Disparities in Total Knee and Total Hip Arthroplasty Rates in the Population of Alaska, 2015 to 2018.

OBJECTIVE: Racial and ethnic disparities in total joint replacements have been documented. Our objective was to determine the rates of total joint replacements for Alaska Native/American Indian (AN/AI) individuals compared with non-AN/AI individuals in Alaska and investigate the differences in characteristics and outcomes by race. METHODS: We used hospital discharge data from the Alaska Health Facilities Data Reporting Program from 2015 to 2018. We identified people with an inpatient primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA). We determined the population proportion of each procedure, age-adjusted rates by race, age-specific rates, and multivariable adjusted rate ratios for TKA or THA. We compared the characteristics of people undergoing primary TKA and THA by race. RESULTS: In 2,195,806 person-years, there were 8,131 arthroplasty procedures (4,594 primary TKAs, 2,791 primary THAs, 378 revision TKAs, and 368 revision THAs). Primary TKAs and THAs were less likely in people of AN/AI or "Other" race compared with people of White race, with some heterogeneity in the "Other" race category. In multivariable models, the adjusted rate ratio for AN/AI compared with White race for TKA was 0.70 (95% confidence interval [CI] 0.60-0.82) and for THA was 0.69 (95% CI 0.55-0.85). AN/AI individuals undergoing TKA and THA were more likely to reside in rural locations, be younger than 65 years, have longer hospital stay, and discharge to home. CONCLUSION: This study confirmed the existence of racial disparities in TKA and THA in Alaska. There may be many underlying causes, and future research should focus on improving access to care.

Living well with diabetes in Alaska.

Many people with diabetes mellitus experience minimal or no complications. Our objective was to determine the proportion of Alaska Native people who experienced four major complications or mortality and to identify factors that may be associated with these outcomes. We used records in a diabetes registry and clinical and demographic variables in our analyses. We used logistic regression and Cox Proportional Hazards models to evaluate associations of these parameters with death and complications that occurred prior to 2013. The study included 591 Alaska Native people with non-type 1 diabetes mellitus, diagnosed between 1986 and 1992. Over 60% of people in this study remained free of four major diabetes-related complications for the remainder of life or throughout the approximately 20-year study period. Lower BMI, higher age at diagnosis of diabetes, and use of at least one diabetes medication were associated with death and a composite of four complications. A majority of Alaska Native people with DM had none of four major complications over a 20-year period. Lower BMI and use of diabetes medications were associated with higher hazard for some deleterious outcomes. This suggests that goals in care of elders should be carefully individualised. In addition, we discuss several programme factors that we believe contributed to favourable outcomes.

An assessment of cardiovascular disease hospitalizations and disparities by race in patients with rheumatic disease hospitalizations in Alaska, 2015-2018.

BACKGROUND: There is an increased risk of cardiovascular disease in people with many rheumatic diseases. The primary objective of this study was to evaluate cardiovascular disease hospitalizations in Alaska for people with and without a rheumatic disease diagnosis and assess disparities by race, with a focus on Alaska Native and American Indian people. METHODS: This study used the Alaska Health Facilities Data Reporting Program data on inpatient hospitalizations from 2015 to 2018. We identified people with a rheumatic disease diagnosis based on any hospitalization with a set of rheumatic disease diagnoses and compared them to people hospitalized but without a rheumatic disease diagnosis. We determined the odds of cardiovascular disease hospitalization by rheumatic disease diagnosis and assessed the influence of race and other factors, using univariate analyses and multivariable models. RESULTS: People with a rheumatic disease diagnosis other than osteoarthritis had higher odds of cardiovascular disease hospitalization. The odds ratio was highest in people with gout compared to other rheumatic diseases. In multivariable models, there was an interaction between race and rheumatic disease status. Specifically, having gout increased the odds of cardiovascular disease hospitalization for people of all races, while having a rheumatic disease other than gout or osteoarthritis increased the odds of cardiovascular disease hospitalization in Alaska Native/American Indian people but not in people of other races. CONCLUSIONS: The association between rheumatic disease status and cardiovascular disease hospitalization in Alaska varied by type of rheumatic disease and race. This adds substantially to the literature on associations between rheumatic disease and cardiovascular disease in Indigenous North American populations.