Ethnic and Racial Differences and Disparities

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Lead Author(s): 

Obi Adigweme, MD
Charles L. Nelson, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD


Racial and ethnic disparities in healthcare have been well established in the literature. Reasons for disparities include cultural beliefs, socioeconomic differences, language barriers, and discrimination or bias in the healthcare system. A 2003 IOM report confirmed racial and ethnic minorities receive lower quality healthcare and have poorer outcomes than their Caucasian counterparts.1 A 2019 Medicare study found significantly decreased rates of surgical intervention among racial and ethnic minorities.2 The US Census Bureau reported that minorities comprised 38.4% of the population in 2015; by 2050, it is projected that non-Hispanic whites will no longer be the majority group in the United States.3 The increasing minority population has hastened the need to define, understand, and reduce these differences. Furthermore, disparities in healthcare and health outcomes will become increasingly economically burdensome.

Disparities in musculoskeletal care has been a topic of increased interest in the past decade. Schoenfeld et al et al reported that racial and ethnic minorities are at increased risk of complications and/or mortality after orthopaedic surgical intervention.4 Several other studies have demonstrated decreased utilization and access to orthopaedic care among minorities, such as joint replacement and spinal surgery.

Race and ethnicity also have an impact on the prevalence of certain musculoskeletal conditions. Ankylosing spondylitis and osteoporosis are examples of conditions for which ethnicity is a strong risk factor. Further research is needed to determine whether several other musculoskeletal conditions are impacted by ethnicity.

Racial/ethnic groups in the BMUS report are defined based on the major databases analyzed for this report. The six groups included in the databases are white, black, Hispanic, Asian/Pacific Islander, Native American, and other. Hispanic ethnicity applies to persons of all races, therefore they are identified by their ethnicity, while other persons are defined as non-Hispanic white, non-Hispanic black, and non-Hispanic other. Due to small sample sizes, non-Hispanic other persons include Asian/Pacific Islander, Native American, and others.  

To broaden the scope of ethnic and racial differences and disparities, a literature search was also conducted. Findings on the impact of musculoskeletal diseases on more specific races and ethnic groups are discussed by condition. Data findings are presented to provide a snapshot of differences and disparities. However, the NEDS database, the largest database, does not include a race/ethnicity variable, thus the importance of differences in emergency department visits is unavailable.


Self-Reported Musculoskeletal Conditions

Non-Hispanic white persons report experiencing more musculoskeletal conditions in the previous year than members of other racial/ethnic groups. In 2015, 54.5% of non-Hispanic white persons reported they had at least one musculoskeletal condition, compared to 46.4% of non-Hispanic blacks, 38.6% of non-Hispanic others, and 40.6% of persons of Hispanic ethnicity. Chronic joint pain was the most frequently mentioned condition among all persons, with knee pain the most common joint. Non-Hispanic black persons reported back pain radiating down the leg (11.0%) at nearly the same rate as non-Hispanic white persons (11.4%), and a slightly higher rate of carpal tunnel syndrome (4.2% vs. 3.5%). (Reference Table 7D.1 PDF CSV)

Musculoskeletal Conditions Burden

The burden of musculoskeletal conditions can be defined in economic terms or as it affects those suffering from these conditions. In this section, burden is defined in terms of limitations in activities of daily living (ADL) and as bed or lost work days.


Approximately half of persons reporting musculoskeletal conditions also report they suffer limitations in ADL as a result of these conditions. Among non-Hispanic white persons, 28.7% reported limitations, 24.8% of non-Hispanic black persons have limitations, 18.7% of non-Hispanic other persons, and 18.6% of those of Hispanic ethnicity. Arthritis and back/neck problems are the most common conditions causing limitations. (Reference Table 7D.1 PDF CSV)

Bed and Lost Work Days
Non-Hispanic black persons report the highest number of bed days in the previous year due to musculoskeletal conditions (24.7 days on average), while those of Hispanic ethnicity lost, on average, the most work days (14.3 days).  (Reference Table 7D.1 PDF CSV)

  • 1. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003.
  • 2. Schoenfeld J, Sturgeon D, Dimick JB, Bono C, et al. (2018). Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations. Annals of Surgery 2018:269(3);1.
  • 3. Annual Estimates of the Resident Population by Sex, Race Alone or in Combination, and Hispanic Origin for the United States, States and Counties: April 1, 2010 to July 1, 2015. 2015 Population Estimates. In: United States Census Bureau, American Fact Finder.
  • 4. Schoenfeld AJ, Tipirneni R, Nelson JH, et al. The Influence of Race and Ethnicity on Complications and Mortality After Orthopedic Surgery A Systematic Review of the Literature. Medical Care. 2016:52(9);842-851.


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