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

Ann Rheum Dis. 2014 Dec;73(12):2107-15. doi: 10.1136/annrheumdis-2013-203494. Epub 2013 Sep 18.

Abstract

Objective: To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time.

Methods: We used data from the US Medicare Program (MedPAR data) for years 1991-2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). For each cohort, we calculated standardised arthroplasty usage rates for Caucasian and African-American Medicare beneficiaries for each calendar year, and examined changes in disparities over time. We examined unadjusted and adjusted outcomes (30-day readmission rate, discharge disposition etc.) for Caucasians and African-Americans, and whether disparities decreased over time.

Results: In 1991, the use of primary TKA was 36% lower for African-Americans compared with Caucasians (20.6 per 10,000 for African-Americans; 32.1 per 10,000 for Caucasians; p<0.0001); in 2008, usage of primary TKA was 40% lower for African-Americans (41.5 per 10,000 for African-Americans; 68.8 per 10,000 for Caucasians; p<0.0001) with similar findings for the other cohorts. Black-White disparities in 30-day hospital readmission increased significantly from 1991-2008 among three patient cohorts. For example in 1991 30-day readmission rates for African-Americans receiving primary TKA were 6% higher than for Caucasians; by 2008 readmission rates for African-Americans were 24% higher (p<0.05 for change in disparity). Similarly, black-white disparities in the proportion of patients discharged to home after surgery increased across the study period for all cohorts (p<0.05).

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

Keywords: Epidemiology; Orthopedic Surgery; Osteoarthritis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / statistics & numerical data*
  • Arthroplasty, Replacement, Knee / statistics & numerical data*
  • Cohort Studies
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Healthcare Disparities / ethnology*
  • Humans
  • Male
  • Medicare
  • Osteoarthritis, Hip / ethnology
  • Osteoarthritis, Hip / surgery*
  • Osteoarthritis, Knee / ethnology
  • Osteoarthritis, Knee / surgery*
  • Outcome Assessment, Health Care
  • Patient Readmission / statistics & numerical data
  • Reoperation / statistics & numerical data
  • United States