FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 349:1350-1359 October 2, 2003 Number 14 Next

	Full Text PDF PDA Full Text Editorial by Lavizzo-Mourey, R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background There are large variations in the use of knee arthroplasty among Medicare enrollees according to race or ethnic group and sex. Are racial and ethnic disparities more pronounced in some regions than in others, and if so, why?

Methods We used all Medicare fee-for-service claims data for 1998 through 2000 to determine the incidence of knee arthroplasty according to Hospital Referral Region, sex, and race or ethnic group. A total of 430,726 knee arthroplasties were performed during the three-year study period.

Results At the national level, the annual rate of knee arthroplasty was higher for non-Hispanic white women (5.97 procedures per 1000) than for Hispanic women (5.37 per 1000) and black women (4.84 per 1000). The rate for non-Hispanic white men (4.82 procedures per 1000) was higher than that for Hispanic men (3.46 per 1000) and more than double that for black men (1.84 per 1000). The rates were significantly lower for black men than for non-Hispanic white men in nearly every region of the country (P<0.05). For the Hispanic population and for black women, racial or ethnic disparities at the national level were due in part to geographic differences rather than to differences in the rates for different racial and ethnic groups within geographic areas. Residential segregation and low income levels contributed to racial and ethnic disparities in arthroplasty rates.

Conclusions In the Medicare population, the rate of surgical treatment for osteoarthritis of the knee varies dramatically according to sex, race or ethnic group, and region. These variations underscore the importance of geography and sex in determining racial or ethnic barriers to health care.

Source Information

From the Center for the Evaluative Clinical Sciences and Community and Family Medicine, Dartmouth Medical School, Lebanon, N.H. (J.S., J.N.W., J.E.W.); the Department of Economics, Dartmouth College, Hanover, N.H. (J.S.); the Department of Orthopedics, Dartmouth–Hitchcock Medical Center, Lebanon, N.H. (J.N.W., S.M.S.); and the National Bureau of Economic Research, Cambridge, Mass. (J.S.).

Address reprint requests to Dr. Weinstein at the Dartmouth–Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, or at james.weinstein{at}dartmouth.edu.

Full Text of this Article

Related Letters:

Racial, Ethnic, and Geographic Disparities in Rates of Knee Arthroplasty
Kulig K., Bingham C. O. III, Steele L. L., Skinner J., Weinstein J.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:305-306, Jan 15, 2004. Correspondence

This article has been cited by other articles:

• Kramer, M. R., Hogue, C. R. (2009). Is Segregation Bad for Your Health?. Epidemiol Rev 31: 178-194 [Abstract] [Full Text]  
• (2009). Racial Disparities in Total Knee Replacement Among Medicare Enrollees--United States, 2000-2006. JAMA 302: 1525-1526 [Full Text]  
• Judge, A., Welton, N. J., Sandhu, J., Ben-Shlomo, Y. (2009). Geographical variation in the provision of elective primary hip and knee replacement: the role of socio-demographic, hospital and distance variables. J Public Health (Oxf) 31: 413-422 [Abstract] [Full Text]  
• ANG, D. C., TAHIR, N., HANIF, H., TONG, Y., IBRAHIM, S. A. (2009). African Americans and Whites Are Equally Appropriate to be Considered for Total Joint Arthroplasty. The Journal of Rheumatology 36: 1971-1976 [Abstract] [Full Text]  
• Fanuele, J., Koval, K. J., Lurie, J., Zhou, W., Tosteson, A., Ring, D. (2009). Distal Radial Fracture Treatment: What You Get May Depend on Your Age and Address. JBJS 91: 1313-1319 [Abstract] [Full Text]  
• Bible, J. E., Lee, R. S., Friedlaender, G. E. (2009). The Need for Increased Access to the U.S. Health-Care System. JBJS 91: 476-484 [Full Text]  
• Hawker, G., Guan, J., Judge, A., Dieppe, P. (2008). Knee Arthroscopy in England and Ontario: Patterns of Use, Changes Over Time, and Relationship to Total Knee Replacement. JBJS 90: 2337-2345 [Abstract] [Full Text]  
• Smith, D. B., Feng, Z., Fennell, M. L., Zinn, J., Mor, V. (2008). Racial Disparities in Access to Long-Term Care: The Illusive Pursuit of Equity. Journal of Health Politics, Policy and Law 33: 861-881 [Abstract]  
• Basu, J., Mobley, L. R. (2008). Trends in Racial Disparities Among the Elderly for Selected Procedures. Med Care Res Rev 65: 617-637 [Abstract]  
• Hamel, M. B., Toth, M., Legedza, A., Rosen, M. P. (2008). Joint Replacement Surgery in Elderly Patients With Severe Osteoarthritis of the Hip or Knee: Decision Making, Postoperative Recovery, and Clinical Outcomes. Arch Intern Med 168: 1430-1440 [Abstract] [Full Text]  
• Gaskin, D. J., Spencer, C. S., Richard, P., Anderson, G. F., Powe, N. R., LaVeist, T. A. (2008). Do Hospitals Provide Lower-Quality Care To Minorities Than To Whites?. Health Aff (Millwood) 27: 518-527 [Abstract] [Full Text]  
• Clarke, S. P., Davis, B. L., Nailon, R. E. (2007). Racial Segregation and Differential Outcomes in Hospital Care. West J Nurs Res 29: 739-757 [Abstract]  
• SooHoo, N. F., Zingmond, D. S., Ko, C. Y. (2007). Comparison of Reoperation Rates Following Ankle Arthrodesis and Total Ankle Arthroplasty. JBJS 89: 2143-2149 [Abstract] [Full Text]  
• Smith, D. B., Feng, Z., Fennell, M. L., Zinn, J. S., Mor, V. (2007). Separate And Unequal: Racial Segregation And Disparities In Quality Across U.S. Nursing Homes. Health Aff (Millwood) 26: 1448-1458 [Abstract] [Full Text]  
• Nelson, C. L. (2007). Disparities in Orthopaedic Surgical Intervention. J Am Acad Orthop Surg 15: S13-S17 [Abstract] [Full Text]  
• Rowley, D. L., Jenkins, B. C., Frazier, E. (2007). Utilization of Joint Arthroplasty: Racial and Ethnic Disparitiesin the Veterans Affairs Health Care System. J Am Acad Orthop Surg 15: S43-S48 [Abstract] [Full Text]  
• Ibrahim, S. A. (2007). Racial and Ethnic Disparities in Hip and Knee Joint Replacement:A Review of Research in the Veterans Affairs Health Care System. J Am Acad Orthop Surg 15: S87-S94 [Abstract] [Full Text]  
• Chen, A. Y., Schrag, N. M., Halpern, M., Stewart, A., Ward, E. M. (2007). Health Insurance and Stage at Diagnosis of Laryngeal Cancer: Does Insurance Type Predict Stage at Diagnosis?. Arch Otolaryngol Head Neck Surg 133: 784-790 [Abstract] [Full Text]  
• White, A. A. III, Hill, J. A., Mackel, A. M., Rowley, D. L., Rickards, E. P., Jenkins, B. (2007). Symposium. The Relevance of Culturally Competent Care in Orthopaedics to Outcomes and Health Care Disparities. JBJS 89: 1379-1384 [Full Text]  
• Losina, E., Wright, E. A., Kessler, C. L., Barrett, J. A., Fossel, A. H., Creel, A. H., Mahomed, N. N., Baron, J. A., Katz, J. N. (2007). Neighborhoods Matter: Use of Hospitals With Worse Outcomes Following Total Knee Replacement by Patients From Vulnerable Populations. Arch Intern Med 167: 182-186 [Abstract] [Full Text]  
• Liang, S.-Y., Phillips, K. A., Haas, J. S. (2006). Measuring Managed Care and Its Environment Using National Surveys: A Review and Assessment. Med Care Res Rev 63: 9S-36S [Abstract]  
• Skinner, J., Zhou, W., Weinstein, J. (2006). The Influence of Income and Race on Total Knee Arthroplasty in the United States. JBJS 88: 2159-2166 [Abstract] [Full Text]  
• Punglia, R. S., Weeks, J. C., Neville, B. A., Earle, C. C. (2006). Radiation Therapy After Mastectomy Between 1991 and 1999 in Elderly Women: Response to Clinical Trial Information. JCO 24: 3474-3482 [Abstract] [Full Text]  
• Malat, J. (2006). Expanding research on the racial disparity in medical treatment with ideas from sociology.. Health (London) 10: 303-321 [Abstract]  
• Robbins, J. M., Webb, D. A. (2006). Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study. AJPH 96: 1260-1264 [Abstract] [Full Text]  
• Sequist, T. D., Adams, A., Zhang, F., Ross-Degnan, D., Ayanian, J. Z. (2006). Effect of quality improvement on racial disparities in diabetes care.. Arch Intern Med 166: 675-681 [Abstract] [Full Text]  
• Trivedi, A. N., Sequist, T. D., Ayanian, J. Z. (2006). Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality. J Am Coll Cardiol 47: 417-424 [Abstract] [Full Text]  
• Krupski, T. L., Kwan, L., Afifi, A. A., Litwin, M. S. (2005). Geographic and Socioeconomic Variation in the Treatment of Prostate Cancer. JCO 23: 7881-7888 [Abstract] [Full Text]  
• Skinner, J., Chandra, A., Staiger, D., Lee, J., McClellan, M. (2005). Mortality After Acute Myocardial Infarction in Hospitals That Disproportionately Treat Black Patients. Circulation 112: 2634-2641 [Abstract] [Full Text]  
• Freburger, J. K, Carey, T. S, Holmes, G. M (2005). Management of Back and Neck Pain: Who Seeks Care From Physical Therapists?. ptjournal 85: 872-886 [Abstract] [Full Text]  
• Jha, A. K., Fisher, E. S., Li, Z., Orav, E. J., Epstein, A. M. (2005). Racial Trends in the Use of Major Procedures among the Elderly. NEJM 353: 683-691 [Abstract] [Full Text]  
• Stuart, M., Ryser, C., Levitt, A., Beer, S., Kesselring, J., Chard, S., Weinrich, M. (2005). Stroke Rehabilitation in Switzerland versus the United States: A Preliminary Comparison. Neurorehabil Neural Repair 19: 139-147 [Abstract]  
• Mahomed, N. N., Barrett, J., Katz, J. N., Baron, J. A., Wright, J., Losina, E. (2005). Epidemiology of Total Knee Replacement in the United States Medicare Population. JBJS 87: 1222-1228 [Abstract] [Full Text]  
• Suarez-Almazor, M. E., Souchek, J., Kelly, P. A., O'Malley, K., Byrne, M., Richardson, M., Pak, C. (2005). Ethnic Variation in Knee Replacement: Patient Preferences or Uninformed Disparity?. Arch Intern Med 165: 1117-1124 [Abstract] [Full Text]  
• Dormandy, E., Michie, S., Hooper, R., Marteau, T. M (2005). Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women's attitudes or a failure to facilitate informed choices?. Int J Epidemiol 34: 346-352 [Abstract] [Full Text]  
• Groeneveld, P. W., Heidenreich, P. A., Garber, A. M. (2005). Trends in implantable cardioverter-defibrillator racial disparity: The importance of geography. J Am Coll Cardiol 45: 72-78 [Abstract] [Full Text]  
• Freburger, J. K, Holmes, G. M (2005). Physical Therapy Use by Community-Based Older People. ptjournal 85: 19-33 [Abstract] [Full Text]  
• Long, J. A., Chang, V. W., Ibrahim, S. A., Asch, D. A. (2004). Update on the Health Disparities Literature. ANN INTERN MED 141: 805-812 [Full Text]  
• Bach, P. B., Pham, H. H., Schrag, D., Tate, R. C., Hargraves, J. L. (2004). Primary Care Physicians Who Treat Blacks and Whites. NEJM 351: 575-584 [Abstract] [Full Text]  
• Linden, H. M., Ramsey, S., Anderson, N. (2004). An Ounce of Prevention or a Pound of Cure? Investing to Improve Breast Cancer Outcomes for African American Women. JCO 22: 2517-2518 [Full Text]  
• Kulig, K., Bingham, C. O. III, Steele, L. L., Skinner, J., Weinstein, J. (2004). Racial, Ethnic, and Geographic Disparities in Rates of Knee Arthroplasty. NEJM 350: 305-306 [Full Text]  
• Lavizzo-Mourey, R., Knickman, J. R. (2003). Racial Disparities -- The Need for Research and Action. NEJM 349: 1379-1380 [Full Text]