@article {7209, title = {Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 Feb}, pages = {200-8}, publisher = {46}, abstract = {

BACKGROUND: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.

OBJECTIVE: This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries.

DESIGN: Longitudinal (1998-2004) Health and Retirement Study.

SETTING: National probability sample of US community-dwelling adults.

SAMPLE: A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older.

MEASUREMENTS: The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population.

RESULTS: Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95\% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences.

CONCLUSIONS: These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation.

}, keywords = {Age Distribution, Aged, Arthritis, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Black or African American, Female, Health Services Accessibility, Healthcare Disparities, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, United States, Utilization Review, White People}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e31815cecd8}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Sohn, Min-Woong and Joseph Feinglass and Huan J. Chang and Rowland W Chang} } @article {6881, title = {Health care utilization among older adults with arthritis.}, journal = {Arthritis Rheum}, volume = {49}, year = {2003}, month = {2003 Apr 15}, pages = {164-71}, publisher = {49}, abstract = {

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources.

RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis.

CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Arthritis, Comorbidity, Cost of Illness, Female, Health Services, Home Care Services, Hospitals, Humans, Insurance, Health, Longitudinal Studies, Male, Nursing homes, Physicians{\textquoteright} Offices, Social Class}, issn = {0004-3591}, doi = {10.1002/art.11003}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6749, title = {Arthritis prevalence and activity limitations in older adults.}, journal = {Arthritis Rheum}, volume = {44}, year = {2001}, month = {2001 Jan}, pages = {212-21}, publisher = {44}, abstract = {

OBJECTIVE: To evaluate the prevalence of arthritis and activity limitations among older Americans by assessing their demographic, ethnic, and economic characteristics.

METHODS: Data from the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults born before 1924, were analyzed cross-sectionally. Arthritis that resulted in a physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture was ascertained by self-report.

RESULTS: The prevalence of arthritis in older adults ranged from 25\% in non-Hispanic whites to 40\% in non-Hispanic blacks to 44\% in Hispanics. A higher prevalence of arthritis was associated with less education as well as lower income and less wealth. The prevalence of limitations in activities of daily living (ADL) among non-Hispanic white, non-Hispanic black, and Hispanic adults who reported arthritis only was 29\%, 30\%, and 37\%, respectively, and increased to 48\%, 57\%, and 56\%, respectively, among those reporting arthritis plus other chronic conditions, after adjustment for age and sex.

CONCLUSION: Non-Hispanic black and Hispanic older adults reported having arthritis at a substantially higher frequency than did non-Hispanic whites. In addition, Hispanics reported higher rates of ADL limitations than did non-Hispanic whites with comparable disease burden. Further study is needed to confirm and elucidate the reasons for these racial and economic disparities in older populations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Arthritis, Data collection, Humans, Prevalence, Racial Groups, Socioeconomic factors, Surveys and Questionnaires}, issn = {0004-3591}, doi = {10.1002/1529-0131(200101)44:1<212::AID-ANR28>3.0.CO;2-Q}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} }