Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty
Background Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. Questions/purposes We asked: (1) Are race and socioeconomic...
Gespeichert in:
Veröffentlicht in: | Clinical orthopaedics and related research 2016-09, Vol.474 (9), p.1986-1995 |
---|---|
Hauptverfasser: | , , , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 1995 |
---|---|
container_issue | 9 |
container_start_page | 1986 |
container_title | Clinical orthopaedics and related research |
container_volume | 474 |
creator | Goodman, Susan M. Mandl, Lisa A. Parks, Michael L. Zhang, Meng McHugh, Kelly R. Lee, Yuo-Yu Nguyen, Joseph T. Russell, Linda A. Bogardus, Margaret H. Figgie, Mark P. Bass, Anne R. |
description | Background
Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA.
Questions/purposes
We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA?
Methods
We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among patients without a college education (67%) compared with those with a college education (71%). Our final study cohort consisted of 4035 patients, 3841 (95%) of whom were white and 194 (5%) of whom were black. Using geocoding, we linked individual-level registry data to US census tracts data through patient addresses. We constructed a multivariate linear mixed-effect model in multilevel frameworks to assess the interaction between race and census tract poverty on WOMAC pain and function scores 2 years after TKA. We defined a clinically important effect as 10 points on the WOMAC (which is scaled from 1 to 100 points, with higher scores being better).
Results
Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes were small, and below the threshold of clinical importance. Whites and blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA (WOMAC pain, 1.01 ± 1.59 points lower for blacks than for whites, p = 0.53; WOMAC function, 2.32 ± 1.56 lower for blacks than for whites, p = 0.14). WOMAC pain and function scores 2 years after TKA worsen with increasing levels of community poverty, but do so to a greater extent among blacks than whites. Disparities in pain and function between blacks and whites are evident only in the poorest communities; decrea |
doi_str_mv | 10.1007/s11999-016-4919-8 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4965380</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4145999541</sourcerecordid><originalsourceid>FETCH-LOGICAL-c503t-954c2fc259ebf1cfd1c6eaeaae1beadd7217b967194c9646e71c4539dd581f93</originalsourceid><addsrcrecordid>eNqNkUFvFCEUx4nR2LX6AbwYEi9eRnnMMIAHk7qt2tikRvegJ8Iyb1qaXViBadNvX9atTTUx8UTg_d7_AT9CngN7DYzJNxlAa90w6JtOg27UAzIDwVUD0PKHZMYY043m8H2PPMn5om7bTvDHZI9LLlUvxYz8OPR5Y5MvHjP1gS4-H9DTqbi4xvyWzjHkKdNFsq7QQ1ss_XYer-hxKLg98jFk-h7LFWKgX61DasNAv8RLTOX6KXk02lXGZ7frPll8OFrMPzUnpx-P5wcnjROsLY0WneOj40LjcgQ3DuB6tGgtwhLtMEgOcql7Cbpzuu96lOA60ephEApG3e6Td7vYzbRc4-AwlGRXZpP82qZrE603f1aCPzdn8dJ0uhetYjXg1W1Aij8nzMWsfXa4WtmAccoGFIBSbR39HyiTmjGlRUVf_oVexCmF-hG_AoG1jPNKwY5yKeaccLy7NzCzVWx2ik1VbLaKjao9L-4_-K7jt9MK8B2QaymcYbo3-p-pN8rIsdc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1811103022</pqid></control><display><type>article</type><title>Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty</title><source>MEDLINE</source><source>SpringerNature Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Goodman, Susan M. ; Mandl, Lisa A. ; Parks, Michael L. ; Zhang, Meng ; McHugh, Kelly R. ; Lee, Yuo-Yu ; Nguyen, Joseph T. ; Russell, Linda A. ; Bogardus, Margaret H. ; Figgie, Mark P. ; Bass, Anne R.</creator><creatorcontrib>Goodman, Susan M. ; Mandl, Lisa A. ; Parks, Michael L. ; Zhang, Meng ; McHugh, Kelly R. ; Lee, Yuo-Yu ; Nguyen, Joseph T. ; Russell, Linda A. ; Bogardus, Margaret H. ; Figgie, Mark P. ; Bass, Anne R.</creatorcontrib><description>Background
Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA.
Questions/purposes
We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA?
Methods
We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among patients without a college education (67%) compared with those with a college education (71%). Our final study cohort consisted of 4035 patients, 3841 (95%) of whom were white and 194 (5%) of whom were black. Using geocoding, we linked individual-level registry data to US census tracts data through patient addresses. We constructed a multivariate linear mixed-effect model in multilevel frameworks to assess the interaction between race and census tract poverty on WOMAC pain and function scores 2 years after TKA. We defined a clinically important effect as 10 points on the WOMAC (which is scaled from 1 to 100 points, with higher scores being better).
Results
Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes were small, and below the threshold of clinical importance. Whites and blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA (WOMAC pain, 1.01 ± 1.59 points lower for blacks than for whites, p = 0.53; WOMAC function, 2.32 ± 1.56 lower for blacks than for whites, p = 0.14). WOMAC pain and function scores 2 years after TKA worsen with increasing levels of community poverty, but do so to a greater extent among blacks than whites. Disparities in pain and function between blacks and whites are evident only in the poorest communities; decreasing in a linear fashion as poverty increases. In census tracts with greater than 40% poverty, blacks score 6 ± 3 points lower (worse) than whites for WOMAC pain (p = 0.03) and 7 ± 3 points lower than whites for WOMAC function (p = 0.01).
Conclusions
Blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities. Efforts to improve TKA outcomes among blacks will need to address individual- and community-level socioeconomic factors.
Level of Evidence
Level III, therapeutic study.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-016-4919-8</identifier><identifier>PMID: 27278675</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>African Americans ; Aged ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Hip - economics ; Censuses ; Chi-Square Distribution ; Clinical Research ; Confounding Factors (Epidemiology) ; Conservative Orthopedics ; European Continental Ancestry Group ; Female ; Healthcare Disparities - economics ; Healthcare Disparities - ethnology ; Hip Joint - physiopathology ; Hip Joint - surgery ; Hispanic Americans ; Humans ; Joint Diseases - economics ; Joint Diseases - ethnology ; Joint Diseases - physiopathology ; Joint Diseases - surgery ; Knee ; Linear Models ; Male ; Medicaid - economics ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Orthopedics ; Pain Measurement ; Pain, Postoperative - economics ; Pain, Postoperative - ethnology ; Patient Reported Outcome Measures ; Poverty - economics ; Poverty - ethnology ; Recovery of Function ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Time Factors ; Treatment Outcome ; United States - epidemiology</subject><ispartof>Clinical orthopaedics and related research, 2016-09, Vol.474 (9), p.1986-1995</ispartof><rights>The Association of Bone and Joint Surgeons® 2016</rights><rights>The Association of Bone and Joint Surgeons 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-954c2fc259ebf1cfd1c6eaeaae1beadd7217b967194c9646e71c4539dd581f93</citedby><cites>FETCH-LOGICAL-c503t-954c2fc259ebf1cfd1c6eaeaae1beadd7217b967194c9646e71c4539dd581f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965380/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965380/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27278675$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goodman, Susan M.</creatorcontrib><creatorcontrib>Mandl, Lisa A.</creatorcontrib><creatorcontrib>Parks, Michael L.</creatorcontrib><creatorcontrib>Zhang, Meng</creatorcontrib><creatorcontrib>McHugh, Kelly R.</creatorcontrib><creatorcontrib>Lee, Yuo-Yu</creatorcontrib><creatorcontrib>Nguyen, Joseph T.</creatorcontrib><creatorcontrib>Russell, Linda A.</creatorcontrib><creatorcontrib>Bogardus, Margaret H.</creatorcontrib><creatorcontrib>Figgie, Mark P.</creatorcontrib><creatorcontrib>Bass, Anne R.</creatorcontrib><title>Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Background
Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA.
Questions/purposes
We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA?
Methods
We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among patients without a college education (67%) compared with those with a college education (71%). Our final study cohort consisted of 4035 patients, 3841 (95%) of whom were white and 194 (5%) of whom were black. Using geocoding, we linked individual-level registry data to US census tracts data through patient addresses. We constructed a multivariate linear mixed-effect model in multilevel frameworks to assess the interaction between race and census tract poverty on WOMAC pain and function scores 2 years after TKA. We defined a clinically important effect as 10 points on the WOMAC (which is scaled from 1 to 100 points, with higher scores being better).
Results
Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes were small, and below the threshold of clinical importance. Whites and blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA (WOMAC pain, 1.01 ± 1.59 points lower for blacks than for whites, p = 0.53; WOMAC function, 2.32 ± 1.56 lower for blacks than for whites, p = 0.14). WOMAC pain and function scores 2 years after TKA worsen with increasing levels of community poverty, but do so to a greater extent among blacks than whites. Disparities in pain and function between blacks and whites are evident only in the poorest communities; decreasing in a linear fashion as poverty increases. In census tracts with greater than 40% poverty, blacks score 6 ± 3 points lower (worse) than whites for WOMAC pain (p = 0.03) and 7 ± 3 points lower than whites for WOMAC function (p = 0.01).
Conclusions
Blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities. Efforts to improve TKA outcomes among blacks will need to address individual- and community-level socioeconomic factors.
Level of Evidence
Level III, therapeutic study.</description><subject>African Americans</subject><subject>Aged</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Hip - economics</subject><subject>Censuses</subject><subject>Chi-Square Distribution</subject><subject>Clinical Research</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Conservative Orthopedics</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Healthcare Disparities - economics</subject><subject>Healthcare Disparities - ethnology</subject><subject>Hip Joint - physiopathology</subject><subject>Hip Joint - surgery</subject><subject>Hispanic Americans</subject><subject>Humans</subject><subject>Joint Diseases - economics</subject><subject>Joint Diseases - ethnology</subject><subject>Joint Diseases - physiopathology</subject><subject>Joint Diseases - surgery</subject><subject>Knee</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medicaid - economics</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Orthopedics</subject><subject>Pain Measurement</subject><subject>Pain, Postoperative - economics</subject><subject>Pain, Postoperative - ethnology</subject><subject>Patient Reported Outcome Measures</subject><subject>Poverty - economics</subject><subject>Poverty - ethnology</subject><subject>Recovery of Function</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkUFvFCEUx4nR2LX6AbwYEi9eRnnMMIAHk7qt2tikRvegJ8Iyb1qaXViBadNvX9atTTUx8UTg_d7_AT9CngN7DYzJNxlAa90w6JtOg27UAzIDwVUD0PKHZMYY043m8H2PPMn5om7bTvDHZI9LLlUvxYz8OPR5Y5MvHjP1gS4-H9DTqbi4xvyWzjHkKdNFsq7QQ1ss_XYer-hxKLg98jFk-h7LFWKgX61DasNAv8RLTOX6KXk02lXGZ7frPll8OFrMPzUnpx-P5wcnjROsLY0WneOj40LjcgQ3DuB6tGgtwhLtMEgOcql7Cbpzuu96lOA60ephEApG3e6Td7vYzbRc4-AwlGRXZpP82qZrE603f1aCPzdn8dJ0uhetYjXg1W1Aij8nzMWsfXa4WtmAccoGFIBSbR39HyiTmjGlRUVf_oVexCmF-hG_AoG1jPNKwY5yKeaccLy7NzCzVWx2ik1VbLaKjao9L-4_-K7jt9MK8B2QaymcYbo3-p-pN8rIsdc</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Goodman, Susan M.</creator><creator>Mandl, Lisa A.</creator><creator>Parks, Michael L.</creator><creator>Zhang, Meng</creator><creator>McHugh, Kelly R.</creator><creator>Lee, Yuo-Yu</creator><creator>Nguyen, Joseph T.</creator><creator>Russell, Linda A.</creator><creator>Bogardus, Margaret H.</creator><creator>Figgie, Mark P.</creator><creator>Bass, Anne R.</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160901</creationdate><title>Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty</title><author>Goodman, Susan M. ; Mandl, Lisa A. ; Parks, Michael L. ; Zhang, Meng ; McHugh, Kelly R. ; Lee, Yuo-Yu ; Nguyen, Joseph T. ; Russell, Linda A. ; Bogardus, Margaret H. ; Figgie, Mark P. ; Bass, Anne R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-954c2fc259ebf1cfd1c6eaeaae1beadd7217b967194c9646e71c4539dd581f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>African Americans</topic><topic>Aged</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Hip - economics</topic><topic>Censuses</topic><topic>Chi-Square Distribution</topic><topic>Clinical Research</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Conservative Orthopedics</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Healthcare Disparities - economics</topic><topic>Healthcare Disparities - ethnology</topic><topic>Hip Joint - physiopathology</topic><topic>Hip Joint - surgery</topic><topic>Hispanic Americans</topic><topic>Humans</topic><topic>Joint Diseases - economics</topic><topic>Joint Diseases - ethnology</topic><topic>Joint Diseases - physiopathology</topic><topic>Joint Diseases - surgery</topic><topic>Knee</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medicaid - economics</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Orthopedics</topic><topic>Pain Measurement</topic><topic>Pain, Postoperative - economics</topic><topic>Pain, Postoperative - ethnology</topic><topic>Patient Reported Outcome Measures</topic><topic>Poverty - economics</topic><topic>Poverty - ethnology</topic><topic>Recovery of Function</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goodman, Susan M.</creatorcontrib><creatorcontrib>Mandl, Lisa A.</creatorcontrib><creatorcontrib>Parks, Michael L.</creatorcontrib><creatorcontrib>Zhang, Meng</creatorcontrib><creatorcontrib>McHugh, Kelly R.</creatorcontrib><creatorcontrib>Lee, Yuo-Yu</creatorcontrib><creatorcontrib>Nguyen, Joseph T.</creatorcontrib><creatorcontrib>Russell, Linda A.</creatorcontrib><creatorcontrib>Bogardus, Margaret H.</creatorcontrib><creatorcontrib>Figgie, Mark P.</creatorcontrib><creatorcontrib>Bass, Anne R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goodman, Susan M.</au><au>Mandl, Lisa A.</au><au>Parks, Michael L.</au><au>Zhang, Meng</au><au>McHugh, Kelly R.</au><au>Lee, Yuo-Yu</au><au>Nguyen, Joseph T.</au><au>Russell, Linda A.</au><au>Bogardus, Margaret H.</au><au>Figgie, Mark P.</au><au>Bass, Anne R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>474</volume><issue>9</issue><spage>1986</spage><epage>1995</epage><pages>1986-1995</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Background
Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA.
Questions/purposes
We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA?
Methods
We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among patients without a college education (67%) compared with those with a college education (71%). Our final study cohort consisted of 4035 patients, 3841 (95%) of whom were white and 194 (5%) of whom were black. Using geocoding, we linked individual-level registry data to US census tracts data through patient addresses. We constructed a multivariate linear mixed-effect model in multilevel frameworks to assess the interaction between race and census tract poverty on WOMAC pain and function scores 2 years after TKA. We defined a clinically important effect as 10 points on the WOMAC (which is scaled from 1 to 100 points, with higher scores being better).
Results
Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes were small, and below the threshold of clinical importance. Whites and blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA (WOMAC pain, 1.01 ± 1.59 points lower for blacks than for whites, p = 0.53; WOMAC function, 2.32 ± 1.56 lower for blacks than for whites, p = 0.14). WOMAC pain and function scores 2 years after TKA worsen with increasing levels of community poverty, but do so to a greater extent among blacks than whites. Disparities in pain and function between blacks and whites are evident only in the poorest communities; decreasing in a linear fashion as poverty increases. In census tracts with greater than 40% poverty, blacks score 6 ± 3 points lower (worse) than whites for WOMAC pain (p = 0.03) and 7 ± 3 points lower than whites for WOMAC function (p = 0.01).
Conclusions
Blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities. Efforts to improve TKA outcomes among blacks will need to address individual- and community-level socioeconomic factors.
Level of Evidence
Level III, therapeutic study.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27278675</pmid><doi>10.1007/s11999-016-4919-8</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0009-921X |
ispartof | Clinical orthopaedics and related research, 2016-09, Vol.474 (9), p.1986-1995 |
issn | 0009-921X 1528-1132 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4965380 |
source | MEDLINE; SpringerNature Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
subjects | African Americans Aged Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - economics Censuses Chi-Square Distribution Clinical Research Confounding Factors (Epidemiology) Conservative Orthopedics European Continental Ancestry Group Female Healthcare Disparities - economics Healthcare Disparities - ethnology Hip Joint - physiopathology Hip Joint - surgery Hispanic Americans Humans Joint Diseases - economics Joint Diseases - ethnology Joint Diseases - physiopathology Joint Diseases - surgery Knee Linear Models Male Medicaid - economics Medicine Medicine & Public Health Middle Aged Multivariate Analysis Orthopedics Pain Measurement Pain, Postoperative - economics Pain, Postoperative - ethnology Patient Reported Outcome Measures Poverty - economics Poverty - ethnology Recovery of Function Registries Retrospective Studies Risk Assessment Risk Factors Sports Medicine Surgery Surgical Orthopedics Time Factors Treatment Outcome United States - epidemiology |
title | Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T16%3A14%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Disparities%20in%20TKA%20Outcomes:%20Census%20Tract%20Data%20Show%20Interactions%20Between%20Race%20and%20Poverty&rft.jtitle=Clinical%20orthopaedics%20and%20related%20research&rft.au=Goodman,%20Susan%20M.&rft.date=2016-09-01&rft.volume=474&rft.issue=9&rft.spage=1986&rft.epage=1995&rft.pages=1986-1995&rft.issn=0009-921X&rft.eissn=1528-1132&rft_id=info:doi/10.1007/s11999-016-4919-8&rft_dat=%3Cproquest_pubme%3E4145999541%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1811103022&rft_id=info:pmid/27278675&rfr_iscdi=true |