Recipients of hip replacement for arthritis are less likely to be Hispanic, independent of access to health care and socioeconomic status

Objective. To compare the proportion of Hispanics among recipients of hip r eplacements for primary articular disorders, recipients of knee replacement s for the same reason, and persons hospitalized for other reasons. Methods. Twelve of the 17 accredited hospitals in Bexar County, Texas, in w hich hip or knee replacement surgery is performed permitted us to review th eir medical records. From 1993 through 1995, 3,100 elective, non-fracture-r elated, hip or knee replacements were performed. These individuals were mat ched by age, sex, hospital, and month of admission with 4,604 persons hospi talized for other reasons. Age, sex, ethnic background, type of medical ins urance, median household income by zip code of residence, joint replaced, a nd surgical diagnosis were abstracted from the medical records. The validit y of variables abstracted from the medical records was tested by comparison with self-report data in 115 patients interviewed prior to elective hip or knee replacement surgery. Results, During the study period, 2,275 subjects had a total knee replaceme nt and 825 had a total hip replacement. Recipients of hip replacements were significantly less Likely to be Hispanic than were recipients of knee repl acements (19.5% versus 29.9%; odds ratio [OR] 0.57, 95% confidence interval [95% CI] 0.46-0.71; P less than or equal to 0.001) or persons hospitalized for other reasons (29.4% Hispanic; OR 0.67, 95% CI 0.55-0.81). The under-r epresentation of Hispanics was more pronounced among persons undergoing hip replacement for osteoarthritis compared with recipients of knee replacemen ts for the same disease (OR 0.38, 95% CI 0.37-0.62). This pattern persisted after adjusting for age, sex, type of medical insurance, and median househ old income by the zip code of residence. Concordance between medical record s and self-report data on ethnic background was high (kappa = 0.93). Conclusion. Recipients of hip replacement are less likely to be Hispanic th an are other hospitalized persons with a similar level of access to care. T he reasons for this under-representation probably involve factors in additi on to lack of access to health care and low socioeconomic status. Further r esearch is needed to understand the nature of such factors.