Purpose: The purpose of this study is to examine whether there is a racial difference in social support among patients with knee osteoarthritis (OA), and whether social support contributes to African-American (AA) and white OA patients’ treatment preferences for TJR surgery.
Method: Data from 514 white & 285 AA patients with chronic, frequent knee pain and radiographic evidence of knee OA were evaluated. Structured interviews were conducted to determine sociodemographic information, clinical characteristics, treatment preferences, and extent of structural and functional social support. Logistic regression models, stratified by race, were conducted to assess the association between willingness to undergo TJR surgery and each measure of social support, adjusted for age, sex, income level, disease severity and study site.
Result: Among AA participants, 22.8% were married, as compared with 53.5% of white participants (p<0.001). The mean numbers of close friends/relatives reported by AA and white patients were 7.5 ± 8.9 and 10.3 ± 13.1, respectively (p<0.001). Half of AA patients reported living alone, as compared with 33.5% of white patients (p<0.001). Mean Medical Outcomes Study-Social Support Scale (MOS-SSS) scores were lower in AA (13.4 ± 5.3) as compared with white (15.2 ± 4.8) participants (p<0.001). Compared to white patients with knee OA, AA patients with knee OA were less willing to undergo TJR surgery (80.0% vs. 62.4%, p<0.001). Among AA knee OA patients, willingness to undergo TJR surgery was not significantly associated with marital status (OR 1.2; 95% CI, 0.6-2.2), number of close friends/relatives (OR 1.0; 95% CI, 0.8-1.3) or MOS-SSS (OR 1.0; 95% CI, 1.0-1.1). Among white knee OA patients, the odds of willingness to undergo TJR surgery was nearly twice as high among those who were married compared to those who were not (OR 1.9, 95% CI 1.1-3.2). In addition, the association between willingness and MOS-SSS score remained significant even after controlling for sociodemographic and clinical variables (OR 1.1, 95% CI 1.0-1.1).
Conclusion: In this sample of patients with knee OA, AA patients had lower preference for TJR compared with white patients. Furthermore, AA patients reported less structural and functional social support than white patients. However, social support appears to be an important determinant of TJR preference among white patients but not AA patients.
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