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Disparities/Minority Health

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Patient preference may underlie ethnic variation in knee replacement surgery

Knee osteoarthritis (OA) is a major cause of knee pain and disability. Individuals who obtain no relief from medication often undergo total knee replacement (TKR). Whites are twice as likely as blacks or Hispanics to undergo TKR, a difference that persists even after controlling for health insurance.

Patient preferences appear to underlie much of the variation in TKR, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS10876). Researchers surveyed an ethnically diverse group of 198 patients with knee OA about whether their doctor recommended TKR, their thoughts about the procedure, and their trust in physicians and the health system.

Regardless of severity of OA, white patients were more likely than minority patients to have considered undergoing TKR. In addition, white patients were more likely to consider TKR if their OA worsened and their physician recommended the procedure. They also were more likely than minority patients to view TKR as a beneficial procedure.

Blacks had a higher physician recommendation rate than whites, and, although the rate was not statistically significant, it suggested that physician bias was not a factor in TKR in this group. Yet, many minority patients surveyed would not be willing to consider surgery even if their physicians recommended it. Major determinants of preferences were patients' beliefs about the efficacy of the procedure and knowing individuals in their close social environment who had undergone TKR. Improved physician-patient communication to provide more information and reassurance about the procedure could help more eligible patients benefit from TKR, note the researchers.

See "Ethnic variation in knee replacement: Patient preferences or uninformed disparity?" by Maria E. Suarez-Almazor, M.D., Ph.D., Julianne Souchek, Ph.D., P. Adam Kelly, Ph.D., and others, in the May 23, 2005, Archives of Internal Medicine 165, pp. 1117-1124.

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