Minorities Have Fewer TKRs Than Whites

Are referral patterns biased?

According to a study published in the Journal of Bone and Joint Surgery, minorities are less likely to have knee replacement (TKR) surgery and, when they do have it, they are more likely to experience complications. The Agency for Healthcare Research and Quality (AHRQ) funded the study.

Researchers examined four outcome variables: the rate of total knee arthroplasty, the use of high total knee arthroplasty volume hospitals, in-hospital mortality and in-hospital complications.

They categorized patient’s race as white, black, Hispanic, Asian, Native American, and mixed race. According to the report in Medical Press, investigators analyzed data from eight years (2001-2008) and eight racially diverse states. The eight states were Arizona, Colorado, Iowa, North Carolina, New Jersey, Rhode Island, Wisconsin, and Florida. They identified a total of 547, 380 admissions that underwent TKR.

The three largest ethnic groups were whites (87.24%), blacks (5.88%) and Hispanics (4.20%). The smallest were Asians (0.46%), Native Americans (0.51%) and mixed race (1.71%).

The results: In comparison to the white population, minorities had lower rates of TKR utilization. They were also less likely to undergo their TKR in high-volume hospitals. The risk for in-hospital mortality, and the complication rate following TKR, were significantly higher for blacks, Native Americans and mixed-race individuals.

“Even after adjusting for certain patient demographics, socioeconomic status, and health care system characteristics, significant racial disparities in TKR utilization and outcomes exist, ” said Yan Ma, Ph.D., corresponding author of the study and associate professor in the Milken Institute School of Public Health at George Washington University. “These findings create an opportunity for health care providers to consider differences in utilization and outcomes that may result directly from their referral patterns.”