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Disparities in Total Hip Arthroplasty Outcomes: Census Tract Data Show Interactions Between Race and Community Deprivation

Goodman, Susan M., MD; Mehta, Bella, MD; Zhang, Meng, PhD; Szymonifka, Jaqueline, MS; Nguyen, Joseph T., MPH; Lee, Lily, MS; Figgie, Mark P., MD; Parks, Michael L., MD; Dey, Shirin A., BS; Crego, Daisy, BA; Russell, Linda A., MD; Mandl, Lisa A., MD, MPH; Bass, Anne R., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: November 1, 2018 - Volume 26 - Issue 21 - p e457–e464
doi: 10.5435/JAAOS-D-17-00393
Research Article

Introduction: Socioeconomic factors such as poverty may mediate racial disparities in health outcomes after total hip arthroplasty (THA) and confound analyses of differences between blacks and whites.

Methods: Using a large institutional THA registry, we built models incorporating individual and census tract data and analyzed interactions between race and percent of population with Medicaid coverage and its association with 2-year patient-reported outcomes.

Results: Black patients undergoing THA had worse baseline and 2-year pain and function scores compared with whites. We observed strong positive correlations between census tract Medicaid coverage and percent living below poverty (rho = 0.69; P < 0.001). Disparities in 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function were magnified in communities with high census tract Medicaid coverage. For blacks in these communities, 2-year WOMAC function scores were predicted to be −5.54 points lower (80.42 versus 85.96) compared with blacks in less deprived communities, a difference not observed among whites.

Conclusion: WOMAC pain and function 2 years after THA are similar among blacks and whites in communities with little deprivation (low percent census tract Medicaid coverage). WOMAC function at 2 years is worse among blacks in areas of higher deprivation but is not seen among whites.

Level of Evidence: Level II - Cohort Study

From the Department of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medicine (Dr. Goodman, Dr. Mehta, Dr. Zhang, Dr. Russell, Dr. Bass and Dr. Mandl), Department of Orthopedic Surgery (Dr. Figgie and Dr.Parks) and Department of Medicine (Ms. Szymonifka, Mr. Nguyen, Ms. Lee, Ms. Dey and Ms. Crego), Hospital for Special Surgery, New York, NY.

Correspondence to Dr. Goodman: goodmans@hss.edu

Dr. Goodman or an immediate family member has received research or institutional support from Novartis and Roche. Dr. Parks or an immediate family member serves as a paid consultant to and has received research or institutional support from Zimmer Biomet and serves as a board member, owner, officer, or committee member of the Orthopaedic Research and Education Foundation and the Orthopaedic Learning Center. Dr. Russell or an immediate family member serves as a board member, owner, officer, or committee member of the Arthritis Foundation. Dr. Mandl or an immediate family member has received research or institutional support from Boehringer-Ingellheim. Dr. Bass or an immediate family member serves as a board member, owner, officer, or committee member of the American College of Rheumatology and the Rheumatology Research Foundation. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Mehta, Dr. Zhang, Ms. Szymonifka, Mr. Nguyen, Ms. Lee, Dr. Figgie, Ms. Dey, and Ms. Crego.

© 2018 by American Academy of Orthopaedic Surgeons
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