Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty

Wei Zhang, Stephen Lyman, Carla Boutin-Foster, Michael L. Parks, Ting Jung Pan, Alexis Lan, Yan Ma

研究成果: ジャーナルへの寄稿記事

32 引用 (Scopus)

抄録

Background: Previous studies of racial disparities in total joint replacement, particularly total knee arthroplasty, in the U.S. have predominantly focused on disparities between blacks and whites and were limited to Medicare patients or veterans, populations that are not representative of the entire U.S. population. We sought to study racial disparities in the utilization of total knee arthroplasty, the use of high-volume hospitals, and total knee arthroplasty outcomes, including mortality and complications, using all-payer databases. Methods: We analyzed data from 8 years and 8 racially diverse states in the State Inpatient Databases (SID). Patient race was categorized according to the SID as white, black, Hispanic, Asian, Native American, and mixed race. Both crude and adjusted racial and/or ethnic disparities were evaluated. Results: In comparison with whites (4.65 per 1000 population per year), black (3.90), Hispanic (3.71), Asian (3.89), Native American (4.40), and mixed-race (3.69) populations had lower rates of total knee arthroplasty utilization (p < 0.0001). After risk adjustment, the rate of total knee arthroplasty utilization was significantly lower for blacks (odds ratio [OR] = 0.87 [95% confidence interval (CI), 0.85 to 0.89]; p < 0.0001), Hispanics (OR = 0.76 [95% CI, 0.68 to 0.83]; p < 0.0001), Asians (OR = 0.83 [95%CI, 0.78 to 0.89]; p < 0.0001), Native Americans (OR = 0.87 [95%CI, 0.81 to 0.93]; p < 0.0001), and mixed race (OR = 0.84 [95% CI, 0.79 to 0.90]; p < 0.0001) compared with the rate for whites. Lower rates of total knee arthroplasty utilization for blacks, Hispanics, and mixed-race groups becameworse over the years. Patients fromminority groups were less likely to undergo total knee arthroplasty in high-volume hospitals than were whites. Moreover, the rates of mortality were significantly higher for blacks (OR = 1.52 [95% CI, 1.17 to 1.97]; p = 0.0017), Native Americans (OR = 6.52 [95% CI, 4.63 to 9.17]; p < 0.0001), and mixed-race patients (OR = 4.35 [95% CI, 3.24 to 5.84]; p < 0.0001). Blacks (OR = 1.08 [95% CI, 1.01 to 1.15]; p = 0.01) and mixed-race patients (OR = 1.17 [95% CI, 1.001 to 1.36]; p = 0.04) had higher rates of complications than whites. Conclusions: Minorities had lower rates of total knee arthroplasty utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics. Utilization rates were based on overall population as the proportion of the population with osteoarthritis requiring arthroplasty is unknown. Future studies that consider specific patient-level information with psychosocial and behavioral factors are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

元の言語英語
ページ(範囲)1243-1252
ページ数10
ジャーナルJournal of Bone and Joint Surgery - American Volume
98
発行部数15
DOI
出版物ステータス出版済み - 1 1 2016

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Knee Replacement Arthroplasties
Odds Ratio
Confidence Intervals
North American Indians
Hispanic Americans
High-Volume Hospitals
Population
Databases
Inpatients
Replacement Arthroplasties
Risk Adjustment
Asian Americans
Mortality
Veterans
Medicare
Osteoarthritis
Arthroplasty
Psychology
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

これを引用

Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. / Zhang, Wei; Lyman, Stephen; Boutin-Foster, Carla; Parks, Michael L.; Pan, Ting Jung; Lan, Alexis; Ma, Yan.

:: Journal of Bone and Joint Surgery - American Volume, 巻 98, 番号 15, 01.01.2016, p. 1243-1252.

研究成果: ジャーナルへの寄稿記事

Zhang, Wei ; Lyman, Stephen ; Boutin-Foster, Carla ; Parks, Michael L. ; Pan, Ting Jung ; Lan, Alexis ; Ma, Yan. / Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. :: Journal of Bone and Joint Surgery - American Volume. 2016 ; 巻 98, 番号 15. pp. 1243-1252.
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title = "Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty",
abstract = "Background: Previous studies of racial disparities in total joint replacement, particularly total knee arthroplasty, in the U.S. have predominantly focused on disparities between blacks and whites and were limited to Medicare patients or veterans, populations that are not representative of the entire U.S. population. We sought to study racial disparities in the utilization of total knee arthroplasty, the use of high-volume hospitals, and total knee arthroplasty outcomes, including mortality and complications, using all-payer databases. Methods: We analyzed data from 8 years and 8 racially diverse states in the State Inpatient Databases (SID). Patient race was categorized according to the SID as white, black, Hispanic, Asian, Native American, and mixed race. Both crude and adjusted racial and/or ethnic disparities were evaluated. Results: In comparison with whites (4.65 per 1000 population per year), black (3.90), Hispanic (3.71), Asian (3.89), Native American (4.40), and mixed-race (3.69) populations had lower rates of total knee arthroplasty utilization (p < 0.0001). After risk adjustment, the rate of total knee arthroplasty utilization was significantly lower for blacks (odds ratio [OR] = 0.87 [95{\%} confidence interval (CI), 0.85 to 0.89]; p < 0.0001), Hispanics (OR = 0.76 [95{\%} CI, 0.68 to 0.83]; p < 0.0001), Asians (OR = 0.83 [95{\%}CI, 0.78 to 0.89]; p < 0.0001), Native Americans (OR = 0.87 [95{\%}CI, 0.81 to 0.93]; p < 0.0001), and mixed race (OR = 0.84 [95{\%} CI, 0.79 to 0.90]; p < 0.0001) compared with the rate for whites. Lower rates of total knee arthroplasty utilization for blacks, Hispanics, and mixed-race groups becameworse over the years. Patients fromminority groups were less likely to undergo total knee arthroplasty in high-volume hospitals than were whites. Moreover, the rates of mortality were significantly higher for blacks (OR = 1.52 [95{\%} CI, 1.17 to 1.97]; p = 0.0017), Native Americans (OR = 6.52 [95{\%} CI, 4.63 to 9.17]; p < 0.0001), and mixed-race patients (OR = 4.35 [95{\%} CI, 3.24 to 5.84]; p < 0.0001). Blacks (OR = 1.08 [95{\%} CI, 1.01 to 1.15]; p = 0.01) and mixed-race patients (OR = 1.17 [95{\%} CI, 1.001 to 1.36]; p = 0.04) had higher rates of complications than whites. Conclusions: Minorities had lower rates of total knee arthroplasty utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics. Utilization rates were based on overall population as the proportion of the population with osteoarthritis requiring arthroplasty is unknown. Future studies that consider specific patient-level information with psychosocial and behavioral factors are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.",
author = "Wei Zhang and Stephen Lyman and Carla Boutin-Foster and Parks, {Michael L.} and Pan, {Ting Jung} and Alexis Lan and Yan Ma",
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TY - JOUR

T1 - Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty

AU - Zhang, Wei

AU - Lyman, Stephen

AU - Boutin-Foster, Carla

AU - Parks, Michael L.

AU - Pan, Ting Jung

AU - Lan, Alexis

AU - Ma, Yan

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Previous studies of racial disparities in total joint replacement, particularly total knee arthroplasty, in the U.S. have predominantly focused on disparities between blacks and whites and were limited to Medicare patients or veterans, populations that are not representative of the entire U.S. population. We sought to study racial disparities in the utilization of total knee arthroplasty, the use of high-volume hospitals, and total knee arthroplasty outcomes, including mortality and complications, using all-payer databases. Methods: We analyzed data from 8 years and 8 racially diverse states in the State Inpatient Databases (SID). Patient race was categorized according to the SID as white, black, Hispanic, Asian, Native American, and mixed race. Both crude and adjusted racial and/or ethnic disparities were evaluated. Results: In comparison with whites (4.65 per 1000 population per year), black (3.90), Hispanic (3.71), Asian (3.89), Native American (4.40), and mixed-race (3.69) populations had lower rates of total knee arthroplasty utilization (p < 0.0001). After risk adjustment, the rate of total knee arthroplasty utilization was significantly lower for blacks (odds ratio [OR] = 0.87 [95% confidence interval (CI), 0.85 to 0.89]; p < 0.0001), Hispanics (OR = 0.76 [95% CI, 0.68 to 0.83]; p < 0.0001), Asians (OR = 0.83 [95%CI, 0.78 to 0.89]; p < 0.0001), Native Americans (OR = 0.87 [95%CI, 0.81 to 0.93]; p < 0.0001), and mixed race (OR = 0.84 [95% CI, 0.79 to 0.90]; p < 0.0001) compared with the rate for whites. Lower rates of total knee arthroplasty utilization for blacks, Hispanics, and mixed-race groups becameworse over the years. Patients fromminority groups were less likely to undergo total knee arthroplasty in high-volume hospitals than were whites. Moreover, the rates of mortality were significantly higher for blacks (OR = 1.52 [95% CI, 1.17 to 1.97]; p = 0.0017), Native Americans (OR = 6.52 [95% CI, 4.63 to 9.17]; p < 0.0001), and mixed-race patients (OR = 4.35 [95% CI, 3.24 to 5.84]; p < 0.0001). Blacks (OR = 1.08 [95% CI, 1.01 to 1.15]; p = 0.01) and mixed-race patients (OR = 1.17 [95% CI, 1.001 to 1.36]; p = 0.04) had higher rates of complications than whites. Conclusions: Minorities had lower rates of total knee arthroplasty utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics. Utilization rates were based on overall population as the proportion of the population with osteoarthritis requiring arthroplasty is unknown. Future studies that consider specific patient-level information with psychosocial and behavioral factors are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Previous studies of racial disparities in total joint replacement, particularly total knee arthroplasty, in the U.S. have predominantly focused on disparities between blacks and whites and were limited to Medicare patients or veterans, populations that are not representative of the entire U.S. population. We sought to study racial disparities in the utilization of total knee arthroplasty, the use of high-volume hospitals, and total knee arthroplasty outcomes, including mortality and complications, using all-payer databases. Methods: We analyzed data from 8 years and 8 racially diverse states in the State Inpatient Databases (SID). Patient race was categorized according to the SID as white, black, Hispanic, Asian, Native American, and mixed race. Both crude and adjusted racial and/or ethnic disparities were evaluated. Results: In comparison with whites (4.65 per 1000 population per year), black (3.90), Hispanic (3.71), Asian (3.89), Native American (4.40), and mixed-race (3.69) populations had lower rates of total knee arthroplasty utilization (p < 0.0001). After risk adjustment, the rate of total knee arthroplasty utilization was significantly lower for blacks (odds ratio [OR] = 0.87 [95% confidence interval (CI), 0.85 to 0.89]; p < 0.0001), Hispanics (OR = 0.76 [95% CI, 0.68 to 0.83]; p < 0.0001), Asians (OR = 0.83 [95%CI, 0.78 to 0.89]; p < 0.0001), Native Americans (OR = 0.87 [95%CI, 0.81 to 0.93]; p < 0.0001), and mixed race (OR = 0.84 [95% CI, 0.79 to 0.90]; p < 0.0001) compared with the rate for whites. Lower rates of total knee arthroplasty utilization for blacks, Hispanics, and mixed-race groups becameworse over the years. Patients fromminority groups were less likely to undergo total knee arthroplasty in high-volume hospitals than were whites. Moreover, the rates of mortality were significantly higher for blacks (OR = 1.52 [95% CI, 1.17 to 1.97]; p = 0.0017), Native Americans (OR = 6.52 [95% CI, 4.63 to 9.17]; p < 0.0001), and mixed-race patients (OR = 4.35 [95% CI, 3.24 to 5.84]; p < 0.0001). Blacks (OR = 1.08 [95% CI, 1.01 to 1.15]; p = 0.01) and mixed-race patients (OR = 1.17 [95% CI, 1.001 to 1.36]; p = 0.04) had higher rates of complications than whites. Conclusions: Minorities had lower rates of total knee arthroplasty utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics. Utilization rates were based on overall population as the proportion of the population with osteoarthritis requiring arthroplasty is unknown. Future studies that consider specific patient-level information with psychosocial and behavioral factors are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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