Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters

Ernest R. Vina, Di Ran, Erin L. Ashbeck, Manjinder Kaur, Chian K Kwoh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To determine if severity of osteoarthritis-related knee pain is associated with a willingness to undergo total knee replacement (TKR) and whether this association is confounded or modified by components of socioeconomic status and health care coverage. Methods: Cross-sectional analysis was conducted among 3,530 Osteoarthritis Initiative study participants. Logistic regression models were used to assess the effect of knee pain severity (where 0 = none, 1–3 = mild, 4–7 = moderate, and 8–10 = severe) on willingness to undergo TKR. Stratified analyses were conducted to evaluate whether socioeconomic status and health care coverage modify the effect of knee pain severity on willingness. Results: Participants with severe knee pain, compared to participants without pain, were less willing to undergo TKR (odds ratio [OR] 0.73, 95% confidence interval [95% CI] 0.57–0.93). This association was attenuated when adjusted for age, sex, comorbidity, depression, health insurance coverage, prescription medicine coverage, health care source, education, income, employment, race, and marital status (adjusted OR 0.92, 95% CI 0.68–1.24). The odds of willingness to undergo TKR were significantly lower in those with the highest level of pain, compared to those without pain, among participants without health insurance (adjusted OR 0.08, 95% CI 0.01–0.56), but not among those with health insurance (adjusted OR 1.03, 95% CI 0.73–1.38), when adjusted for demographic, clinical, health care access, and socioeconomic factors (P = 0.015). However, <5% of participants were without health insurance. Conclusion: Among participants without health insurance, severe knee pain was paradoxically associated with less willingness to undergo TKR. Policies that improve access to quality health care may affect patient preferences and increase utilization of TKR surgery among vulnerable populations.

Original languageEnglish (US)
Pages (from-to)95-103
Number of pages9
JournalArthritis Care and Research
Volume69
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Replacement Arthroplasties
Patient Preference
Knee Replacement Arthroplasties
Knee
Delivery of Health Care
Health Insurance
Pain
Odds Ratio
Confidence Intervals
Social Class
Logistic Models
Health Services Accessibility
Insurance Coverage
Knee Osteoarthritis
Quality of Health Care
Marital Status
Vulnerable Populations
Osteoarthritis
Prescriptions
Comorbidity

ASJC Scopus subject areas

  • Rheumatology

Cite this

Relationship Between Knee Pain and Patient Preferences for Joint Replacement : Health Care Access Matters. / Vina, Ernest R.; Ran, Di; Ashbeck, Erin L.; Kaur, Manjinder; Kwoh, Chian K.

In: Arthritis Care and Research, Vol. 69, No. 1, 01.01.2017, p. 95-103.

Research output: Contribution to journalArticle

Vina, Ernest R. ; Ran, Di ; Ashbeck, Erin L. ; Kaur, Manjinder ; Kwoh, Chian K. / Relationship Between Knee Pain and Patient Preferences for Joint Replacement : Health Care Access Matters. In: Arthritis Care and Research. 2017 ; Vol. 69, No. 1. pp. 95-103.
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