Simkin Jennifer, Valentino John, Cao Wentao, McCarthy Christina, Schuon Jonathan, Davis Jacob, Marrero Luis, Dasa Vinod, Leonardi Claudia, Yu Qingzhao
Department of Orthopaedic Surgery, School of Medicine, LSUHSC-New Orleans, New Orleans, Louisiana.
JB JS Open Access. 2021 Jul 28;6(3). doi: 10.2106/JBJS.OA.21.00004. eCollection 2021 Jul-Sep.
Studies on symptomatic osteoarthritis suggest that Black patients report worse pain and symptoms compared with White patients with osteoarthritis. In this study, we aimed to quantify the relationship among variables such as overall health and socioeconomic status that may contribute to disparities in patient-reported outcomes.
A total of 223 patients were enrolled. A mediation analysis was used to evaluate cross-sectional associations between race and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire, which was administered to patients prior to undergoing primary total knee arthroplasty.
Black patients had worse KOOS pain, symptoms, and activities of daily living subscale scores than White patients. In our cohort, Black patients were younger, more likely to be female, and more likely to report lower educational status. We identified age, sex, Charlson Comorbidity Index, and education as partial mediators of racial disparities in KOOS subscale scores. Insurance status, deformity, radiographic (Kellgren-Lawrence) grade, C-reactive protein level, marital status, body mass index, and income did not show mediating effects. We found that, if age and sex were equal in both cohorts, the racial disparity in KOOS symptom scores would be reduced by 20.7% and 9.1%, respectively (95% confidence intervals [CIs], -5.1% to 47% and -5.5% to 26.3%). For KOOS pain scores, age and education level explained 18.9% and 5.1% of the racial disparity (95% CIs, -0.6% to 37% and -10.8% to 22.9%). Finally, for KOOS activities of daily living scores, education level explained 3.2% of the disparity (95% CI, -19.4% to 26.6%).
No single factor in our study completely explained the racial disparity in KOOS scores, but our findings did suggest that several factors can combine to mediate this disparity in outcome scores. Quantification of variables that mediate racial disparity can help to build models for risk adjustment, pinpoint vulnerable populations, and identify primary points of intervention.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
关于症状性骨关节炎的研究表明，与患骨关节炎的白人患者相比，黑人患者报告的疼痛和症状更严重。在本研究中，我们旨在量化总体健康和社会经济地位等变量之间的关系，这些变量可能导致患者报告结果的差异。
共纳入223例患者。采用中介分析来评估种族与膝关节损伤和骨关节炎结果评分（KOOS）问卷之间的横断面关联，该问卷在患者接受初次全膝关节置换术前进行发放。
黑人患者的KOOS疼痛、症状和日常生活活动分量表评分比白人患者更差。在我们的队列中，黑人患者更年轻，更可能为女性，且更可能报告教育程度较低。我们确定年龄、性别、查尔森合并症指数和教育程度是KOOS分量表评分种族差异的部分中介因素。保险状况、畸形、影像学（凯尔格伦-劳伦斯）分级、C反应蛋白水平、婚姻状况、体重指数和收入未显示中介作用。我们发现，如果两个队列中的年龄和性别相同，KOOS症状评分的种族差异将分别降低20.7%和9.1%（95%置信区间[CI]，-5.1%至47%和-5.5%至26.3%）。对于KOOS疼痛评分，年龄和教育水平分别解释了种族差异的18.9%和5.1%（95%CI，-0.6%至37%和-10.8%至22.9%）。最后，对于KOOS日常生活活动评分，教育水平解释了差异的3.2%（95%CI，-19.4%至26.6%）。
我们研究中的单一因素均未完全解释KOOS评分中的种族差异，但我们研究结果确实表明，几个因素可共同介导结果评分中的这种差异。对介导种族差异的变量进行量化有助于建立风险调整模型、确定弱势群体并识别主要干预点。
预后III级。有关证据水平的完整描述，请参阅作者指南。
