The study sample included 141 African-American and 61 Caucasian veterans with OA. Demographic and clinical characteristics according to race are presented in Table 1. The sample was predominantly male (91%), which is characteristic of VA healthcare users, and about half had some college education. African-American patients were significantly younger than Caucasian patients, had a smaller proportion of males, and had greater disease severity.

There was a fairly high level of disease severity in this sample. The average WOMAC (disease severity) score was 50 (on a scale of 0-96), reflecting moderate-to-severe symptoms. Individuals with a WOMAC score of greater than or equal to 39 are considered candidates for joint replacement surgery. The average number of joints affected was six, and the average duration of having OA was 19 years.
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Table 1. Demographic and Clinical Characteristics

Total Sample (N=202) Caucasians (N=141) African Americans (N=61) p-Value
Males [%)

91.1

94.3

83.6

0.01

Some college (%)

55.4

53.9

59.0

0.50

Age (mean (SD))

63.5 (11.4)

65.6 (9.9)

58.6 (13.1)

O.001

Total WOMAC score (mean (SD))

50.3 (17.7)

48.4 (17.6)

54.6 (17.2)

0.02

Years with OA (mean (SD))

19.1 (13.1)

20.2 (13.4)

16.7 (12.1)

0.09

Number of affected joints (mean (SD))

6.1 (3.7)

6.3 (3.7)

5.6 (3.8)

0.29

Number of drugs taken (mean (SD))

0.99 (0.80)

0.99 (0.79)

0.98 (0.83)

0.94

Seventy-seven percent of participants (N=156) reported using some over-the-counter or prescription analgesic or anti-inflammatory drug. Proportions of patient using specific drug categories were as follows: acetaminophen (19%; N=39), COX-2 inhibitor (17%; N=34), NSAID (48%; N=96), opioid analgesic (19%; N=39). Comparisons of drug use according to race are presented in Table 2. In both bivariate and multivariable two-level analyses, there were no significant differences in the proportion of African-American and Caucasian participants using any of the drug categories.

Table 2. Use of Analgesic/Anti-Inflammatory Drugs According to Race

Drug Class

Percent of Caucasians (N=141) Percent of African Americans (N=61) Bivariate p-Value

Multivariable p-Value*

None

22.0

24.6

0.69

0.48
Acetaminophen

19.9

18.0

0.76

0.75
COX-2 inhibitor

18.4

13.1

0.36

0.33
NSAID

46.1

50.8

0.54

0.61
Opioid analgesic

21.3

14.8

0.28

0.19
*Multivariable analysis included age, gender education, WOMAC score, years with OA, and number of affected joints.

Among the 156 subjects currently using analgesic and/or anti-inflammatory drugs, the mean rating of drug helpfulness (on a scale of 1-10) was 6.14 (SD=2.19), with Caucasian patients averaging 5.94 (SD=2.11) and African-American patients averaging 6.57 (SD=2.35). Mean helpfulness ratings according to specific drug categories were as follows: acetamin-ophen=5.51 (SD=2.34), COX-2 inhibitors = 6.77 (SD=1.76), NSAIDs=5.93 (SD=2.21), opioid analgesics=6.64 (SD=2.16). In the multivariable analysis, the relationship of race to medication helpfulness approached statistical significance (p=0.05; Table 3). Three other variables were significantly associated with ratings of medication helpfulness. Patients who currently used the three different drugs reported the drugs were significantly more helpful than patients who were using one drug. Ratings of medication helpfulness decreased significantly with increasing arthritis severity. Finally, there were differences in helpfulness ratings according to drug class. Ratings did not differ between acetaminophen and NSAJDs. However, both COX-2 inhibitors and opioid analgesics were rated as significantly more helpful than NSAIDs.
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Table 3. Significant Correlates of Medication Helpfulness Rating

t Statistic

p-value

African-American race                                                         1.91 Number of analgesic/anti-inflammatory medications = 3*               2.62 WOMAC score                                                                    -3.52 COX-2**                                                                              2.46 Opioid analgesic**                                                             2.68 0.05 0.01 O.001 0.02 0.01
* Referent category = 1 medication; ** Referent category = NSAIDs; Note: analysis included only subjects currently using analgesic or anti-inflammatory medications (N=156). Statistical model also included: age, education, number of years with OA, number of affected joints and acetaminophen use, and current use of two medications. Between Subjects F(3,i40)=6.78, pO.OOl; Within subjects F(2.54)=4.93, p=0.011