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Racial Differences in Health Care Utilization Among Patients with Osteoarthritis
KELLI L. DOMINICK, TARA K. DUDLEY, STEVEN C. GRAMBOW, EUGENE Z. ODDONE, and HAYDEN B. BOSWORTH
ABSTRACT.
Methods. Subjects were 1612 white and 861 African American patients receiving medical care for OA at the Durham VAMC, Durham, NC, USA. Two major components of OA related medical care were examined during a one-year period: physician visits and use of analgesic and antiinflammatory medications. Results. There were no racial differences in overall frequency of OA related physician visits or visits to rheumatologists. About 86% of both African American and white patients were prescribed some analgesic or antiinflammatory medication. There were, however, racial differences in the use of specific drug classes. African Americans were more likely to be prescribed nonselective nonsteroidal antiinflammatory drugs (69% vs 60%), but less likely to be prescribed COX-2 inhibitors (4% vs 7%) and narcotic analgesics (33% vs 40%) than whites (all p < 0.05). African Americans also had a shorter annual mean days' supply for several common medications, including acetaminophen, acetaminophen combined with codeine, and acetaminophen combined with oxycodone (all p < 0.05). Conclusion. African Americans and white veterans with OA did not differ substantially in their use of physician services. However, within this equal access health care system that requires minimal co-payments for medications, there were racial differences in prescription medication use. These differences may have implications for both quality of pain relief and risk of side effects. (J Rheumatol 2003;30:2201-6) Key Indexing Terms:
OSTEOARTHRITIS
From the Center for Health Services Research in Primary Care, Durham VAMC; and the Division of General Internal Medicine, Department of Psychiatry and Behavioral Sciences, Department of Biostatistics and Bioinformatics, and Center for Aging and Human Development of Duke University Medical Center, Durham, North Carolina, USA. Dr. Dominick was supported by a post-doctoral fellowship from the Department of Veterans Affairs, Veterans Health Administration, HSR&D Service. K.L. Dominick, PhD, Health Research Scientist, Center for Health Services Research in Primary Care, Durham VAMC, Assistant Research Professor, Department of General Internal Medicine, Senior Fellow, Center for the Study of Aging and Human Development, Duke University; T.K. Dudley, MStat, Statistician, Center for Health Services Research in Primary Care, Durham VAMC; S.C. Grambow, PhD, Senior Statistician, Center for Health Services Research in Primary Care, Durham VAMC, Assistant Research Professor, Department of Biostatistics and Bioinformatics, Duke University; E.Z. Oddone, MD, MHSc, Director, Center for Health Services Research in Primary Care, Durham VAMC, Chief, Division of General Internal Medicine and Senior Fellow, Center for the Study of Aging and Human Development, Duke University; H.B. Bosworth, PhD, Associate Director, Center for Health Services Research in Primary Care, Durham VAMC, Associate Research Professor, Department of Medicine, Assistant Research Professor, Department of Psychiatry and Behavioral Sciences, Senior Fellow, Center for the Study of Aging and Human Development, Duke University. Address reprint requests to Dr. K.L. Dominick, Veterans Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705. E-mail: domin004@mc.duke.edu Submitted May 8, 2002; revision accepted March 12, 2003. |