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Disparities/Minority Health

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Ethnic differences in willingness to undergo knee replacement may explain disparities in receipt of this procedure

Disparities in receipt of medical procedures by minorities are not entirely explained by financial or other barriers to care. Ethnic differences in willingness to undergo certain procedures may also play a role, suggests a study supported in part by the Agency for Healthcare Research and Quality (HS10876). For example, blacks are less likely than whites to undergo total knee arthroplasty (TKA, knee joint replacement) to relieve the pain and dysfunction of knee osteoarthritis (OA). However, the researchers also found that blacks are significantly less willing than whites to undergo TKA to relieve the problem.

The researchers surveyed 193 black, white, and Hispanic adults about how much money they were willing to pay to rid themselves of two hypothetical conditions: mild OA, which involved some problems with walking, work, or leisure activities, along with moderate pain and discomfort; and severe OA, which included some problems with walking, self-care (for example, washing and dressing), and usual activities, as well as extreme pain and discomfort and moderate anxiety and depression. Willingness-to-pay (WTP, as a percentage of income) to relieve symptoms of mild OA for each of the two scenarios was highest for whites, intermediate for Hispanics, and lowest for blacks (33 percent, 26 percent, and 17 percent, respectively).

After controlling for income, WTP was lower for all health scenarios for Hispanics and blacks than for whites, with significant differences between blacks and whites. Thus, whites placed a much higher value on improvements in knee OA than blacks, while values for Hispanics fell somewhere between those for blacks and whites. Individuals who place a lower value on health improvements may be less willing to undergo procedures that entail significant initial pain, cost, or a chance of death, note the researchers.

See "Ethnic differences in health preferences: Analysis using willingness-to-pay," by Margaret M. Byrne, Ph.D., Kimberly J. O'Malley, Ph.D., and Maria E. Suarez-Almazor, M.D., Ph.D., in the September 2004 Journal of Rheumatology 31(9), pp. 1811-1818.

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