Impact of social disadvantage among total knee arthroplasty places of service on procedural volume: a nationwide Medicare analysis

Wu, Victoria S.; Acuña, Alexander J.; Kim, Andrew G; Burkhart, Robert J.; Kamath, Atul F.

doi:10.1007/s00402-022-04708-7

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…50 Indeed, emerging data show resource deprivation alone and especially that which occurs early in life 40 is a significant observable contributor in its own right to perceived or actual osteoarthritis treatment inequities and outcomes. 65…”

Section: Discussionmentioning

confidence: 99%

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

Marks

2024

IPMRJ

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Osteoarthritis, a widespread arthritic disease commonly resulting in considerable pain and functional disability is often found to vary among those deemed affected. While age, gender, and genetics commonly explain this, what does the research show specifically in terms of extrinsic factors such as social disadvantage? This report aimed to update what is known about the social context and its role as a possible remediable osteoarthritis disability determinant if suboptimal. Using the PUBMED data base and others, osteoarthritis studies published between January 1, 2000 and March 20, 2024 concerning possible social disadvantage linkages were sought and carefully examined. As well, data drawn from the researcher’s repository were reviewed. The search results revealed a growing interest in this topic where osteoarthritis can be observed to be negatively influenced in the face of one or more forms of social deprivation. Yet, very few clinical trials prevail to either test the validity of this idea or apply these understandings to preventing suffering. In light of the increasing osteoarthritis burden, despite years of research, it appears that to maximize wellbeing for all, and to limit or obviate unwanted osteoarthritis associated health and disability costs, more resounding research along with a focus on advancing social equity and mitigating all forms of social deprivation is strongly indicated.

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Section: Discussionmentioning

confidence: 99%

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

Marks

2024

IPMRJ

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“…This realm of endeavor affecting many older adults and all societies can arguably be greatly enhanced in the realm of training future allied health and medical professionals, as well as economists, and policy makers, plus psychologists to ascertain more precisely how social factors can have an influence on cartilage degradation mechanisms and clinical pain or how their management recommendations may prove suboptimal if ignored. To this end, further studies including those that are lab based, plus both qualitative and quantitative clinical research approaches to address osteoarthritis mechanistic issues may prove helpful in determining more targeted and therefore successful pain relief and intervention [34,35,[40][41][42][43][44][45]. Additionally, efforts to eradicate perceptions of past racism may prove helpful and thus warrant attention [46].…”

Section: Discussionmentioning

confidence: 99%

Osteoarthritis and Poverty: Challenges and Opportunities

Marks

2024

ARAR

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“…However, the multivariate analysis controlled for such demographic variables. In addition, the ADI is an imperfect proxy for socioeconomic deprivation, but it is a multidimensional and validated tool that reflects social and economic needs including education, income, and housing quality and has been studied in arthroplasty research [9,13,33]. The ADI is derived from the previous 5 years of American Community Survey data, and the 2018 to 2019 ADI data reasonably represent the socioeconomic health of our patients between 2016 and 2021.…”

Section: Limitationsmentioning

confidence: 99%

High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

Hadad,

Pasqualini,

Klika

et al. 2024

Clin Orthop Relat Res

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Background The Area Deprivation Index (ADI) approximates a patient’s relative socioeconomic deprivation. The ADI has been associated with increased healthcare use after TKA, but it is unknown whether there is an association with patient-reported outcome measures (PROMs). Given that a high proportion of patients are dissatisfied with their results after TKA, and the large number of these procedures performed, knowledge of factors associated with PROMs may indicate opportunities to provide support to patients who might benefit from it. Questions/purposes (1) Is the ADI associated with achieving the minimum clinically important difference (MCID) for the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, Joint Replacement (JR), and Physical Function (PS) short forms after TKA? (2) Is the ADI associated with achieving the patient-acceptable symptom state (PASS) thresholds for the KOOS pain, JR, and PS short forms? Methods This was a retrospective study of data drawn from a longitudinally maintained database. Between January 2016 and July 2021, a total of 12,239 patients underwent unilateral TKA at a tertiary healthcare center. Of these, 92% (11,213) had available baseline PROM data and were potentially eligible. An additional 21% (2400) of patients were lost before the minimum study follow-up of 1 year or had incomplete data, leaving 79% (8813) for analysis here. The MCID is the smallest change in an outcome score that a patient is likely to perceive as a clinically important improvement, and the PASS refers to the threshold beyond which patients consider their symptoms acceptable and consistent with adequate functioning and well-being. MCIDs were calculated using a distribution-based method. Multivariable logistic regression models were created to investigate the association of ADI with 1-year PROMs while controlling for patient demographic variables. ADI was stratified into quintiles based on their distribution in our sample. Achievement of MCID and PASS thresholds was determined by the improvement between preoperative and 1-year PROMs. Results After controlling for patient demographic factors, ADI was not associated with an inability to achieve the MCID for the KOOS pain, KOOS PS, or KOOS JR. A higher ADI was independently associated with an increased risk of inability to achieve the PASS for KOOS pain (for example, the odds ratio of those in the ADI category of 83 to 100 compared with those in the 1 to 32 category was 1.34 [95% confidence interval 1.13 to 1.58]) and KOOS JR (for example, the OR of those in the ADI category of 83 to 100 compared with those in the 1 the 32 category was 1.29 [95% CI 1.10 to 1.53]), but not KOOS PS (for example, the OR of those in the ADI category of 83 to 100 compared with those in the 1 the 32 category was 1.09 [95% CI 0.92 to 1.29]). Conclusion Our findings suggest that social and economic factors are associated with patients’ perceptions of their overall pain and function after TKA, but such factors are not associated with patients’ perceptions of their improvement in symptoms. Patients from areas with higher deprivation may be an at-risk population and could benefit from targeted interventions to improve their perception of their healthcare experience, such as through referrals to nonemergent medical transportation and supporting applications to local care coordination services before proceeding with TKA. Future research should investigate the mechanisms underlying why socioeconomic disadvantage is associated with inability to achieve the PASS, but not the MCID, after TKA. Level of Evidence: Level III, therapeutic study.

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Impact of social disadvantage among total knee arthroplasty places of service on procedural volume: a nationwide Medicare analysis

Cited by 4 publications

References 34 publications

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

Osteoarthritis and Poverty: Challenges and Opportunities

High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

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