Does race dictate quality of care?

Racial minorities have reduced access to high-quality joint replacement care, according to Dr. Xueya Cai and colleagues from the University of Iowa in the US. Their work, published online in Springer's journal Clinical Orthopaedics and Related Research, shows that African American patients are more likely than Caucasians to receive total knee arthroplasty (or replacement surgery) in low-quality hospitals.

Total joint arthroplasty is widely performed in patients of all races with severe osteoarthritis to relieve pain and improve joint function and mobility. Although several studies have suggested that racial minority patients are less likely to undergo joint replacement surgery, little is known about the quality of arthroplasty care that African Americans receive as compared to Caucasians.

Using data from the Medicare Provider Analysis and Review (MedPAR) files between 2002 and 2005, which contain information regarding hospitalization for , Cai and colleagues profiled US hospitals' quality of care. Quality was based on the rate of complications including sepsis, hemorrhage, pulmonary embolism, and severe wound infection, as well as the number of deaths, experienced in the 90 days after total .

To test for a racial difference in access to high-, intermediate- and low-quality hospitals, the authors then looked at 91,599 elderly patient admissions for total knee replacement between July and December 2005 in 2,842 hospitals.

Their analyses, which focused on Caucasian and African American patients only, showed that undergoing total knee arthroplasty were less likely to be admitted to high-volume hospitals. Instead, compared to , they were more likely to be admitted to hospitals that perform fewer knee replacements, which have been correlated to lower-quality knee arthoplasty surgery. The fact that African American race was a predictor for admissions to low-quality hospitals, provides direct evidence of racial disparities in access to high-quality arthroplasty care.

Dr. Xueya Cai concludes: "This racial disparity in access to high-quality arthroplasty care is a major issue, especially as arthroplasties continue to be more widely performed in both Caucasian and non-Caucasian patients with severe osteoarthritis. More work is needed to explore African American neighborhoods, as well as social and physician-referring factors to better understand and address the issues of unequal access and quality of arthroplasties."

More information: Cai X et al (2011). Are African American patients more likely to receive total knee arthroplasty in a low-quality hospital? Clinical Orthopaedics and Related Research. DOI:10.1007/s11999-011-2032-6

add to favorites email to friend print save as pdf

Related Stories

Race for new hips

Jun 01, 2010

A recent study by researchers at the VA Center for Health Equity Research and Promotion in Pittsburgh, Pennsylvania, suggests that patient treatment preferences play an important role in racial disparities in total joint ...

'Shrug off' shoulder surgery myth, study suggests

Mar 26, 2007

Contrary to widespread belief, total surgical replacement of arthritic shoulder joints carries no greater risk of complications than replacement of other major joints, a Johns Hopkins study suggests.

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

dbr1
not rated yet Sep 13, 2011
How about the problem that Blacks are far less likely to be insured or employed? I'm sure if you adjusted the study for these factors, the numbers would be the same.