Table 1:
Summary of Literature on Racial and Socioeconomic Disparities in OA Management
| OA Treatment | Quantity of Evidence (minimal, some, moderate, many) | Quality of Evidence | Is Data Consistent or Conflicting? In Which Direction? |
|---|---|---|---|
| Recommended Management | |||
| Arthritis Education (race)7–9 | Minimal | Large cross-sectional | No association |
| Arthritis Education (SES)3–11 | Moderate | Large cross-sectional with adjustment | Consistent: higher education associated with higher self-education program use, more provider education |
| Dietary Weight Management13–16,18 | Minimal (OA patients) | - | - |
| Many (general population) | Large cross-sectional | Consistent: blacks, Hispanics, low income, low education associated with higher obesity rates, worse diet quality | |
| Exercise/Physical Therapy: Access/Use (race)19,25–29 | Some | Large cross-sectional surveys with adjustment | Consistent: Hispanics, blacks get less PT/exercise |
| Exercise/Physical Therapy: Access/Use (SES)20–29 | Moderate | Cross-sectional surveys with adjustment | Consistent: higher education and private insurance associated with more PT/exercise; lower education and Medicaid or no insurance with less PT/exercise |
| Exercise/Physical Therapy: Outcomes30–35 | Some | Prospective studies, 6 weeks-18 months follow up | Consistent: PT/exercise programs help regardless of education/race, may help reduce disparities in functional outcomes |
| Pharmacology: NSAIDs (race)36–45 | Moderate | Moderate/large retrospective and cross-sectional, with adjustment | Mixed for OTC/prescription NSAID use; Consistent for drug classes: blacks, Hispanics get non-selective NSAIDs, whites get more COX-2 selective NSAIDs (older literature) |
| Pharmacology: NSAIDS (SES) | Minimal | - | - |
| Intraarticular Steroid Injections | Minimal | - | - |
| Total Joint Replacement: Access/Use (race)2,38–57–74,74–79,81,86–88,91,94,105,112–120,127–131 | Many | Large retrospective with adjustment | Consistent: blacks, Hispanics receive less TKA, THA than whites; Evidence for structural, provider-and patient-level barriers |
| Total Joint Replacement: Access/Use59,65,66,82,86,87,89,90 | Moderate | Large retrospective with adjustment | Consistent: low SES associated with less THA, TKA |
| Total Joint Replacement: Outcomes65,66,76,78,106,137–146,151–153,157–162,166–172 | Many | Large retrospective and some prospective, with adjustment | Mostly consistent: blacks, Hispanics have worse functional outcomes and more complications |
| Total Joint Replacement: Outcomes (SES)137,140,145,147–150,154–156,161,163–165,169,170 | Moderate | Large retrospective with adjustment | Mostly consistent: low SES (insurance, income) associated with worse functional outcomes and more complications |
| Not Recommended | |||
| Pharmacology: Opioids (race)38,41,43,45,54–56 | Moderate (OA), Many (general) | Large retrospective and cross-sectional, with adjustment | Mostly consistent: whites more likely than blacks or Hispanics to receive opioid prescription; days’ supply for whites is higher than for blacks |
| Pharmacology: Opioids (SES)54 | Minimal | Large retrospective with adjustment | Living in a low-education area or having low income associated with prolonged opioid prescription |