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Determinants of patient preferences for total knee replacement: African-Americans and whites

Kwoh, CK and Vina, ER and Cloonan, YK and Hannon, MJ and Boudreau, RM and Ibrahim, SA (2015) Determinants of patient preferences for total knee replacement: African-Americans and whites. Arthritis Research and Therapy, 17 (1). ISSN 1478-6354

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Introduction: Patient preferences contribute to marked racial disparities in the utilization of total knee replacement (TKR). The objectives of this study were to identify the determinants of knee osteoarthritis (OA) patients' preferences regarding TKR by race and to identify the variables that may mediate racial differences in willingness to undergo TKR. Methods: Five hundred fourteen White (WH) and 285 African-American (AA) patients with chronic knee pain and radiographic evidence of OA participated in the study. Participants were recruited from the community, an academic medical center, and a Veterans Affairs hospital. Structured interviews were conducted to collect socio-demographics, disease severity, socio-cultural determinants, and treatment preferences. Logistic regression was performed, stratified by race, to identify determinants of preferences. Clinical and socio-cultural factors were entered simultaneously into the models. Stepwise selection identified factors for inclusion in the final models (p < 0.20). Results: Compared to WHs, AAs were less willing to undergo TKR (80% vs. 62%, respectively). Better expectations regarding TKR surgery outcomes determined willingness to undergo surgery in both AAs (odds ratio (OR) 2.08, 95% confidence interval (CI) 0.91-4.79 for 4th vs. 1st quartile) and WHs (OR 5.11, 95% CI 2.31-11.30 for 4th vs. 1st quartile). Among AAs, better understanding of the procedure (OR 1.80, 95% CI 0.97-3.35), perceiving a short hospital course (OR 0.81, 95% CI 0.58-1.13), and believing in less post-surgical pain (OR 0.73, 95% CI 0.39-1.35) and walking difficulties (OR 0.66, 95% CI 0.37-1.16) also determined willingness. Among WHs, having surgical discussion with a physician (OR 1.96, 95% CI 1.05-3.68), not ever receiving surgical referral (OR 0.56, 95% CI 0.32-0.99), and higher trust in the healthcare system (OR 1.58, 95% CI 0.75-3.31 for 4th vs. 1st quartile) additionally determined willingness. Among the variables considered, only knowledge-related matters pertaining to TKR attenuated the racial difference in knee OA patients' treatment preference. Conclusions: Expectations of surgical outcomes influence preference for TKR in all patients, but clinical and socio-cultural factors exist that shape marked racial differences in preferences for TKR. Interventions to reduce or eliminate racial disparities in the utilization of TKR should consider and target these factors.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Kwoh, CK
Vina, ER
Cloonan, YKykc1@pitt.eduYKC1
Hannon, MJmjh58@pitt.eduMJH58
Boudreau, RMrob21@pitt.eduROB21
Ibrahim, SA
Date: 3 December 2015
Date Type: Publication
Journal or Publication Title: Arthritis Research and Therapy
Volume: 17
Number: 1
DOI or Unique Handle: 10.1186/s13075-015-0864-2
Schools and Programs: School of Public Health > Epidemiology
School of Medicine > Medicine
Refereed: Yes
ISSN: 1478-6354
Date Deposited: 27 Jul 2016 16:21
Last Modified: 02 Jul 2022 10:56


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