Disparities in Total Knee Replacement: Population Losses in Quality‐Adjusted Life‐Years Due to Differential Offer, Acceptance, and Complication Rates for African Americans

Kerman, Hannah M.; Smith, Savannah; Smith, Karen C.; Collins, Jamie E.; Suter, Lisa G.; Katz, Jeffrey N.; Losina, Elena

doi:10.1002/acr.23484

Cited by 14 publications

(20 citation statements)

References 42 publications

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“…Higher prevalence of continuous opioid use among African Americans could be partly due to multi-level barriers prior to the final decision on the TJR surgery. These barriers include differential access to healthcare facilities, surgeon preferences, and patient preference, acceptance or expectations of the surgery 27,29 . Furthermore, the present study showed associations between geographic regions and continuous opioid use prior to TJR, where patients from the Midwest and South were more likely to be continuous opioid users compared to patients from the Northeast.…”

Section: Discussionmentioning

confidence: 99%

Patterns of prescription opioid use before total hip and knee replacement among US Medicare enrollees

Jin

Solomon

Franklin

et al. 2019

Osteoarthritis and Cartilage

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Objective: To examine patterns of prescription opioid use before total joint replacement (TJR) and factors associated with continuous use of opioids before TJR. Design: We conducted an observational cohort study among Medicare enrollees aged !65 years who underwent TJR between 2010 and 2014. Preoperative opioid use was defined as having any opioid prescription in the 12-month period before TJR. Patients who had an opioid prescription every month for a 12-month period were defined as continuous users. We examined patients' demographics, pain-related conditions, medication use, other comorbidities, healthcare utilization and their association with use of opioids before TJR. Results: A total of 473,781 patients underwent TJR:,155,516 THR and 318,265 TKR. Among the total cohort, 60.2% patients had any use of opioids and of those, 12.4% used opioids at least once a month continuously over the 12-month baseline period. Correlates of continuous opioid use included African American race (OR ¼ 2.14, 95% confidence intervals (CI) ¼ 2.01e2.28, compared to White patients), history of drug abuse (OR ¼ 5.18, 95% CI ¼ 3.95e6.79) and back pain (OR ¼ 2.32, 95% CI ¼ 2.24e2.39). Conclusions: In this large cohort of patients undergoing TJR, over 60% ever used opioids and 12.4% of them continuously used opioids in the 12-month prior to surgery. Utilization of opioids became more frequent and high-dosed near the surgery. History of drug abuse, back pain, and African American race were strongly associated with continuous use of opioids preoperatively. Further research is needed to determine short-term and long-term risks of preoperative use of opioids in TJR patients and to optimize pre-and post-TJR pain management of patients with arthritis.

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Section: Discussionmentioning

confidence: 99%

Patterns of prescription opioid use before total hip and knee replacement among US Medicare enrollees

Jin

Solomon

Franklin

et al. 2019

Osteoarthritis and Cartilage

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“…Disparities in TJA use among minority patients has societal and economic implications. Kerman et al ( 14 ) used a Markov simulation model to predict the number of quality‐adjusted life‐years (QALYs) lost by Black patients because of lower TKA use. Assuming 40% lower use of TKA by Black patients compared with White patients, they estimated 72,000 QALYs lost by Black patients ( 14 ).…”

Section: Racial Disparities In Tja Usementioning

confidence: 99%

Racial Disparities in Elective Total Joint Arthroplasty for Osteoarthritis

Usiskin

Misra

2022

ACR Open Rheumatology

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Total joint arthroplasty (TJA) is an effective elective surgical procedure for knee and hip osteoarthritis (OA), yet racial disparities in the use of and outcomes from TJA have been recognized. Racial minority individuals are less willing to undergo TJA, demonstrate worse surgical and functional outcomes, and are more likely to undergo surgery at a low‐procedure‐volume center. In this systematic review, we summarize evidence to date on racial disparities in TJA and discuss potential factors that may underlie this gap in care for patients with OA.

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“…A recent study performed by Kermann and colleagues used a validated computer simulation model (Osteoarthritis Policy Model) of the natural history and treatment of knee OA to estimate QALY in Black and White patients with and without TKA. According to the data, Black patients gain fewer QALYs (per 100 patients) from TKA compared with White patients (see Figure 5) [69].…”

Section: Utilization Of Other Treatments Apart From Surgery and Treatment Recommendationsmentioning

confidence: 99%

Section: The Influence Of Poverty On Racial Disparity In Treatment Outcomesmentioning

confidence: 99%

“…Key insight [66,69]. A study by Goodman and colleagues investigated whether race and socioeconomic factors at the individual level were associated with patient-reported pain and function, A study by Goodman and colleagues investigated whether race and socioeconomic factors at the individual level were associated with patient-reported pain and function, and if there was an interaction between race and community poverty and patient-reported pain and function 2 years after TKA [66].…”

Section: The Influence Of Poverty On Racial Disparity In Treatment Outcomesmentioning

confidence: 99%

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Disparities across Diverse Populations in the Health and Treatment of Patients with Osteoarthritis

2021

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The study of disparities across diverse populations regarding the health and treatment of patients with osteoarthritis (OA) is recognized as a priority for investigation and action by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the American Academy of Orthopedic Surgeons (AAOS). OA is a common condition that increases with age, but with prevalence generally similar across racial and ethnic groups. However, disparities in the treatment of OA among racial, ethnic, and socioeconomic groups are well-documented and continue to rise and persist. The reasons are complex, likely involving a combination of patient, provider, and healthcare system factors. Treatment disparities among these different populations have an impact on clinical outcomes, healthcare, and productivity, and are projected to increase significantly with the growing diversity of the United States population. The aim of this short review is to summarize studies of racial, ethnic, and socioeconomic disparities among patients with OA in the United States, with a focus on prevalence, treatment utilization, and clinical and economic outcomes.

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Disparities in Total Knee Replacement: Population Losses in Quality‐Adjusted Life‐Years Due to Differential Offer, Acceptance, and Complication Rates for African Americans

Abstract: African Americans lose 72,000 QALYs due to disparities in TKR offer and complication rates. Programs to decrease disparities in TKR use are urgently needed.

Cited by 14 publications

References 42 publications

Patterns of prescription opioid use before total hip and knee replacement among US Medicare enrollees

Patterns of prescription opioid use before total hip and knee replacement among US Medicare enrollees

Racial Disparities in Elective Total Joint Arthroplasty for Osteoarthritis

Disparities across Diverse Populations in the Health and Treatment of Patients with Osteoarthritis

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