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Disparities in total knee replacement: Population losses in quality-adjusted life years due to differential offer, acceptance, and complication rates for Black Americans
- Publication Year :
- 2018
-
Abstract
- Objective Total knee replacement (TKR) is an effective treatment for end-stage knee osteoarthritis (OA). American racial minorities undergo fewer TKRs than whites. We estimated quality-adjusted life-years (QALYs) lost for African American knee OA patients due to differences in TKR offer, acceptance, and complication rates. Methods We used the Osteoarthritis Policy Model, a computer simulation of knee OA, to predict QALY outcomes for African American and white knee OA patients with and without TKR. We estimated per-person QALYs gained from TKR as the difference between QALYs with current TKR use and QALYs when no TKR was performed. We estimated average, per-person QALY losses in African Americans as the difference between QALYs gained with white rates of TKR and QALYs gained with African American rates of TKR. We calculated population-level QALY losses by multiplying per-person QALY losses by the number of persons with advanced knee OA. Finally, we estimated QALYs lost specifically due to lower TKR offer and acceptance rates and higher rates of complications among African American knee OA patients. Results African American men and women gain 64,100 QALYs from current TKR use. With white offer and complications rates, they would gain an additional 72,000 QALYs. Because these additional gains are unrealized, we call this a loss of 72,000 QALYs. African Americans lose 67,500 QALYs because of lower offer rates, 15,800 QALYs because of lower acceptance rates, and 2,600 QALYs because of higher complication rates. Conclusion African Americans lose 72,000 QALYs due to disparities in TKR offer and complication rates. Programs to decrease disparities in TKR use are urgently needed.
- Subjects :
- musculoskeletal diseases
Male
medicine.medical_treatment
Population
Total knee replacement
Article
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Rheumatology
medicine
African american men
Effective treatment
Humans
030212 general & internal medicine
Healthcare Disparities
education
Arthroplasty, Replacement, Knee
Aged
030203 arthritis & rheumatology
African american
education.field_of_study
business.industry
Middle Aged
Models, Theoretical
Osteoarthritis, Knee
Patient Acceptance of Health Care
Arthroplasty
humanities
Quality-adjusted life year
Black or African American
surgical procedures, operative
Female
Quality-Adjusted Life Years
Complication
business
Demography
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....c9242fb7daaa9ebb3fe3527b977bc573