Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: TKR is a cost-effective treatment option for end-stage knee osteoarthritis (OA). Although it is one of the fastest growing elective surgeries, there are marked racial disparities in the utilization of TKR. Patient’s preferences have been found to be an important consideration in TKR disparities. However, determinants of patients’ preference regarding TKR remain unclear. We sought to identify whether determinants of patients’ preference for TKR differ by race.
Methods: Our sample consisted of 514 whites (59% female) and 285 AAs (73% female) with chronic, frequent knee pain and radiographic evidence of knee OA. Structured interviews were conducted to collect sociodemographic information, socio-cultural determinants, disease severity (i.e, WOMAC), and treatment preferences. We performed hierarchical logistic regression, stratified by race, to identify determinants of patients’ preference for TKR. Clinical and socio-cultural factors were entered simultaneously into race stratified models. Stepwise selection identified factors for inclusion in the final models, using a criterion of p<0.20. All models were adjusted for age, sex, income level, disease severity (WOMAC), and study site.
Results: Compared to whites, AA patients were less willing to undergo TKR (80% vs. 62%, respectively, adjusted OR=0.45, 95%CI 0.29 to 0.70). The results of the multivariate model are summarized in the table below. Among AA patients, knowledge (p=0.031) and expectations (p=0.084) regarding surgical outcomes, religiosity (p=0.045), and physician trust (p=0.104) were included in the final multivariate model. Among white patients, expectations regarding surgical outcomes (p<0.001), two items related to physician interaction and referral patterns (p=0.039), and trust in the healthcare system (0.068) were included in the final multivariate model.
Conclusion: Although expectations regarding surgical outcomes are associated with preference for TKR in both AA and white patients, they differed with regard to which other clinical and socio-cultural determinants impact the preference to undergo TKR. Interventions to reduce or eliminate racial disparities in the utilization of TKR should consider and target these factors.
|
OR for Willingness to Undergo TKR
|
AAs OR (95% CI)* |
Whites OR (95% CI)* |
|
Knowledge Regarding TKR
|
|
|
|
Understands TKR |
1.80 (0.97, 3.35) |
|
|
Prolonged Length of Stay After TKR |
0.81 (0.58, 1.13) |
|
|
Residual Pain After TKR |
0.73 (0.39, 1.35) |
|
|
Residual Difficulty Walking After TKR |
0.66 (0.37, 1.16) |
|
|
Ever Discuss TKR with a physician |
|
1.96 (1.05, 3.68) |
|
Referred to Surgeon |
|
0.56 (0.32, 0.99) |
|
Expectations Regarding TKR** Second Quartile |
1.85 (0.76, 4.51) |
1.70 (0.86, 3.33) |
|
Third Quartile |
2.82 (1.30, 6.15) |
2.73 (1.32, 5.65) |
|
Highest Quartile |
2.08 (0.91, 4.79) |
5.11 (2.31, 11.30) |
|
Religiosity** Second Quartile |
2.52 (0.93, 6.84) |
|
|
Third Quartile |
1.21 (0.43, 3.42) |
|
|
Highest Quartile |
0.85 (0.32, 2.26) |
|
|
Physician Trust** Second Quartile |
2.14 (0.89, 5.15) |
|
|
Third Quartile |
1.01 (0.46, 2.25) |
|
|
Highest Quartile |
2.17 (0.90, 5.23) |
|
|
Trust in Healthcare System** Second Quartile |
|
2.69 (1.26, 5.76) |
|
Third Quartile |
|
1.94 (0.91, 4.13) |
|
Highest Quartile |
|
1.58 (0.75, 3.31) |
* adjusted for sex, age, income level, WOMAC and site; ** Lowest Quartile is reference group.
Disclosure:
C. K. Kwoh,
AstraZeneca,
2,
Beverage Institute,
2;
R. M. Boudreau,
None;
Y. Cloonan,
None;
M. J. Hannon,
None;
E. R. Vina,
None;
S. Ibrahim,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-patient-preferences-for-total-knee-replacement-a-comparison-of-whites-and-african-americans/