Workshop Explores Strategies to Tackle Health Disparities in Osteoarthritis
A recent 2-day NIH workshop aimed to better understand health disparities in caring for and treating people with osteoarthritis (OA) and the role played by social determinants of health. NIAMS, NIA and NIMHD sponsored the event.
OA is a degenerative joint disease and a leading cause of pain and disability. There are currently no FDA-approved therapies to prevent or slow its progression, and current treatments focus on reducing pain or—at later stages of disease—surgical replacement of the joint.
The meeting convened osteoarthritis investigators and health disparities researchers to discuss why inequities in OA treatment outcomes and access to care exist and how to address these challenges.
In opening remarks, NIAMS director Dr. Lindsey Criswell called for participants to “continue to look holistically at all the opportunities to work across the many fields of science in order to equitably reduce the impact of disease caused by osteoarthritis.”
Throughout the meeting, speakers outlined documented health disparities in OA. For example, knee OA is more prevalent and more severe in African Americans than in Whites. African Americans are also more likely than Whites to delay doctor-recommended knee replacement and tend to experience worse post-operative outcomes. Additionally, African Americans perceive joint replacement to be less useful than Whites due to different expectations and knowledge about the procedure.
Breakout sessions, which expanded upon the workshop topics, let participants identify gaps and opportunities to improve issues related to health disparities in OA. “The diverse group of participants provided collaborative and informative discussions,” said meeting organizer and NIAMS scientific program director Dr. Kristy Nicks. “Several overlapping themes emerged.”
The need to better integrate resources outside of the traditional health care arena into OA patient care was a common suggestion among participants. For example, community health workers, social workers, community centers and libraries can all play an important role in bridging the gap between OA patients and health services.
Fellow meeting organizer Dr. Patricia Jones, who directs NIA’s Office of Special Populations, reiterated the need for and value of community involvement. “The community-level discussions were particularly insightful in enlightening us on important points to consider that may be highlighted in the literature but not fully appreciated in the real-world context,” she later said about the meeting. “Participants were able to provide that context in real time.”
Given the role of excessive weight and physical inactivity in the development and progression of OA, participants also discussed the need to emphasize and integrate evidence-based interventions that can lead to improved health. To improve outcomes and address disparities, programs should be tailored to specific patient communities and cultures.
Enhancing patient-provider communication and establishing easily accessible OA information resources were additional meeting themes. Resources need to target both patients and providers, while addressing language, cultural and health literacy barriers.
“An important objective for this meeting was to identify research gaps and needs that could be addressed in future NIH activities,” said Nicks. “Participants expressed continued support for large OA studies that are collecting data from underrepresented and understudied populations.”
Additional research opportunities included the need for standardized OA measures and consistent reporting practices to enhance clinical assessment and outcome analysis. Another echoed theme was the need to leverage evidence-based resources and methods from other fields to address OA health disparities.
“Although the three NIH components leading this effort focused specifically on OA, we hope this workshop can serve as a model for other NIH entities and other federal agencies that are committed to reducing disparities in, and the overall impact of, diseases across the NIH mission,” Criswell concluded.