where decedents received care. SETTING Stratified sample of 164 residential care/assisted living facilities and nursing homes in Florida, Maryland, New Jersey, and North Carolina. SUBJECTS Family members and facility liaisons who gave 446 and 1014 reports, respectively, on 1015 decedent residents. MEASUREMENTS Reports of death/dying discussions, known treatment preferences, and reports and records of signed living wills (LW), health care powers of attorney (HCPOA), do-not-resuscitate orders, and do-not-hospitalize orders. RESULTS Family respondents reported a higher prevalence, compared with facility reports, of HCPOAs (92% versus 49%) and LWs (84% versus 43%). In family reports, non-white race and no private insurance were significantly associated with lower prevalence of LWs and HCPOAs; additionally, residing in nursing homes (versus assisted living facilities) and in North Carolina were associated with lower prevalence of reported LWs. In facility reports, non-white race, unexpected death, and residing in North Carolina or Maryland were significantly associated with lower prevalence of LWs, whereas high Medicaid case mix, intact cognitive status, and high family involvement were associated with lower prevalence of HCPOAs. Concordance of family and facility reporting of HCPOAs was significantly greater in facilities with fewer than 120 beds. CONCLUSIONS The prevalence of ACP in LTC is much higher than previously described, and there is marked variation in characteristics associated with ACP, despite moderately high concordance, when reported by the facility or family caregivers.
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Affiliation(s)
- Timothy P Daaleman
- Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7595, USA.
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Rowley DL, Jenkins BC, Frazier E. Utilization of joint arthroplasty: racial and ethnic disparities in the Veterans Affairs Health Care System. J Am Acad Orthop Surg 2007; 15 Suppl 1:S43-8. [PMID: 17766789 DOI: 10.5435/00124635-200700001-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Studies within the Veterans Administration health care system have been very useful in identifying the existence of racial and ethnic disparities with regard to patient utilization of hip and knee joint arthroplasty. Existing studies have focused on three factors: estimates of joint arthroplasty utilization,postoperative outcomes, and patient-related variables (eg, expectations of and familiarity with the procedure, religious beliefs). Although Veterans Administration-based studies have produced helpful data, these data are limited because the populations studied are not representative of the larger US population. Specifically, studies from the Veterans Administration health care system are composed of a predominantly male patient demographic;in addition, patients are more likely to have lower income and education levels than the US population as a whole.
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MESH Headings
- Arthroplasty, Replacement/mortality
- Arthroplasty, Replacement/statistics & numerical data
- Arthroplasty, Replacement, Hip/mortality
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/mortality
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Female
- Healthcare Disparities/statistics & numerical data
- Hospitalization/statistics & numerical data
- Hospitals, Veterans/statistics & numerical data
- Humans
- Male
- Minority Groups/statistics & numerical data
- Outcome Assessment, Health Care
- Quality of Life
- United States
- United States Department of Veterans Affairs/statistics & numerical data
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Affiliation(s)
- Diane L Rowley
- Research Center on Health Disparities, Morehouse College, Atlanta, GA, USA
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Sokka T, Kautiainen H, Hannonen P. Stable occurrence of knee and hip total joint replacement in Central Finland between 1986 and 2003: an indication of improved long-term outcomes of rheumatoid arthritis. Ann Rheum Dis 2006; 66:341-4. [PMID: 17068067 PMCID: PMC1855996 DOI: 10.1136/ard.2006.057067] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Total joint replacement (TJR) surgery is an important severe long-term outcome of rheumatoid arthritis, but relatively little is known about changes of its incidence in patients with rheumatoid arthritis over the past two decades. METHODS A population-based, retrospective, incidence case review was conducted to analyse the frequency of primary TJR surgery of the knee and hip in all patients, and specifically in patients with rheumatoid arthritis in Central Finland between 1986 and 2003. Patients with TJR surgery of the knee and hip were identified in hospital databases over the 18-year period. Age-standardised incidence rate ratios for the primary TJR of the knee and hip were calculated, stratified to sex and diagnosis, with 1986 as the reference value. RESULTS In patients without rheumatoid arthritis the age-adjusted incidence rate ratios (with 95% CI) for TJR of the knee increased 9.8-fold from 1986 to 2003 in women and men, and for TJR of the hip 1.8-fold in women and 2-fold in men. By contrast, no meaningful change was seen over this period, in age-adjusted incidence rate ratios for TJR of the knee or hip in patients with rheumatoid arthritis, ranging from 0.7 to 1.2 in 2003 compared with 1986. CONCLUSION The prevalence of TJR surgery has increased 2-10-fold in patients without rheumatoid arthritis patients, associated with an ageing population, but has not increased in patients with rheumatoid arthritis between 1986 and 2003. These data are consistent with emerging evidence that long-term outcomes of rheumatoid arthritis have improved substantially, even before the availability of biological agents.
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Affiliation(s)
- Tuulikki Sokka
- Jyväskylä Central Hospital, Arkisto/Tutkijat, Jyväskylä 40620, Finland.
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