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Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national medicare data

Objective To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time. Methods We used data from the US Medicare Program (MedPAR data) for years 1991–2008 to identify four separate cohorts of patients (primary TKA, revisi... Full description

Journal Title: Annals of the rheumatic diseases 2014-12, Vol.73 (12), p.2107-2115
Main Author: Singh, Jasvinder A
Other Authors: Lu, Xin , Rosenthal, Gary E , Ibrahim, Said , Cram, Peter
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: BMJ Publishing Group Ltd
ID: ISSN: 0003-4967
Link: https://www.ncbi.nlm.nih.gov/pubmed/24047869
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title: Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national medicare data
format: Article
creator:
  • Singh, Jasvinder A
  • Lu, Xin
  • Rosenthal, Gary E
  • Ibrahim, Said
  • Cram, Peter
subjects:
  • African Americans
  • African Americans - statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Analysis
  • Arthroplasty
  • Arthroplasty, Replacement, Hip - statistics & numerical data
  • Arthroplasty, Replacement, Hip - utilization
  • Arthroplasty, Replacement, Knee - statistics & numerical data
  • Arthroplasty, Replacement, Knee - utilization
  • Article
  • Cohort Studies
  • European Continental Ancestry Group - statistics & numerical data
  • Female
  • Health aspects
  • Health care disparities
  • Healthcare Disparities - ethnology
  • Humans
  • Joint surgery
  • Male
  • Medicare
  • Osteoarthritis, Hip - ethnology
  • Osteoarthritis, Hip - surgery
  • Osteoarthritis, Knee - ethnology
  • Osteoarthritis, Knee - surgery
  • Outcome Assessment (Health Care)
  • Patient outcomes
  • Patient Readmission - statistics & numerical data
  • Reoperation - statistics & numerical data
  • Studies
  • United States
  • Usage
  • Whites
ispartof: Annals of the rheumatic diseases, 2014-12, Vol.73 (12), p.2107-2115
description: Objective To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time. Methods We used data from the US Medicare Program (MedPAR data) for years 1991–2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). For each cohort, we calculated standardised arthroplasty usage rates for Caucasian and African–American Medicare beneficiaries for each calendar year, and examined changes in disparities over time. We examined unadjusted and adjusted outcomes (30-day readmission rate, discharge disposition etc.) for Caucasians and African–Americans, and whether disparities decreased over time. Results In 1991, the use of primary TKA was 36% lower for African–Americans compared with Caucasians (20.6 per 10 000 for African–Americans; 32.1 per 10 000 for Caucasians; p
language: eng
source:
identifier: ISSN: 0003-4967
fulltext: no_fulltext
issn:
  • 0003-4967
  • 1468-2060
url: Link


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titleRacial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national medicare data
creatorSingh, Jasvinder A ; Lu, Xin ; Rosenthal, Gary E ; Ibrahim, Said ; Cram, Peter
creatorcontribSingh, Jasvinder A ; Lu, Xin ; Rosenthal, Gary E ; Ibrahim, Said ; Cram, Peter
descriptionObjective To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time. Methods We used data from the US Medicare Program (MedPAR data) for years 1991–2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). For each cohort, we calculated standardised arthroplasty usage rates for Caucasian and African–American Medicare beneficiaries for each calendar year, and examined changes in disparities over time. We examined unadjusted and adjusted outcomes (30-day readmission rate, discharge disposition etc.) for Caucasians and African–Americans, and whether disparities decreased over time. Results In 1991, the use of primary TKA was 36% lower for African–Americans compared with Caucasians (20.6 per 10 000 for African–Americans; 32.1 per 10 000 for Caucasians; p<0.0001); in 2008, usage of primary TKA was 40% lower for African–Americans (41.5 per 10 000 for African–Americans; 68.8 per 10 000 for Caucasians; p<0.0001) with similar findings for the other cohorts. Black–White disparities in 30-day hospital readmission increased significantly from 1991–2008 among three patient cohorts. For example in 1991 30-day readmission rates for African–Americans receiving primary TKA were 6% higher than for Caucasians; by 2008 readmission rates for African–Americans were 24% higher (p<0.05 for change in disparity). Similarly, black–white disparities in the proportion of patients discharged to home after surgery increased across the study period for all cohorts (p<0.05). Conclusions In an 18-year analysis of US Medicare data, we found little evidence of declines in racial disparities for joint arthroplasty usage or outcomes.
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descriptionObjective To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time. Methods We used data from the US Medicare Program (MedPAR data) for years 1991–2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). For each cohort, we calculated standardised arthroplasty usage rates for Caucasian and African–American Medicare beneficiaries for each calendar year, and examined changes in disparities over time. We examined unadjusted and adjusted outcomes (30-day readmission rate, discharge disposition etc.) for Caucasians and African–Americans, and whether disparities decreased over time. Results In 1991, the use of primary TKA was 36% lower for African–Americans compared with Caucasians (20.6 per 10 000 for African–Americans; 32.1 per 10 000 for Caucasians; p<0.0001); in 2008, usage of primary TKA was 40% lower for African–Americans (41.5 per 10 000 for African–Americans; 68.8 per 10 000 for Caucasians; p<0.0001) with similar findings for the other cohorts. Black–White disparities in 30-day hospital readmission increased significantly from 1991–2008 among three patient cohorts. For example in 1991 30-day readmission rates for African–Americans receiving primary TKA were 6% higher than for Caucasians; by 2008 readmission rates for African–Americans were 24% higher (p<0.05 for change in disparity). Similarly, black–white disparities in the proportion of patients discharged to home after surgery increased across the study period for all cohorts (p<0.05). Conclusions In an 18-year analysis of US Medicare data, we found little evidence of declines in racial disparities for joint arthroplasty usage or outcomes.
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7Arthroplasty, Replacement, Hip - utilization
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31Usage
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abstractObjective To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time. Methods We used data from the US Medicare Program (MedPAR data) for years 1991–2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). For each cohort, we calculated standardised arthroplasty usage rates for Caucasian and African–American Medicare beneficiaries for each calendar year, and examined changes in disparities over time. We examined unadjusted and adjusted outcomes (30-day readmission rate, discharge disposition etc.) for Caucasians and African–Americans, and whether disparities decreased over time. Results In 1991, the use of primary TKA was 36% lower for African–Americans compared with Caucasians (20.6 per 10 000 for African–Americans; 32.1 per 10 000 for Caucasians; p<0.0001); in 2008, usage of primary TKA was 40% lower for African–Americans (41.5 per 10 000 for African–Americans; 68.8 per 10 000 for Caucasians; p<0.0001) with similar findings for the other cohorts. Black–White disparities in 30-day hospital readmission increased significantly from 1991–2008 among three patient cohorts. For example in 1991 30-day readmission rates for African–Americans receiving primary TKA were 6% higher than for Caucasians; by 2008 readmission rates for African–Americans were 24% higher (p<0.05 for change in disparity). Similarly, black–white disparities in the proportion of patients discharged to home after surgery increased across the study period for all cohorts (p<0.05). Conclusions In an 18-year analysis of US Medicare data, we found little evidence of declines in racial disparities for joint arthroplasty usage or outcomes.
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