National Meeting 2007

3032 — Racial Differences in Joint Replacement Expectations among Veterans with Osteoarthritis

Groeneveld PW (Philadelphia VAMC) , Kwoh CK (Pittsburgh VAHCS), Mor MK (Pittsburgh VAHCS), Geng M (Pittsburgh VAHCS), Appelt CJ (Pittsburgh VAHCS), Gutierrez JC (Philadelphia VAMC), Ibrahim SA (Pittsburgh VAHCS)

Objectives:
Black and white veterans with osteoarthritis (OA) undergo joint replacement surgery at different rates. Expectations of the outcomes of surgery are likely to influence the willingness of patients to undergo surgery. There are limited data, however, on whether blacks and whites differ in their expectations of joint replacement outcomes.

Methods:
We surveyed 939 veterans (459 blacks, 480 whites) ages 50-79 with OA receiving primary care in the Pittsburgh or Philadelphia VA Health Care Systems. All enrollees were potential candidates for joint replacement as indicated by the Western Ontario and McMaster Universities OA Index. The previously validated Hospital for Special Surgery Joint Replacement Expectations Survey (JRES) was used to assess patients’ expectations for pain relief, functional improvement, and psychological well-being after surgery. Regression models were fitted to assess the relationship between race and JRES score, adjusting for age, sex, income, education, employment, marital status, symptoms, functional status, and clinical site.

Results:
Among hip OA patients (n=296), unadjusted JRES scores among blacks (median=40, interquartile range [IQR]=30-50) were lower than whites’ scores (median=48, IQR=36-60, p<0.001). The adjusted mean score for blacks was 1.3 points lower than for whites (p=0.009), and blacks with hip OA were more likely than whites (adjusted odds ratio[OR] 1.19, p=0.03) to be in the lowest expectations quartile. Among knee OA patients (n=643), blacks’ unadjusted JRES scores (median=44, IQR=33-56) also were lower than scores for whites (median=49.5, IQR=37-63, p=0.002). The adjusted mean score for blacks was 0.8 points lower than for whites (p=0.03), but blacks with knee OA were not more likely to be in the lowest expectations quartile (p=0.41). Both hip JRES scores (OR for 1 point increase = 1.06, p<0.001) and knee JRES scores (OR for 1 point increase = 1.04, p<0.001) were strongly associated with patients’ willingness to undergo surgery.

Implications:
Among potential candidates for joint replacement, blacks have significantly lower expectations for the outcomes of surgery than whites. Furthermore, favorable expectations of surgical outcomes were highly correlated with increased willingness to consider joint replacement.

Impacts:
Educational interventions targeting patient expectations of surgical outcomes may help reduce racial disparity in the utilization of joint replacement for knee/hip OA.