Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register

Abstract

Background Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.Questions/purposes We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA. Methods All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes. Results High education attainment was associated with higher HRQoL (EQ-5D index ß high = 0.03 ± 0.01; EQ VAS ß high = 2.6 ± 0.5) after THA, whereas those with This study was funded by the Swedish Hip Arthroplasty Register,

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

“…The key demographic factors considered important to include in the Standard Set were patient age, sex, and socioeconomic status 35, 36, 37. Although many different indicators of socioeconomic status have been published in the literature, only education level as defined by the International Standard Classification of Education can be considered consistent across countries and cultures for international use 36, 38.…”

“…Although many different indicators of socioeconomic status have been published in the literature, only education level as defined by the International Standard Classification of Education can be considered consistent across countries and cultures for international use 36, 38. The working group also identified body mass index, smoking status, and living condition as having a potentially important influence on outcomes and relevant for inclusion in the Standard Set 39.…”

Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty

“…If a patient had both hips operated on during the observation period, only the first hip with complete PROMs was included in the analysis. There was a slight predominance of women patients (12,696). To calculate comorbidity scores for each patient, we obtained individual diagnoses (ICD-10) from the Swedish National Patient Register.…”

“…Although no such ideal outcome measure exists, numerous patient-reported outcome measures (PROMs) appear in the literature and practitioners have augmented the measures with different comorbidity scores. PROMs not only help assess patient eligibility for elective surgery, but also can serve as predictors of patient quality of life after hip surgery [12]. Existing comorbidities are known to influence the outcome of surgery and, depending on the severity, can inhibit elective procedures such as THA.…”

Editorial: Large Database Studies—What They Can Do, What They Cannot Do, and Which Ones We Will Publish

“…We publish it frequently [10,11], and we have promoted it in Spotlight commentaries and interviews on these pages [13]. CORR 1 will publish selected proceedings from the most-recent meeting of the International Society of Arthroplasty Registries this summer, and we will cover the important role registries play in clinical research in an editorial in the coming months.…”