Reduced rates of primary joint replacement for osteoarthritis in Italian and Greek migrants to Australia: the Melbourne Collaborative Cohort Study

Wang YS, J. A.; Wluka, A. E.; Urquhart, D. M.; English, D. R.; Giles, G. G.; Graves, S.; Cicuttini, F. M. (2009) Reduced rates of primary joint replacement for osteoarthritis in Italian and Greek migrants to Australia: the Melbourne Collaborative Cohort Study. Arthritis Res Ther 11:R86

INTRODUCTION: Racial and ethnic disparities in rates of total joint replacement have been described, but little work has been done in well-established migrant groups. The aim of this study was to compare the rates of primary joint replacement for osteoarthritis for Italian and Greek migrants to Australia and Australian-born individuals. METHODS: Eligible participants (n = 39,023) aged 27 to 75 years, born in Italy, Greece, Australia and the United Kingdom, were recruited for the Melbourne Collaborative Cohort Study between 1990 and 1994. Primary hip and knee replacement for osteoarthritis between 2001 and 2005 was determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. RESULTS: Participants born in Italy and Greece had a lower rate of primary joint replacement compared with those born in Australia (hazard ratio [HR] 0.32, 95% confidence interval [CI] 0.26 to 0.39, P < 0.001),="" independent="" of="" age,="" gender,="" body="" mass="" index,="" education="" level,="" and="" physical="" functioning.="" this="" lower="" rate="" was="" observed="" for="" joint="" replacements="" performed="" in="" private="" hospitals="" (hr="" 0.17,="" 95%="" ci="" 0.13="" to="" 0.23),="" but="" not="" for="" joint="" replacements="" performed="" in="" public="" hospitals="" (hr="" 0.96,="" 95%="" ci="" 0.72="" to="" 1.29).="" conclusions:="" people="" born="" in="" italy="" and="" greece="" had="" a="" lower="" rate="" of="" primary="" joint="" replacement="" for="" osteoarthritis="" in="" this="" cohort="" study="" compared="" with="" australian-born="" people,="" which="" could="" not="" simply="" be="" explained="" by="" factors="" such="" as="" education="" level,="" physical="" functioning,="" and="" weight.="" although="" differential="" access="" to="" health="" care="" found="" in="" the="" population="" may="" explain="" the="" different="" rates="" of="" joint="" replacement,="" it="" may="" be="" that="" social="" factors="" and="" preferences="" regarding="" treatment="" or="" different="" rates="" of="" progression="" to="" end-stage="" osteoarthritis="" in="" this="" population="" are="" important="" to="" ethnic="">