Social Determinants of Health and Patient-Reported Outcomes Following Total Hip and Knee Arthroplasty in Veterans

被引:60
作者
Rubenstein, William J. [1 ]
Harris, Alex H. S. [2 ]
Hwang, Kevin M. [1 ]
Giori, Nicholas J. [3 ,4 ]
Kuo, Alfred C. [1 ,5 ]
机构
[1] Univ Calif San Francisco, Dept Orthopaed Surg, San Francisco, CA USA
[2] Vet Affairs Palo Alto Hlth Care Syst, Ctr Innovat Implementat, Palo Alto, CA USA
[3] Vet Affairs Palo Alto Hlth Care Syst, Orthoped Surg Sect, Palo Alto, CA USA
[4] Stanford Univ, Dept Orthoped Surg, Palo Alto, CA 94304 USA
[5] San Francisco Vet Affairs Hlth Care Syst, Orthoped Surg Sect, San Francisco, CA 94121 USA
关键词
total hip arthroplasty; total knee arthroplasty; patient-reported outcome measure; social determinants of health; health disparity; JOINT REPLACEMENT; ETHNIC DISPARITIES; CARE-SYSTEM; PAYER TYPE; RACE; SURGERY; IMPACT; RISK; ASSOCIATION; COMORBIDITY;
D O I
10.1016/j.arth.2020.04.095
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age. They are associated with disparities in outcomes following total joint arthroplasty (TJA). These disparities occur even in equal-access healthcare systems such as the Veterans Health Administration (VHA). Our goal was to determine whether SDOH affect patient-reported outcome measures (PROMS) following TJA in VHA patients. Methods: Patients scheduled to undergo total hip or knee arthroplasty at VHA Hospitals in Minneapolis, MN, Palo Alto, CA, and San Francisco, CA, prospectively completed PROMS before and 1 year after surgery. PROMS included the Hip disability and Osteoarthritis Outcome Score, the Knee injury and Osteoarthritis Outcome Score, and their Joint Replacement subscores. SDOH included race, ethnicity, marital status, education, and employment status. The level of poverty in each patient's neighborhood was determined. Medical comorbidities were recorded. Univariate and multivariate analyses were performed to deter-mine whether SDOH were significantly associated with PROM improvement after surgery. Results: On multivariate analysis, black race was significantly negatively correlated with knee PROM improvement and Hispanic ethnicity was significantly negatively correlated with hip PROM improvement compared to whites. Higher baseline PROM scores and lower age were significantly associated with lower PROM improvement. Significant associations were also found based on education, gender, comorbidities, and neighborhood poverty. Conclusion: Minority VHA patients have lower improvement in PROM scores after TJA than white patients. Further research is required to identify the reasons for these disparities and to design interventions to reduce them. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:2357 / 2362
页数:6
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