Race and Arthritis: the Problem of Undertreatment

Arthritis is one of the most common chronic pain conditions in America, diagnosed in about 21% of the adult population. And yet, study after study illustrates how the experience of arthritis is significantly more debilitating for black Americans. For instance, there is the recent study finding that black Americans more often ranked arthritis as their primary source of physical limitation; black Americans experienced greater pain severity; and black Americans were less likely to see a physician about their arthritis problems. Then there is the Center for Disease Control's study before that: the study reported a higher rate of physical limitation attributable to arthritis among black Americans even while the prevalence of arthritis was similar between White and black Americans. So what's going on here? There is a noted racial disparity, but what are we to make of it?

Well, the reasons aren't entirely known and, given the stakes and sensitivity of the question, there is little jumping to conclusions. But however tenative, any answer starts with a consideration of the chronic undertreatment that black Americans are prone to. Primarily, this undertreatment is a consequence of inadequate health services, which, in turn, is a consequence of economic disparity. Disadvantaged, often city-dwelling black Americans simply cannot afford regular access to the bestÑand usually most expensiveÑdoctors who would reliably know what action to take and what medicines to prescribe. Instead, the alternatives are overworked hospitals and clinics with a lower paid staff and poorer grade facilities.

Additionally, there is the black American's increased risk of obesity. As a definite precondition to arthritis, this increased risk reveals the same force of economic disadvantage. Walk along any city block and compare the price of milk and eggs to the price of a can of coke and a bag of chips. The sad fact is, it is far cheaper to eat poorly. Alongside limited medical resources, this nutritional deficit may go a long way to explain why arthritis comes with greater severity and with greater physical limitations.

Beyond socioeconomic trends, chronic undertreatment might also spring from an indifferent doctor-patient relationship. Undertreatment operates at many levels and both ways: just as a good doctor knows what the correct diagnosis is and what the proper treatment should be, the patient must be willing to volunteer the information of what hurts, when it hurts etc. Both appear to be lacking for black Americans. A telephone survey recently found black Americans to be less participatory during doctor's visitsÑespecially when the doctor was white. The study found the same decrease in participation for white Americans with a black doctor. Comfortability and trust seem to be at issue here and unlike the ideas of "resources" and "access", this problem turns on a more personal dynamic, perhaps seated in larger ideas of diversity and multiculturalism.

At the same time, the question of arthritis' differing impact doesn't appear to have a viable genetic componentÑnot yet at least. Remember, there was a similar prevalence of condition that suggests a similar genetic risk in all races. Furthermore, a team of scientists studied the genetics of four major racial/ethnic groups (Black, White, Hispanic and East Asian) to find only "modest" genetic differences between the four. Of course, this isn't to say genetics won't play a part in treatment pending future scientific discoveries. But for now, the cultural and economic challenges seem the most glaring factors in this important disparity.

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