Abstract: Is There a Difference in the Perception of Symptoms Between African Americans and Whites with Osteoarthritis?

Is There a Difference in the Perception of Symptoms Between African Americans and Whites with Osteoarthritis?

DENNIS C. ANG, SAID A. IBRAHIM, CHRIS J. BURANT, and C. KENT KWOH

ABSTRACT.

Objective. To determine if there is a difference in the perception of pain and functional disability between African Americans and Whites at any given radiographic severity of osteoarthritis (OA). Ethnic differences in utilization of joint replacement may reflect differences in the perception of symptoms of OA.

Methods. A cross-sectional survey included 596 male veterans (44% African Americans and 56% Whites) with chronic moderate to severe knee and/or hip pain at the General Medicine Clinics. The average age of the total cohort was 65.63 ± 9.5 years. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain and function were the primary outcome measures of interest. All knee and or hip radiographs were graded using the Kellgren-Lawrence (K/L) grading system.

Results. African Americans and Whites were comparable with respect to age (65 ± 9.5 vs 66 ± 9, respectively); body mass index ³ 30 kg/m² (53.9% vs 58.8%); Lequesne severity score (11 ± 4 vs 11 ± 4); geriatric depression score (4.5 ± 3.3 vs 5.0 ± 3.8) and Charlson Comorbidity Index (2.3 ± 2 vs 2.5 ± 2). African Americans had lower socioeconomic status with fewer high school graduates (57% vs 71%, p = 0.001), lower employment rate (8.4% vs 14.7%, p = 0.017), and lower total household incomes (41.4% vs 20.4% reported income < $10,000, p = 0.000). African Americans and Whites were not different in mean scores for WOMAC pain and WOMAC function when stratified by joint space narrowing, osteophyte and Kellgren Lawrence grades. After controlling for important covariates, ethnicity was not a significant predictor of WOMAC pain and function.

Conclusion. In this sample of male veterans, African Americans and Whites perceived the same degree of pain and functional difficulties at any given radiographic severity of OA. Differences in the perception of symptoms cannot explain the observed ethnic disparity in utilization of joint replacement. (J Rheumatol 2003;30:1305-10)

Key Indexing Terms:

OSTEOARTHRITIS
JOINT ARTHROPLASTY
ETHNICITY
HEALTH SERVICE

From the Department of Medicine, Division of Rheumatology, Indiana University, Indianapolis, IN; the Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH; the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and the Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA.

Supported by a grant from the Department of Veterans Affairs, Health Services Research and Development Service (ECV 97-014). Dr. Ibrahim is a recipient of a Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs.

D.C. Ang, MD, MS, Assistant Professor of Medicine, Department of Medicine, Division of Rheumatology, Indiana University; S.A. Ibrahim, MD, MPH, Department of Bioethics, Case Western Reserve University School of Medicine; C.J. Burant, MA, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; C.K. Kwoh, MD, Professor of Medicine, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh.

Address reprint requests to Dr. D.C. Ang, Assistant Professor of Clinical Medicine, Indiana University, Division of Rheumatology, 1110 W. Michigan St., Room 545, Indianapolis, Indiana 46202-5100, USA. E-mail: Dang@iupui.edu

Submitted September 6, 2002; revision accepted November 13, 2002.