Black patients lose 72,000 QALYs due to total knee replacement disparities
Racial disparities in the rates of total knee replacement among patients with osteoarthritis have resulted in blacks losing the equivalent of 72,000 quality-adjusted life years, according to findings published in Arthritis Care and Research.
“This is the first study that translates the racial disparities in TKR utilization into the language of public health relevance — underutilization of the highly successful surgery leads to drastic losses of quality adjusted life years among racial minorities,” Elena Losina, PhD, of Brigham and Women's Hospital, told Healio Rheumatology. “Furthermore, modifiable factors such as increasing offer and reducing complications may lead to substantial gains in communal quality adjusted life years among AA persons with advanced knee OA.”
To determine the approximate total of quality-adjusted life years (QALYs) lost among black patients due to differences in total knee replacement rates, Losina and colleagues used the Osteoarthritis Policy Model, a computer simulation of knee osteoarthritis, to predict outcomes among white and black patients with and without total knee replacement.
The researchers estimated gained per-person QALYs by determining the difference between life years with current knee replacement use, and those with no replacement. In addition, losses among black patients were calculated using the difference between QALYs gained with white rates of total knee replacement and rates reported among blacks. Population-level losses were determined by multiplying per-person QALY losses by the number of patients with advanced knee osteoarthritis.
According to the researchers, both black men and women gain 64,100 QALYs from their current use of total knee replacement. However, had they been offered the procedure, and completed it, at the same rate as white patients, black patients would have gained 72,000 QALYs. In addition, black patients lost 67,500 QALYs due to being offered total knee replacement at a lower rate, 15,800 QALYs because they accept the procedure at a lower rate and 2,600 QALYs because of a higher rate of complications when compared to white patients.
“To improve offer rates, physicians must be educated on racial disparities in [total knee replacement] and the factors that may influence minority patients’ beliefs and attitudes towards surgery,” Losina and the researchers wrote. “To improve acceptance rates, we must adopt patient-centered care that promotes fully informed consent and shared decision making for all patients. Reducing the difference in utilization and complications of [total knee replacement] could increase the quality of life for individual minority patients and have a significant positive effect on the larger population.” – by Jason Laday
Disclosure: The researchers report grant funding from the NIH.