Patients with osteoarthritis (OA) and perceived discrimination, particularly those coming from multiple socially disadvantaged groups, are more likely to experience worse pain and depression, according to a study.
The researchers specifically looked at older veterans with OA, who were enrolled in a randomized controlled trial evaluating a psychological intervention for chronic pain at two Department of Veterans Affairs medical centers. There were 270 Black veterans and 247 White veterans, all of whom were aged ≥50 years and had self‐reported symptomatic knee OA. Data collection included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Each patients’ socially disadvantaged groups were determined to calculate their cumulative disadvantage. Disadvantaged groups included female sex, Black race, annual income <$20,000, and unemployed due to disability.
The mean number of social disadvantages was 1.3 (standard deviation, 1.0). Significant correlations were observed between cumulative disadvantage and higher perceived discrimination, pain, and depression (P<0.001 for all). Perceived discrimination had a large mediative impact on the relationship between cumulative disadvantage and depression symptoms (Z=3.75, P<0.001) and pain severity (Z=2.24, P=0.025).
The study was published in Arthritis Care & Research.
In another study of health disparities among Black patients, the researchers identified “perceived bias” as one contributing factor.
The narrative review, published in PM&R, included studies spanning December 2009 through December 2019 and included subsequent updates through June 2020. Health disparities were observed for a number of conditions, including OA of the knee as well as the hip.
“Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self‐reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature,” the study authors explained.