Ethnic Differences in the Management of Osteoarthritis

描述（由申请人提供）：选择性全关节置换术的使用中的健康差异已被NIAMS作为额外研究的优先领域。拟议的研究旨在审查可能为这些健康差异提供依据的因素，并建立在两项联邦资助的研究基础上。第一个研究男性退伍军人中骨关节炎（OA）管理的种族差异。第二项是健康老化研究：身体成分（健康ABC）研究，是一项由美国国立卫生研究院资助的纵向评估，重点是从宾夕法尼亚州匹兹堡和田纳西州孟菲斯大都市区招募的70至79岁的两个基于人口的人群。本研究的总体目标是更好地了解下肢全膝关节置换术（TKA）或全髋关节置换术（THA）使用的种族差异背后的原因。拟议的研究将检查非裔美国女性和男性以及患有膝关节或髋关节OA的白色女性和男性的健康信念、实践、偏好和看法，以及这些因素如何影响TKA/THA的考虑。将采用横断面研究设计来检查以下特定目的：1）检查具有相似放射学严重程度的OA个体之间个体症状和功能状态自我报告的种族/性别差异; 2）检查对关节炎特定治疗方案的疗效和接受TKA/THA意愿的认知的种族/文化差异; 3）检查对关节炎特定治疗选择的看法和接受TKA/THA意愿的性别差异;和4）检查与TKA/THA相关的提供者层面因素的种族/性别差异。将对来自Health ABC研究的518名有症状和影像学检查的膝关节OA患者和271名有症状和影像学检查的髋关节OA患者进行调查。关于具体目标1和2，可能混淆种族或性别与关节置换意愿之间关系的主要变量包括了解关节置换的风险和获益;疼痛应对策略;对特定治疗方案（如祈祷）有效性的看法，以及对医疗保健的看法。这项拟议的研究是独一无二的，因为它将研究不同疾病严重程度的OA患者在管理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.