Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty

Abstract

BackgroundPatients with higher socioeconomic status (SES) are shown to have better total knee arthroplasty (TKA) outcomes compared to those with lower SES. The relationship between SES and factors that influence TKA use is understudied. We examined the association between SES and pain, function and pain catastrophizing at presentation for TKA.MethodsIn patients undergoing TKA at an academic center, we obtained preoperative pain and functional status (WOMAC Index 0–100, 100 worst), pain catastrophizing (PCS, ≥16 high), and mental health (MHI-5, <68 poor). We described individual-level SES using education as a proxy, and area-level SES using a validated composite index linking geocoded addresses to U.S. Census data. We measured associations between these indicators and pain, function and pain catastrophizing, adjusting for age, sex and BMI.ResultsAmong 316 patients, mean age was 65.9 (SD 8.7), 59% were female, and 88% were Caucasian; 17% achieved less than college education and 62% were college graduates. The median area SES index score was 59 (U.S. median 51). Bivariable analyses demonstrated associations between higher individual- and area-level SES and lower pain, higher function and less pain catastrophizing (all p<0.05). Adjusted analyses demonstrated statistically significant associations between higher individual- and area-level SES and better function and less pain.ConclusionIn this cohort, patients with higher individual- and area-level SES had lower pain and higher function at the time of TKA than lower SES patients. Further research is needed to assess what constitutes appropriate levels of pain and function to undergo TKA in these higher SES groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0475-8) contains supplementary material, which is available to authorized users.

Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?

“…In poor communities, those with some college education achieve significantly better WOMAC scores than those without college education, whereas in wealthy communities, college education provides little additional benefit. Although the impact of poverty and low educational attainment on TKA outcomes has been previously described (4,(23)(24)(25)(26)(27), this is the first study to describe the interaction between community poverty and education as it impacts TKA outcomes.…”

Racial Differences in Performance‐Based Function and Potential Explanatory Factors Among Individuals With Knee Osteoarthritis

“…In another study, patients with lower socioeconomic status at the time of total knee arthroplasty had worse self‐reported function and higher pain scores than those who had higher socioeconomic status (42), illustrating the potential influence of socioeconomics on disease progression and a need for surgical intervention. Although our study did not consider health behavior or health care quality or access in our analysis, results may reflect the impact of socioeconomic influences on such factors, which can affect disease progression and functional limitations.…”

Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

“…SES has also been proposed to have an impact on TKA surgery. 37 However, this may partly be due to longer waiting times in healthcare systems that are mainly run in the private sector. Subsequently, patients of lower SES present with more severe pain and worse functional status.…”

“…Feldman et al 37 aimed to investigate the association of socioeconomic status (SES), both at the individual and area levels, with preoperative pain, function, and pain catastrophizing. They observed associations between higher individual level SES and less pain, better function and lower pain catastrophizing scores.…”