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    Race and socioeconomic status as predictors of utilization and need for total knee arthroplasty for knee osteoarthritis: Data from the OsteoArthritis Initiative study

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    Author
    O'Connor, Shannon Leigh
    0000-0003-0817-258X
    Advisor
    Hochberg, Marc C.
    Date
    2016
    Type
    dissertation
    
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    Other Titles
    Race as a predictor of utilization and need for total knee arthroplasty for knee osteoarthritis: Data from the OsteoArthritis Initiative Study
    Abstract
    Objective: Previous studies consistently report reduced rates of utilization of total knee arthroplasty (TKA) among black U.S. adults as compared with whites. This study assessed whether differences in TKA utilization rates between blacks and whites persist after including estimates of socioeconomic status and theoretical candidacy for joint replacement surgery. This study also examined whether blacks and whites differ in rate of reaching candidacy for TKA, and whether socioeconomic factors are related to reaching VTKA. Methods: This study employed data from the OsteoArthritis Initiative study. Study participants were black and white adults enrolled in the OAI study between the ages of 49 and 79 at baseline. Study aims were achieved using a discrete survival approach. Cox-analogue proportional hazards models were employed using a log minus log link to produce hazard ratios specific to respective intervals between time points. Models were fit using General Estimating Equations. Results: Results showed that blacks were significantly less likely to undergo total knee arthroplasty than whites, even after including estimates of baseline differences in BMI and number of comorbidities, baseline need for TKA, and socioeconomic status (education and income) (e^(β)=0.50, p=0.0016). Individuals who met need for TKA criteria at baseline were significantly more likely to undergoing TKA than those who did not (e^(β)=8.25, p<0.0001). Results also revealed race not to be a significant predictor of reaching need for TKA after including estimates of baseline differences in BMI and number of comorbidities. These findings persisted even with the inclusion of socioeconomic variables. Conclusions: Findings confirmed that substantial racial differences in utilization of TKA exist. The inclusion of socioeconomic status measures accounted for only a small proportion of the difference between blacks and whites in terms of TKA utilization (e^(β)=0.41 versus e^(β)=0.50). Racial differences in progression of knee OA to virtual TKA were also found, although race became non-significant after accounting for baseline differences in BMI categories (overweight and obese). Results suggest that other factors not captured in this study differentially influence the rate of TKA utilization among black and white U.S. adults.
    Description
    University of Maryland, Baltimore. Gerontology. Ph.D. 2016
    Keyword
    proportional hazards model
    racial differences
    total knee arthroplasty
    Socioeconomic status
    Arthroplasty, Replacement, Knee
    Obesity
    Osteoarthritis
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/6275
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    Theses and Dissertations All Schools
    Theses and Dissertations School of Medicine

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