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Thursday, February 14, 2002

Ethnicity differences affect care in aging

Arthritis is the leading cause of disability in the U.S. affecting about 43 million adults. Nearly four million African Americans report having some type of arthritis. By the year 2020, projections of the number of African Americans' arthritis-related conditions will increase to about seven million.

During a briefing, Charles Weiss, MD, an orthopaedic surgeon in practice in Miami Beach, Fla., presented results of studies summarized by Jo-anne M. Jordan, MD on how different ethnic groups are affected by various musculoskeletal conditions, especially osteoarthritis. "Although numerous studies have been conducted on various orthopaedic and musculoskeletal conditions, the effects and reports have been based largely on the Caucasian population," stated Dr. Weiss.

To determine whether an ethnic or racial disparity exists for a given disease or condition, there should be a standard definition of race and ethnicity for use by researchers, and in clinical practice. Past comparisons for differences among the races were limited to whites and non-whites, not broken out into specific groups.

"In order to provide optimal care for various musculoskeletal conditions, it's becoming increasingly necessary to consider race and eth-nicity as indicators for the type of treatment regimen because of the increased ethnic diversity of the U.S. population, i.e. Caucasian, African American, Hispanic, Asian, etc. and the explosion of elderly patients over the next 25 years," Dr. Weiss added.

"There are risk factors for the development, progression and conse-quences (physical, emotional and economic) of some diseases which affect the elderly and that seem more prevalent in certain ethnic and racial groups. These may be due to cultural, biological (genetic), or socioeconomic status or combinations."

Disability (limited activities of daily living, increased dependence, work loss or modification, or receipt of disability benefits) may be the most significant outcome of arthritis. Recent studies comparing differences in arthritis and disability, examined specific ethnic groups, rather than the general categories of whites and non-white. The 1989-1991 National Health Interview Survey, demonstrated that although African Americans reported age-adjusted arthritis and other rheumatic conditions similar to those reported by Caucasians, African Americans were more likely to report age-adjusted arthritis-related activity limitations (24.5% versus 17.6% respectively).

Similarly, while Hispanics had relatively low rates of age-adjusted self-reported arthritis, (11.3% versus 15.5%) they were more likely than non-Hispanics to report activity limitations from their arthritis, (22.2% versus 18.1%), (Helmick, C.G. et al Arthritis Care Res. 1995;8 (4).

Not all studies of ethnic differences in arthritis-related disability, have shown differences between Caucasians and African Americans. Two recent studies using Health Assessment Questionnaire scores found no differences when risk factor profiles were considered.

New data in the areas of ethnic differences in arthritis symptoms, disability, coping, self-efficacy is useful in helping to modify risk factors and appropriate methods of intervention. "If we use these as indicators to treat this particular orthopaedic condition, we can also learn how best to treat other age-related musculoskeletal conditions. Self care, formal medical care-seeking, use of complementary and alternative care and care patterns could assist clinicians and researchers in coming up with best practices for the aging patient," concluded Dr. Weiss.

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Last modified 15/February/2002