Examining Ethnic Differences in Osteoarthritis Patients’ Knowledge and Attitudes Regarding Prescription Nonsteroidal Anti-Inflammatory Drugs Hana S. Masood, Michael J. Hannon, C. Kent Kwoh, Jazmin Dagnino, Andrea Arellano, and Ernest R. Vina University of Arizona College of Medicine and University of Arizona Arthritis Center

Financial Disclosures Dr. Vina is a recipient of the NIH/NIAMS K23 grant (#K23AR067226-01) Dr. Kwoh is supported by NIH/NIAMS (#R01AR066601) Michael Hannon is a consultant for EMD Serono

Background Osteoarthritis (OA) is the most common chronic disease and leading cause of disability among older adults OA affects 58% of men and 68% of women older than 65 years old1 Hispanics have a higher prevalence of self-reported arthritis-related activity limitations compared to non-Hispanic whites (NHWs)1 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are commonly prescribed for the treatment of OA While there are documented differences between Hispanics and NHWs in their treatment preferences for arthroplasty2, little is known about ethnic differences in treatment preferences for NSAIDs The extent to which minority patients convey reluctance to accept proven treatments can contribute to disparities in the utilization of these treatments3

Objective To determine if there are ethnic differences in OA patients’ treatment preferences for, familiarity with, and perceptions of efficacy and risk of prescription oral and topical NSAIDs

Methods Participants with knee or hip OA per ACR criteria were recruited from Banner University Medical Center (BUMC) Rheumatology, Internal Medicine, and Sports Medicine Clinics, and from the University of Arizona Arthritis Center research registry Exclusion Criteria: Moderate to severe cognitive dysfunction, illness with a life expectancy <12 months, age <50 years, Kellgren- Lawrence (K-L) grade hip or knee of <1, hip and knee arthroplasty history, inflammatory arthritis (e.g. rheumatoid arthritis) A questionnaire was administered to patients with knee and/or hip OA; Spanish version was available

Study Variables Sociodemographic: Age, sex, race, ethnicity, education, employment status, marital status, annual income, medical insurance Clinical: Quality of life, Depression (Patient Health Questionnaire-8), OA disease severity (Western Ontario & McMaster Universities Osteoarthritis Index [WOMAC]), Comorbidities, Radiographic OA severity (Kellgren-Lawrence grade) Questions on knowledge and attitudes about prescription oral and topical NSAIDs as OA treatment

Questions on Knowledge and Attitudes about Prescription NSAIDs (Oral and Topical) as OA Treatment Willingness to Receive* (2 items): prescription oral, and topical NSAIDs Familiarity (3 items): Heard of it as OA treatment, Have family/friends that received it for treatment, Have good idea of what happens after treatment (yes/no) Perception of Benefits* (4 items): Beneficial for people with OA, Beneficial for themselves, Pain Relief for themselves, Functional improvement for themselves Perception of Risks* (3 items): Risky/dangerous treatment, Seriousness of complications, Concern about complications *Responses to these question items were based on a 5-category ordinal response scale

Statistics Descriptive statistics, including means and standard deviations (SD) for continuous variables, and frequencies and percentages for categorical variables were calculated Fisher’s exact test for categorical variables and Wilcoxon-Mann- Whitney test for ordinal and continuous variables were conducted to determine if individual items of knowledge and perceptions about prescription NSAIDs differed between Hispanics and NHWs

Table 1. Sociodemographics

Table 1 Continued. Sociodemographics and Clinical Characteristics GED=General Equivalency Diploma; PHQ=Patient Health Questionnaire; QOL-Quality of life; WOMAC=Western Ontario & McMaster Universities Osteoarthritis Index

Results No differences were found between Hispanics and NHWs in willingness to try prescription oral or topical NSAIDs Items pertaining to familiarity with and perceptions of benefits of topical NSAIDs did not significantly differ by ethnicity Hispanics were less likely to believe topical NSAIDs are harmful compared to NHWs (p=0.0040) Hispanics were less likely to have heard about prescription oral NSAIDs as treatment for OA compared to NHWs (75.22% vs. 85.95%, p=0.0293)

Perception of Benefits and Risks of Prescription Oral NSAIDs

Conclusions Among patients with knee or hip OA, Hispanics were less familiar with oral prescription NSAIDs, less likely to believe in their efficacy, and less likely to believe that they are harmful, compared to NHWs Treatment preferences for prescription NSAIDs (oral or topical), however, did not vary by ethnicity Improving patient knowledge and attitudes about prescription NSAIDs may reduce ethnic differences in the utilization of this OA treatment and potential outcomes

References Dominick KL, Baker TA. Racial and ethnic differences in osteoarthritis: prevalence, outcomes, and medical care. Ethn Dis 2004;14(4):558-66. Irgit K, Nelson CL. Defining Racial and Ethnic Disparities in THA and TKA. Clin Orthop Relat Res. 2011;469(7):1817-23. Smedley B, Stith A, Nelson A, eds., Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC, USA: National Academies Press, 2003.