Racialized Inequities in Knee Arthroplasty Receipt After Osteoarthritis Diagnosis in the US Military Health System

Abstract

ObjectiveTo evaluate institutional inequities in the US Military Health System in knee arthroplasty receipt within three years of knee osteoarthritis diagnosis when accounting for other treatments received (e.g., physical therapy, medications).MethodsIn this retrospective observational cohort study, medical record data of patients (N =29,734) who received a primary osteoarthritis diagnosis in the US Military Health System between January 2016 to January 2020 were analyzed. Data included receipt of physical therapy 1‐year pre‐diagnosis and up to 3‐years post‐diagnosis, pre‐diagnosis opioid and non‐opioid prescription receipt, health‐related factors associated with levels of racism, and the primary outcome, knee arthroplasty receipt within 3‐years post‐diagnosis.ResultsIn a generalized additive model with time‐varying covariates, Asian and Pacific Islander (Incidence Rate Ratio (IRR) 0.58; 95% CI 0.45, 0.74), Black (IRR 0.52; 95%CI 0.46, 0.59), and Latinx (IRR 0.66; 95%CI 0.52, 0.85) patients experienced racialized inequities in knee arthroplasty receipt, relative to white patients (all p < 0.001).ConclusionsIn the present sample, Asian and Pacific Islander, Black, and Latinx patients were significantly less likely to receive a knee arthroplasty, relative to white patients. Taken together, system‐level resources are needed to identify and address mechanisms underlying institutional inequities in knee arthroplasty receipt, such as factors related to systemic and structural, institutional, and personally‐mediated racism.