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Disparities/Minority Health

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Even with insurance, elderly Hispanics undergo far fewer hip replacement operations than older non-Hispanic whites

Many Hispanic Medicare beneficiaries who suffer from joint-debilitating arthritis may not be getting hip replacement surgery that could relieve their pain and keep them from becoming disabled even though they have coverage for the procedure, according to a new study sponsored in part by the Agency for Healthcare Research and Quality (HS09775). The study found that Hispanics aged 65 and older in Texas, New Mexico, Arizona, and Illinois were less than one-third as likely as non-Hispanic whites the same age to undergo total hip replacement, an operation that can alleviate pain and improve physical function and quality of life in patients with severe osteoarthritis.

The authors believe that the underuse of total hip replacement surgery among older Hispanics may be due in part to their tendency to be influenced in their medical care decisionmaking by the personal experiences of relatives and acquaintances. Patients in the study may have decided to forego the hip replacement surgery because its limited use among older Hispanics made it less likely that they knew anyone who could tell them first-hand about the operation.

A second, and related factor, may be poor English-language skills. If a patient had difficulty in communicating with the doctor, he or she may have been less inclined to undergo the surgery.

More than half of the Nation's 35 million Hispanics speak Spanish at home, and of these, nearly half speak English less than "very well." Elderly Hispanics, often recent immigrants or people who have lived in the United States awhile but depend on others for their language needs, tend to be less likely to speak English. According to the study's lead author, Agustin Escalante, M.D., of the University of Texas Health Science Center at San Antonio, underuse of hip replacement surgery by the large and growing U.S. Hispanic population could have important consequences for Medicare because the resulting excess disability could increase long-term custodial costs. Data from AHRQ's Nationwide Inpatient Sample (NIS) for 1999 show that nearly 92,000 total hip replacement procedures were performed on Medicare patients, and the average charge for the hospital stay, exclusive of physicians' fees, was about $23,000. Medicare also paid for 84,000 partial hip replacement procedures in 1999.

The study was based on Medicare claims data for approximately 6,500 Spanish-surnamed and non-Hispanic fee-for-service Medicare patients in the four States who underwent total hip replacement surgery between 1995 and 1996. Harvard Medical School's Jeffrey N. Katz, M.D., and Jane Barrett, M.Sc., of Dartmouth Medical School, collaborated with Dr. Escalante.

Details are in "Disparity in total hip replacement affecting Hispanic Medicare beneficiaries," by Dr. Escalante, Ms. Barrett, Inmaculada del Rincon, M.D., and others, in the June 2002 Medical Care 40(6), pp. 451-460.

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