72,755 Patient Study Tests for Racial/Ethnic Bias in THA

Using the Kaiser Permanente joint replacement registry, researchers from that institution set out to determine whether racial/ethnic disparities were measurable in total hip arthroplasty (THA) outcomes.

The study, “Association of Race and Ethnicity with Total Hip Arthroplasty Outcomes in a Universally Insured Population,” appears in the July 3, 2019 edition of The Journal of Bone and Joint Surgery.

Kanu Okike, M.D., M.P.H., with the Hawaii Permanente Medical Group, Kaiser Permanente, in Honolulu and co-author explained the reasoning behind the study to OTW, “Prior studies have consistently documented racial and ethnic disparities in total hip arthroplasty outcomes in the United States. Given that recent research has suggested that healthcare disparities might be ameliorated in settings of equal access, we sought to determine whether total hip arthroplasty disparities existed within the Kaiser Permanente managed care system.”

The authors were able to mine data for 72,755 Kaiser patients, 79.1% of whom were white, 8.2% black, 8.5% Hispanic, and 4.2% Asian. When they compared rates of lifetime all-cause revision cases—using the white patient data as the comparator—they found that rates were LOWER for black, Hispanic, and Asian patients.

The research team also looked at data for 90-day emergency department admissions and they found that they were more likely to occur among black and Hispanic patients. For all other postoperative events, minority patients had similar or lower rates compared with white patients.

Dr. Okike summarized the study’s findings to OTW:“The most important finding of this study was that minority patients enrolled in the managed care system had rates of revision and other postoperative events which were generally similar to or better than those of their white counterparts.”

“These findings could be due to the universal access or standardized protocols associated with treatment in the managed care system. For example, most total hip arthroplasty procedures in the Kaiser Permanente system are performed by high-volume surgeons, with little variation by racial/ethnic group.”

“Our results should not be taken as evidence that healthcare disparities do not exist, or that efforts to address disparities are no longer required. However, by showing that it is in fact possible to achieve equal outcomes, our results should encourage surgeons who are working to provide equitable treatment and reduce disparities. In addition, the dissemination of our findings to minority patients who are candidates for total hip replacement may help to allay their fears and reduce the persistent utilization gap currently observed in this country.”