Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2008-04-29Keywords
AgedAged, 80 and over
Arthroplasty, Replacement, Knee
Comorbidity
Ethnic Groups
Female
Healthcare Disparities
Humans
*Income
Insurance, Health
Logistic Models
Longitudinal Studies
Male
Middle Aged
Sex Distribution
Socioeconomic Factors
United States
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
OBJECTIVE: To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use. DATA SOURCE: US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan. STUDY DESIGN: The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators. SAMPLE: Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA. RESULTS: Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95% CI: 1.03-2.26) to have first TKA. CONCLUSIONS: Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.Source
Med Care. 2008 May;46(5):481-8. Link to article on publisher's siteDOI
10.1097/MLR.0b013e3181621e9cPermanent Link to this Item
http://hdl.handle.net/20.500.14038/47605PubMed ID
18438196Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/MLR.0b013e3181621e9c