Ethnic Differences in the Management of Osteoarthritis

描述(由申请人提供)：选择性全关节置换术使用中的健康差异已被NIAMS作为进一步研究的优先领域。这项拟议的研究试图检查可能为这些健康差距提供基础的因素，并建立在两项联邦资助研究的基础上。第一项研究考察了男性退伍军人在骨关节炎(OA)治疗方面的种族差异。第二项是健康老龄化研究：身体成分(Health ABC)研究，这是一项由NIA资助的纵向评估，重点是从宾夕法尼亚州匹兹堡和田纳西州孟菲斯大都市地区招募的两个年龄在70岁至79岁之间的基于人群的队列个人。这项研究的总体目标是更好地了解在使用全膝关节置换术(TKA)或全髋关节置换术(THA)方面存在种族差异的原因。这项拟议的研究将考察非裔美国人女性和男性以及患有膝盖骨或髋关节骨性关节炎的白人女性和男性的健康信念、做法、偏好和看法，以及这些因素可能如何影响对TKA/THA的考虑。将利用横断面研究设计来检验下列具体目标：1)检验放射学严重程度相似的骨性关节炎患者对症状和功能状态的自我报告的种族/性别差异；2)考察种族/文化差异对关节炎特定治疗方案的疗效和接受TKA/THA的意愿的差异；3)检测对关节炎具体治疗方案的认知和接受TKA/THA的意愿的性别差异；以及4)考察与获得TKA/THA相关的提供者层面因素的种族/性别差异。来自Health ABC研究的518名有症状和放射检查的膝关节骨关节炎患者和271名有症状和放射检查的髋关节骨关节炎患者将接受调查。关于具体目标1和2，可能混淆种族或性别与关节置换术意愿之间关系的主要变量包括：对关节置换术的风险和益处的了解；疼痛应对策略；对特定治疗方案(如祈祷)的有效性的看法，以及对保健的看法。这项拟议的研究的独特之处在于，它将检查不同疾病严重程度的患者在管理骨性关节炎方面的种族和性别差异，重点关注可能解释健康差异的特定因素。

DESCRIPTION (provided by applicant): Health disparities in the utilization of elective total joint replacement has been targeted as a priority area for additional research by NIAMS. The proposed study seeks to examine factors that may provide the basis for these health disparities and builds on two federally funded studies. The first examines ethnic differences in the management of osteoarthritis (OA) among male veterans. The second, the Study of Health Aging: Body Composition (Health ABC) study, is a NIA-funded longitudinal evaluation focusing on two population-based cohorts of individuals between the ages of 70 to 79 recruited from the Pittsburgh, PA and Memphis, TN metropolitan areas. The overall goal of this research is to better understand the reasons behind ethnic variations in the utilization of lower extremity total knee arthroplasty (TKA) or total hip arthroplasty (THA). The proposed study will examine the health beliefs, practices, preferences and perceptions of African American women and men, as well as white women and men with knee or hip OA and how these factors may influence consideration of TKA/THA. A cross-sectional study design will be utilized to examine the following Specific Aims: 1) To examine ethnic/gender differences in individuals' self-report of symptoms and functional status among individuals with OA of similar radiologic severity; 2) To examine ethnic/cultural differences in perceptions of the efficacy of specific treatment options for arthritis and willingness to have TKA/THA; 3) To examine gender differences in perceptions of specific treatment options for arthritis and willingness to have TKA/THA; and 4) To examine ethnic/gender differences in provider-level factors related to access to TKA/THA. The 518 individuals from the Health ABC study with symptomatic and radiographic knee OA and 271 with symptomatic and radiographic hip OA will be surveyed. Regarding Specific Aims 1 and 2, major variables that may confound the relationship between ethnicity or gender and willingness to have joint replacement include understanding the risks and benefits of joint replacement; pain coping strategies; perceptions of the efficacy of a specific treatment option such as prayer, and perceptions of health care. The proposed study is unique in that it will examine ethnic and gender differences in the management of OA across patients with varying disease severity, focusing on specific factors that may explain health disparities.