Gender Disparities in Osteoarthritis-Related Healthcare Utilization Prior to Total Knee Arthroplasty

• Published in: The Journal of arthroplasty
• Main Authors: Bawa, Harpreet S., MD, Weick, Jack W., BS, Dirschl, Douglas R., MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Orthopedics; Total knee arthroplasty; healthcare utilization; gender differences; Level III
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.03.044

Abstract Objectives Women over the age of 50 have higher prevalence of knee osteoarthritis (OA) and experience greater functional disability than men. No studies have examined large populations to identify knee OA-related health care utilization differences. The purpose of this investigation was to evaluate gender differences in the utilization of OA-related healthcare resources in the 12 months preceding total knee arthroplasty (TKA). Methods Truven Health MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefit databases were reviewed from 2005-2012. Subjects were included if they underwent TKA, had associated diagnosis of lower leg OA, and were continuously in the database for 12 months preceding TKA. Patient specific OA-related healthcare utilization was identified. Multivariate logistic regression analysis controlling for age, region, and Charlson Comorbidity Index was performed to isolate the influence of gender. Results 244,059 patients with a mean age of 64.8 years consisting of 61.2% women were included. Multivariate logistic regression adjusted odds ratios showed that, when compared to men, women were 30%, 20%, 31%, 18%, 19%, 29%, 39%, more likely to receive a narcotic analgesic, non-narcotic analgesics, corticosteroid injection, hyaluronic acid injection, knee MRI, a physical therapy evaluation, and occupational therapy evaluation in the 12 months preceding TKA, respectively. Conclusion Women have a significantly higher utilization of knee OA-related healthcare in the 12 months preceding TKA. While the precise cause for this discrepancy in care cannot be determined from this study, it highlights a potential bias in management of advanced knee OA and directions for further investigation.