Session Type: Abstract Submissions (ACR)
There is marked variation in patient preference (i.e. willingness) regarding total knee replacement (TKR), an effective treatment option for end-stage osteoarthritis (OA). Studies have also shown that higher social support is associated with better patient decision-making. No study, though, has ever examined the importance of social support on patient preference. The purpose of this study is to determine whether there are racial differences in social support among patients with knee OA and whether the impact of social support on preference for TKR varies by race and gender.
Methods: Our sample consists of 514 white & 285 African-American (AA) patients with chronic, frequent knee pain and radiographic evidence of knee osteoarthritis (OA). Structured interviews were conducted to determine sociodemographic information, clinical characteristics, and extent of structural (marital status, # of close friends/relatives) and functional (Medical Outcomes Study-Social Support Scale [MOS-SSS]) social support. A hypothetical, Likert-scaled question was also asked: “Would you be willing to have surgery to replace your knee if your doctor recommended it?”. Hierarchical logistic regression models were performed to evaluate the relationship between willingness to undergo TKR and the interaction of patient race and sex, adjusted for recruitment site, age, income, WOMAC total score and measures of social support.
Among AA participants, 22.8% were married, as compared with 53.5% of white participants (p<0.001). The mean numbers of close friends/relatives reported by AA and white patients were 7.52 ± 8.88 and 10.31 ± 13.13, respectively (p<0.001). Half of AA patients reported living alone, as compared with 33.5% of white patients (p<0.001). MOS-SSS scores were lower in AA (13.44 ± 5.26) as compared with white (15.17 ± 4.79) participants (p<0.001). Compared to white patients with knee OA, AA patients with knee OA were less willing to undergo TKR surgery (80.0% vs. 62.4%, p<0.001).
The odds of willingness to undergo TKR surgery was less in white females compared to white males when adjusted for recruitment site, age, income and WOMAC score (OR 0.57, 95% CI 0.34-0.96), but this difference was no longer significant when further adjusted for marital status, number of close friends/relatives and MOS-SSS score (OR 0.60, 95% CI 0.35-1.02). The odds of willingness to undergo TKR surgery was also less in AA females (OR 0.33, 95% CI 0.18-0.60) and AA males (OR 0.26, 95% CI 0.13-0.52) compared to white males when adjusted for sociodemographic and clinical factors. These differences in odds remained significant when further adjusted for all social support measures (OR 0.35, 95% CI 0.19-0.64, in AA females; OR 0.28, 95% CI 0.14-0.54, in AA males).
We found lower preference for TKR surgery in AA compared to white patients with knee OA. AA OA patients also reported less structural and functional social support than white patients. There was a race and gender interaction in patient preferences for TKR surgery. In white patients, social support accounted for the gender difference in willingness to consider TKR. Social support, though, did not seem to mediate the racial difference in patient preferences for TKR.
E. R. Vina,
M. J. Hannon,
R. M. Boudreau,
C. K. Kwoh,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/race-gender-and-total-knee-replacement-consideration-the-role-of-social-support/