Institutional members access full text with Ovid®

The Association of Race/Ethnicity With the Receipt of Traditional and Alternative Arthritis-Specific Health Care

Mikuls, Ted R. MD, MSPH*; Mudano, Amy S. MPH†; Pulley, LeaVonne PhD‡; Saag, Kenneth G. MD, MSc†

Original Articles

Background. The role of race/ethnicity in the receipt of arthritis-specific health care has not been well defined.

Objective. To examine the association of race/ethnicity with the utilization of arthritis health care among community-dwelling older adults.

Research Design. We used a computer-assisted telephone interview.

Subjects. A population-based random sample was drawn from 6 preselected Alabama counties. Eligible respondents had self-reported arthritis and were over 50 years of age; 1424 people responded to the survey.

Measures. Logistic regression was used to examine the association of race/ethnicity with the use of conventional (including use of a rheumatologist, primary care physician, and prescription arthritis medicines) and complementary and alternative medicines (CAM), including the use of chiropractic care, glucosamine and/or chondroitin, and herbals.

Results. Reflecting stratified sampling, respondents were white (n = 852, 60%) or black (n = 528, 37%), female (72%), and had a mean age of 65 years. After multivariable adjustment, race/ethnicity was not a significant determinant of receiving rheumatology care or prescription arthritis medicines. However, whites were more likely than blacks to have seen a primary care physician for arthritis care (adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.12–1.98) or to have used CAM (OR, 1.47; 95% CI, 1.13–1.91) and twice as likely to have used glucosamine and/or chondroitin (OR, 1.99; 95% CI, 1.30–3.05).

Conclusion. In this population of community-dwelling older adults, white race was significantly associated with CAM use and visits to primary care physicians for arthritis care. In contrast, the use of specialists and prescription arthritis medications was better explained by factors other than race/ethnicity, which included female gender, urban residence, higher educational level, and other arthritis-specific variables.

Despite the large public health impact of arthritis, 1,2 factors leading to the receipt of arthritis-specific health care among older adults have not been completely defined. 2–7 There is growing appreciation that race/ethnicity could be a correlate of healthcare utilization, both in terms of conventional health care 8–12 and complementary and alternative medicine (CAM). 13,14 Compared with whites, blacks with arthritis are less likely to see a rheumatologist, 9 to use prescription arthritis medicines, 12 or to undergo total joint replacement 8,11 and are more likely to perceive prayer as a helpful treatment. 15 We conducted a computer-assisted telephone interview (CATI) of community-dwelling older adults with arthritis to assess the association of race/ethnicity with the receipt of arthritis-specific health care. We hypothesized that blacks, particularly those residing in rural areas, would be less likely than whites to receive either conventional treatments or CAM for their arthritis care.

From the *Department of Medicine, Section of Rheumatology and Immunology, University of Nebraska Medical Center and the Omaha VA Medical Center, Omaha, Nebraska.

From the †Department of Medicine, Division of Clinical Immunology and Rheumatology, Center for Education and Research for Therapeutics (CERTs) in Musculoskeletal Disorders

and the ‡School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.

Funded in part by an unrestricted educational grant from Pfizer Pharmaceuticals and a grant from the Agency for Healthcare Research and Quality (UAB Center for Education and Research on Therapeutics, AHRQ U18 HS10389).

Address correspondence and reprint requests to: Kenneth G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, 1530 3rd Avenue South, MEB 625, Birmingham, AL 35294. E-mail: ksaag@uab.edu

© 2003 Lippincott Williams & Wilkins, Inc.