Objective. Osteoarthritis (OA) is a major debilitating disease affecting ϳ27 million persons in the US. Yet, the financial costs to patients and insurers remain poorly understood. The purpose of this study was to quantify by multivariate analyses the relationships between OA and annual health care expenditures borne by patients and insurers. Conclusion. The health care cost burden associated with OA is quite large for all groups examined and is disproportionately higher for women. Although insurers bear the brunt of treatment costs for OA, the OOP costs are also substantial. Osteoarthritis (OA) is a common and debilitating disease that affects ϳ27 million people in the US (1).Given an aging population, the prevalence and costs associated with OA are projected to increase. Forecasts indicate that by the year 2030, 25% of the adult US population, or nearly 67 million people, will have physician-diagnosed arthritis (2). It is thus important from a policy perspective to quantify the direct health care costs associated with this disease.While a number of studies have estimated the direct costs of OA (3-12), existing studies using US data are regionally based, and the results may not be generalizable. These studies typically use data obtained during the early 1990s. In reviewing the literature on the costs of OA, Xie et al (13) noted that ". . . cost of OA studies were insufficiently performed in the past decade . . ." Existing studies typically did not perform multivariate analyses to better isolate the effects of OA on health expenditures. While studies have adjusted for age and sex in comparing cohorts of OA and non-OA patients, Maetzel (14) noted that such matching ". . . is unlikely to weed out the costs that are attributable to other comorbidities, unless they have been adjusted for."Evidence on the direct costs of OA varies greatly. In their literature review, Xie et al (13) noted that direct costs from OA varied 10-fold among studies in the US. Wide variations across other countries were observed as well. These striking variations reflect a host of factors, including different geographic regions assessed, differ-

Aggregate annual absenteeism costs of osteoarthritis are quite substantial as measured by the probability of absenteeism, days missed from work, and their dollar values, compared with other major chronic diseases.

IntroductionWhile studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors.MethodsThis study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates.ResultsMultivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis.ConclusionsRacial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.Electronic supplementary materialThe online version of this article (doi:10.1007/s40615-016-0261-9) contains supplementary material, which is available to authorized users.

After adjusting for sociodemographic characteristics, patient comorbidities, and hospital characteristics, Native Americans with PAD who reside in the West Census Region are substantially more likely to undergo amputation than are non-Hispanic Whites.

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