Byrne M, Byrne M, O'Malley K, Souchek J, Suarez-Almazor M; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 14.
Department of Medicine, University of Pittsburgh, 3708 Fifth Avenue, Suite 300, Pittsburgh, PA 15213; Tel: (412) 647-0899; Fax: (412) 647- 5877; E-mail: byrnem@pitt.edu
RESEARCH OBJECTIVE: Although knee osteoarthritis (OA) appears to be at least as prevalent in African-Americans than Caucasians, Caucasians have age-adjusted rates of total knee arthroplasty (TKA) that are two to five times higher than for African Americans. The aim of this study was to determine whether the strength of preferences for improvements in knee OA was also higher for Caucasians than for African Americans and Hispanics. STUDY DESIGN: Contingent valuation surveys using willingness-to-pay (WTP) methodology were conducted to elicit preferences for three OA scenarios. Participants were asked what amount of money they would be willing to pay to: a) eliminate moderately painful osteoarthritis of the knee (MOA), b) eliminate extremely painful osteoarthritis of the knee (SOA), and c) move from SOA to MOA state. WTP amounts were calculated as a percentage of income to control for differences in ability to pay. Sociodemographic information was collected, and a relative propensity to spend variable, adjusted for income was constructed for each individual from WTP values for 5 non-health items. Univariate and multivariate regression analyses were conducted to determine whether there were differences across race in WTP for health improvements and non-health items. POPULATION STUDIED: White (63), African American (64), and Hispanic (63) individuals over the age of 18 who live in Harris County Texas were interviewed. PRINCIPAL FINDINGS: WTP as a percentage of income for each of the three scenarios was highest for Caucasians, followed by Hispanics, and lowest for African Americans (e.g. 32.9%, 26.4%, and 16.7% for MOA). Univariate analyses showed that for each scenario, WTP as a percentage of income for Caucasians was significantly higher than for African American (p<0.05), and WTP for the move from SOA to MOA was significantly higher for Hispanics than for African Americans. Multivariate regression analyses, including variables for age, insurance status, religion and education level, retained the significant differences for Caucasians and African Americans, with moderate R2 values (MOA R2= 15.8%, SOA R2= 12.3%, SOA to MOA R2= 18.8%). A multivariate regression model with propensity of spend as the dependent variable and race as the independent variable of interest, controlling for sociodemographic variables, showed that African Americans had significantly higher WTP as a percentage of income for non-health items than did Caucasians. CONCLUSIONS: African-Americans report lower preferences in terms of WTP for improvements in knee osteoarthritis than do Caucasians, but higher propensity to spend on non-health related items. Thus the differences in the rates of TKA between African Americans and Caucasians are consistent with reported preferences for knee OA improvements. However, reasons for differences in preferences ? e.g. trust in the medical system ? should also be explored before disparities in TKA rates are seen as appropriate based on patient preferences. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Racial disparities in health care procedures may be due to a variety of causes including differences in preferences. When differences in preferences are found, differences in procedure rates may be justified, but additional factors affecting reported preferences must also be considered as well. PRIMARY FUNDING SOURCE: AHRQ
Publication Types:
Keywords:
- African Americans
- Animals
- Arthroplasty, Replacement, Knee
- Continental Population Groups
- Data Collection
- Delivery of Health Care
- Educational Status
- European Continental Ancestry Group
- Health Expenditures
- Hispanic Americans
- Humans
- Income
- Osteoarthritis, Knee
- Patient Satisfaction
- Regression Analysis
- Texas
- economics
- surgery
- hsrmtgs
Other ID:
UI: 102273752
From Meeting Abstracts