Racial and Ethnic Disparities in the Imaging Workup and Treatment of Knee and Hip Osteoarthritis

• Published in: The Journal of arthroplasty 2022-08, Vol.37 (8), p.S753-S760.e2
• Main Authors: Wu, Mark, Case, Ayden, Kim, Billy I., Cochrane, Niall H., Nagy, Gabriela A., Bolognesi, Michael P., Seyler, Thorsten M.
• Format: Article
• Language: English
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.02.019

There is limited evidence on sociodemographic differences in osteoarthritis management, particularly in non-African American (AA) minorities. We sought to identify differences in imaging modalities, administration of intra-articular injections, and total joint arthroplasty (TJA) between racial/ethnic groups. We retrospectively reviewed patients presenting to outpatient clinics with a diagnosis of hip or knee osteoarthritis from January 2013 to March 2020 at a tertiary center. Univariate analyses compared differences between groups. Multivariate logistic regression analyses determined sociodemographic predictors of imaging workup and treatment. In total, 105,873 patients were included. There were 74,769 (70.6%) Caucasian, 27,117 (25.6%) AA, 1,878 (1.8%) Hispanic, 1,479 (1.4%) Asian, and 630 (0.6%) Native American patients. Multivariate analyses demonstrated that AAs had decreased odds of undergoing a knee magnetic resonance imaging (odds ratio [OR] 0.77, P < .001) or injection (OR 0.94, P = .006). Asian patients had lower odds of receiving any hip X-ray (OR 0.72, P = .047) or knee injection (OR 0.83, P = .017). AA (total knee arthroplasty [TKA]: OR 0.51, P < .001; total hip arthroplasty [THA]: OR 0.57, P < .001), Hispanic (TKA: OR 0.69, P = .003; THA: OR 0.60, P = .006), and Asian (TKA: OR 0.73, P = .010; THA: OR 0.56, P = .010) patients had lower odds of undergoing TJA compared to Caucasians. We found that higher income quartiles had greater odds of receiving a magnetic resonance imaging and TJA, males had lower odds of receiving injections and greater odds of undergoing TJA, and Medicaid and self-pay patients had lower odds of undergoing TJA (P < .05). After adjusting for sociodemographic factors, we found disparities in the imaging, administration of injections, and/or arthroplasty for AA, Asian, and Hispanic patients. Insurance status, income, and gender were also associated with imaging and treatments performed in managing hip and knee osteoarthritis. •Racial disparities exist in the imaging and treatment of hip/knee osteoarthritis.•Asian patients are less likely to undergo knee injections and hip radiographs.•African Americans are less likely to undergo knee MRI and injections.•AA, Hispanic, and Asian patients are less likely to undergo THA and TKA.•Income, insurance status, and patient gender are also associated with imaging and treatment.