Sec. 7401. Findings
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Congress finds as follows: Eighty percent of African-American women and nearly 74 percent of Hispanic men are either overweight or obese, speeding the onset and progression of knee arthritis. Arthritis affects 58,500,000 people in the United States, and that number will rise to 78,000,000 by the year 2040. 32,500,000 people in the United States suffer from osteoarthritis, the most common form of arthritis, making it the leading cause of disability in the United States. Osteoarthritis is sometimes referred to as degenerative joint disease.
Obesity accelerates the onset of arthritis: 70 percent of obese adults with mild osteoarthritis of the knee at age 60 will develop advanced end-stage disease by age 80. In contrast, just 43 percent of non-obese adults will have end-stage disease over the same time period. Arthritis affects 1 in 4 people in the United States and is the single greatest cause of chronic pain and disability in the United States. Women, Black Americans, and Hispanics have more severe arthritis and functional limitations.
These same individuals are more likely to be obese and diabetic, and have a higher incidence of heart diseases. Arthritis costs $304,000,000,000 a year, including $140,000,000,000 in direct costs (medical) and $164,000,000,000 in indirect costs (lost earnings). Obesity and other chronic health conditions exacerbate the debilitating impact of arthritis, leading to inactivity, loss of independence, and a perpetual cycle of comorbid chronic conditions. Sixty-one percent of arthritis sufferers are women, and women represent 64 percent of an estimated 43,000,000 annual visits to physicians’ offices and outpatient clinics where arthritis was the primary diagnosis.
Women also represented 60 percent of approximately 1,000,000 hospitalizations that occurred in 2003 for which arthritis was the primary diagnosis. Women ages 65 and older have up to 2½ times more disabilities than men of the same age. Higher rates of obesity and arthritis among this group explained up to 48 percent of the gender gap in disability, above all other common chronic health conditions. The primary indication for total knee arthroplasty (referred to in this section as TKA ), also known as knee replacement, is relief of significant, disabling pain caused by severe arthritis.
Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow an individual to be more active. The process for a total knee replacement involves the surgeon removing damaged cartilage and bone from the surface of the knee joint and replacing the cartilage and bone with a man-made surface of metal and plastic. In a partial knee replacement, the surgeon only replaces part of the knee joint. Total hip replacement, also called total hip arthroplasty (referred to in this section as THA ), is used if hip pain interferes with daily activities and more conservative treatments have not helped.
Arthritis damage is the most common reason to need hip replacement. The odds of a family practice physician recommending TKA to a male patient with moderate arthritis are twice that of a female patient, while the odds of an orthopedic surgeon recommending TKA to a male patient with moderate arthritis are 22 times that of a female patient. Black Americans with doctor-diagnosed arthritis have a higher prevalence of severe pain attributable to arthritis, compared with White Americans (34.0 percent versus 22.6 percent).
Black Americans, compared to White Americans, report a higher proportion of work limitations (39.5 percent versus 28.0 percent) and a higher prevalence of arthritis-attributable work limitation (6.6 percent versus 4.6 percent). Hispanics are 50 percent more likely than non-Hispanic Whites to report needing assistance with at least one instrumental activity of daily living and to have difficulty walking. Black Americans and Hispanics were 1.3 times more likely to have activity limitation, 1.6 times more likely to have work limitations, and 1.9 times more likely to have severe joint pain than Whites.
In 2003, the National Academy of Medicine reported that the rates of TKA and THA among Black American and Hispanic patients are significantly lower than for Whites—even for those with equitable health care coverage such as through Medicare or the Department of Veterans Affairs. According to the Centers for Disease Control and Prevention, in 2000, Black American Medicare enrollees were 37 percent less likely than White Medicare enrollees to undergo total knee replacements. In 2006, the disparity increased to 39 percent.
Even after adjusting for insurance and health access, Hispanics and Black Americans are almost 50 percent less likely to undergo total knee replacement than Whites.