Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients.

@article{Skinner2003RacialEA,
  title={Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients.},
  author={Jonathan Skinner and James N Weinstein and Scott M. Sporer and John E. Wennberg},
  journal={The New England journal of medicine},
  year={2003},
  volume={349 14},
  pages={
          1350-9
        }
}
BACKGROUND There are large variations in the use of knee arthroplasty among Medicare enrollees according to race or ethnic group and sex. Are racial and ethnic disparities more pronounced in some regions than in others, and if so, why? METHODS We used all Medicare fee-for-service claims data for 1998 through 2000 to determine the incidence of knee arthroplasty according to Hospital Referral Region, sex, and race or ethnic group. A total of 430,726 knee arthroplasties were performed during the… 

Figures and Tables from this paper

Racial and Ethnic Disparities in Utilization Rate, Hospital Volume, and Perioperative Outcomes After Total Knee Arthroplasty.

Minorities had lower rates of total knee arthroplasty utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics.

Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national medicare data

In an 18-year analysis of US Medicare data, there is little evidence of declines in racial disparities for joint arthroplasty usage or outcomes.

Racial trends in the use of major procedures among the elderly.

Racial Trends in the Use of Major Procedures among the Elderly

No evidence is found that efforts to eliminate racial disparities in the use of high-cost surgical procedures were successful for the decade of the 1990s, either nationally or locally.

Racial disparities in total knee replacement among Medicare enrollees--United States, 2000-2006.

CDC analyzed national and state TKR rates for Medicare enrollees for the period 2000-2006, stratified by sex, age group, and black or white race to monitor progress toward eliminating racial disparities in the rate of TKR.

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty: Health Insurance, Income, and Assets

Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.

Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty.

It is indicated that, after adjustment, black patients have significantly higher rates of infection-related and non-infection-related complications following knee arthroplasty, compared with white patients, and adjusted rates of infected patients are higher in Hispanic patients than in white patients.

The influence of income and race on total knee arthroplasty in the United States.

High-income Medicare enrollees are no less likely to have osteoarthritis than low-income enrollees but have somewhat better access to care and racial disparities are more important than those that are attributable to socioeconomic status.
...

References

SHOWING 1-10 OF 54 REFERENCES

Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans.

Findings suggest that even though elderly blacks have higher rates of knee osteoarthritis, they do not receive total knee arthroplasty as often as do elderly whites, and inequality in the use of this procedure would likely persist.

Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans.

Findings suggest that even though elderly blacks have higher rates of knee osteoarthritis, they do not receive total knee arthroplasty as often as do elderly whites, and inequality in the use of this procedure would likely persist.

Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States.

The variations in the rates of elective total hip and total knee arthroplasties for 1988 in the United States were analyzed to determine whether the rates correlated with the numbers of surgeons, and both operations were most common in the seventy to seventy-four-year age-group.

Differences between men and women in the rate of use of hip and knee arthroplasty.

There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men.

Racial differences in the use of revascularization procedures after coronary angiography.

Among Medicare enrollees, whites are more likely than blacks to receive revascularization procedures after coronary angiography and these differences may reflect overuse in whites or underuse in blacks, but they are unlikely to reflect access to cardiologists or hospitals that perform revascularized procedures.

Understanding Ethnic Differences in the Utilization of Joint Replacement for Osteoarthritis: The Role of Patient-Level Factors

Black patients were less likely than white patients to be familiar with joint replacement surgery and more likely to express concerns about postsurgical pain and difficulty walking.

Racial Differences in Cardiac Revascularization Rates: Does Overuse Explain Higher Rates among White Patients?

Whether overuse of CABG surgery procedures is greater among white patients than among African-American patients and whether it accounts for racial disparities in revascularization is assessed.

Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter?

Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical features of their disease.

Recipients of hip replacement for arthritis are less likely to be Hispanic, independent of access to health care and socioeconomic status.

Recipients of hip replacement are less likely to be Hispanic than are other hospitalized persons with a similar level of access to care, and this pattern persisted after adjusting for age, sex, type of medical insurance, and median household income by the zip code of residence.
...