Newswise — Among total knee replacement candidates, the likelihood of reporting lack of social support is higher among black patients compared to white patients, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.
Social support is achieved when a patient is shown physical or emotional concern for well-being. The patient may receive social support through communication, financial aid, sharing of information, and material aid, among others.
To determine if unmet social support needs vary between races and ethnicities, researchers addressed four types of social support in 193 white and 185 black TKR candidates to determine if financial, tangible, informational and emotional social support needs were being met.
Researchers inquired about financial social support by asking participants if they needed and received money or items needed to live, such as food. To investigate tangible social support, researchers specifically asked participants about needing and receiving help with daily duties, such as running errands, performing household tasks, or providing child care. Emotional social support was explored by asking participants if they needed to confide or did confide in someone about their worries or problems. Finally, researchers inquired about informational social support by asking participants if they needed or received information or advice from anyone about a problem.
Among all patients, nearly 20 percent had at least one unmet need, meaning that they needed support, but did not receive it.
Financial needs were met less frequently among black men and women than among white men and women. Black men and women were also more likely to report unmet tangible, emotional and informational social support needs, though the racial and ethnic associations in these categories were not statistically significant.
Researchers in the study agree that future studies with more participants are needed to help quantify the social support needs of TKR candidates, particularly among minority groups, and to understand how unmet social support need may influence a patient's decision to have TKR.
"Among total knee replacement candidates, black men and women appear to be at risk for having increased unmet social support needs compared to white men and women," said Huan Justina Chang, MD, MPH; assistant professor of medicine, rheumatology; Northwestern University, Feinberg School of Medicine; and the lead investigator in the study. "The disparity in unmet social support needs between black and white men and women is particularly notable in the unmet financial need group. Future studies in this area should focus on whether there is a causal relationship between social support and timing of total knee replacement, and the direction of this relationship."
The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.
Editor's Notes: Megan Huisingh-Scheetz, MD, will present this research during the ACR Annual Scientific Meeting at the Boston Convention and Exhibition Center from 4:30 " 6:00 pm ET on Thursday, November 8, 2007, in Room 153. Dr. Huan Justina Chang will be available for media questions and briefing at 1:30 pm ET on Thursday, November 8 in the on-site press conference room, Room 251. Presentation Number: 741
Racial/Ethnic Disparities in Unmet Social Support Need Among Total Knee Replacement Candidates
Megan Huisingh-Scheetz1, Rowland W. Chang2, Dorothy Dunlop2, Anh Chung2, Huan J. Chang2. 1University of Illinois at Chicago, University of Chicago, Chicago, IL; 2Northwestern University Feinberg School of Medicine, Chicago, IL
Purpose: Lower TKR rates for non-Hispanic Blacks may be related to their increased unmet social support needs. This cross-sectional analysis investigates unmet social support need in patients with severe knee osteoarthritis (OA) who have been referred for total knee replacement (TKR). The objective of this study was to determine whether unmet social support need varies between racial/ethnic sub-populations.
Methods: Baseline data from a prospective cohort study consisting of 193 non-Hispanic White and 185 non-Hispanic Black TKR candidates were analyzed. Data regarding four dimensions of social support (financial, tangible, informational, emotional) were collected. Unmet social support need was identified when a participant reported both 1) needing a specific type of social support within the last 30 days and 2) not receiving that type of support during the same period. Four index variables were created, corresponding to the four types of unmet social support need. An additional variable was created identifying any respondent with at least one type of unmet social support need. Rates of unmet need were compared between racial/ethnic subgroups.
Results: Among the entire sample, the crude rate for having at least one unmet social support need was 19.89% (75/377). Financial, tangible, informational, and emotional unmet social support need rates were higher among Black men and women compared to White men and women (Figure 1). After adjusting for race/ethnicity, age, gender, marital status, living alone, education, income, depression (Geriatric Depression Scale), and physical function (WOMAC), the odds ratio was significantly increased for Blacks compared to Whites in the financial unmet social support need comparison (OR=3.063, 95% CI =1.092, 8.590) but not in the tangible (OR=1.75, 95% CI=0.474, 2.909), emotional (OR=2.129, 95% CI=0.650, 6.973), informational (OR=1.425, 95% CI=0.447, 4.539), or any unmet need comparisons (OR=1.915, 95% CI=0.999, 3.672).
Conclusions: Among TKR candidates, the likelihood of reporting financial unmet social support need is higher among Blacks compared to Whites. Blacks were also more likely to report unmet tangible, emotional, and informational unmet social support need, though the racial/ethnic associations were not statistically significant. Future studies with larger sample sizes are needed to help quantify the social support needs of TKR candidates, particularly among minority groups, and to understand how unmet social support need may influence TKR decision-making.
[Figure 1, Unmet Social Support Need by Race, available on request]
Disclosure Block: M. Huisingh-Scheetz, None; R.W. Chang, None; D. Dunlop, None; A. Chung, None; H.J. Chang, Unrestricted Research Grant from Zimmer Corporation but not used for this portion of research, 2.
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