ARTHRITIS & RHEUMATISM Vol. 46, No. 9, September 2002, pp 2429–2435 DOI 10.1002/art.10494 © 2002, American College of Rheumatology Differences in Expectations of Outcome Mediate African American/White Patient Differences in “Willingness” to Consider Joint Replacement Said A. Ibrahim, 1 Laura A. Siminoff, 2 Christopher J. Burant, 2 and C. Kent Kwoh 3 Objective. Joint replacement therapy is an effec- tive treatment option for end-stage osteoarthritis (OA) of the knee and/or hip. There are marked racial/ethnic disparities in the utilization of this procedure. The reasons for these disparities are not known. We sought to determine whether African American patients differ from white patients in their “willingness” to consider joint replacement and to determine the factors that influence this relationship. Methods. We performed a cross-sectional survey of 596 elderly, male, African American or white patients with moderate-to-severe symptomatic knee or hip OA who were receiving primary care at the Department of Veterans Affairs outpatient clinics. Results. The groups were similar with respect to age, severity of arthritis measured by the Lequesne Scale and the Western Ontario and McMaster Univer- sities Osteoarthritis Index, and scores on the Charlson Comorbidity Index and Geriatric Depression Scale. Compared with whites, African Americans were less likely to be employed or married or to have attained a high school education, but were more likely to report a median annual household income of <$10,000. They were also less likely than whites to be familiar with joint replacement and more likely to expect a longer duration of hospital course, pain, and functional disability fol- lowing replacement surgery. African American patients were less “willing” than white patients to consider joint replacement (odds ratio 0.50, 95% confidence interval 0.30–0.84). However, this difference was explained by the between-group differences in expectations. Conclusion. African American patients were less likely than white patients to express “willingness” to consider joint replacement if the procedure was needed and recommended. This difference was explained by differences between the groups in their expectations of hospital course, pain, and function following replace- ment surgery. Joint replacement therapy is a cost-effective treatment option for end-stage osteoarthritis (OA) of the knee and/or hip (1). Ninety percent of those who undergo knee or hip joint replacement experience relief of pain and/or functional improvement—an important outcome(s) for patients (2). The procedure is associated with a mortality risk of 1%, making it one of the safest surgical procedures routinely performed (2). A single successful joint replacement treatment lasts for 10–20 years. One in every 115 Americans over the age of 65 years has had a joint replacement, with 500,000 pro- cedures being performed annually in the US (3). Con- sidering the aging of the US population, the high prevalence of OA in all ethnic and demographic groups (4–6), and the fact that OA is a leading cause of disability among the elderly (7,8), one would expect few disparities in utilization of a treatment that is as effective as joint replacement. Yet there are marked racial/ethnic disparities in the utilization of this procedure. White men are 3.0–5.1 times more likely than African Ameri- can men to undergo knee joint replacement (9–11). Significant differences in favor of whites have also been Supported by the Department of Veterans Affairs (VA) Health Services Research and Development Office (ECV-0003). Dr. Ibrahim is the recipient of a VA Career Development Award in Health Services Research. 1 Said A. Ibrahim, MD, MPH: Center for Health Equity Research and Promotion, VA Pittsburgh HealthCare System, Pitts- burgh, Pennsylvania; 2 Laura A. Siminoff, PhD, Christopher J. Burant, MS: Case Western Reserve University School of Medicine, Cleveland, Ohio; 3 C. Kent Kwoh, MD: Center for Health Equity Research and Promotion, VA Pittsburgh HealthCare System, and University of Pittsburgh, Pittsburgh, Pennsylvania. Address correspondence and reprint requests to Said A. Ibrahim, MD, MPH, Center for Health Equity Research and Promo- tion, VA Pittsburgh HealthCare System, University Drive C, 11-East (130 A-U), Pittsburgh, PA 15240. E-mail: said.ibrahim2@med.va.gov. Submitted for publication October 19, 2001; accepted in revised form May 17, 2002. 2429