Department of Orthopaedic Surgery, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Orthopaedic Surgery, University Hospitals/Cleveland Medical Center, Cleveland, Ohio.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2022 Jul;37(7S):S428-S433. doi: 10.1016/j.arth.2022.02.041. Epub 2022 Feb 18.
Utilization of total joint arthroplasty (TJA) by minorities is disproportionately low compared to Whites. Contributing factors include poorer outcomes, lower expectations, and decreased access to care. This study aimed to evaluate if race and income were predictive of preoperative patient-reported outcome measures (PROMs) and the likelihood of achieving the minimal clinically important difference (MCID) following TJA.
We retrospectively reviewed 1,371 patients who underwent primary TJA between January 2018 and March 2021 in a single healthcare system. Preoperative and postoperative PROM scores were collected for Patient-Reported Outcomes Measurement Information System (PROMIS) Mental Health, PROMIS Physical Function (PF10a), and either Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS). Demographic and comorbidity data were included as explanatory variables. Multivariable regression was used to analyze the association between predictive variables and PROM scores.
Mean preoperative PROM scores were lower for non-Whites compared to Whites. Increased median household income was associated with higher preoperative PROM scores. Non-White race was associated with lower PROMIS Mental Health and KOOS, but not PF10a or HOOS scores. Only non-White race was associated with a decreased likelihood of achieving MCID for PF10a. Neither race nor income was predictive of achieving MCID for KOOS and HOOS.
Non-White race/ethnicity and lower income were associated with lower preoperative PROMs prior to primary TJA. Continued research is necessary to identify the causes of this discrepancy and correct this disparity.
与白人相比，少数民族接受全关节置换术（TJA）的比例不成比例地较低。促成因素包括较差的结果、较低的期望和获得医疗保健的机会减少。本研究旨在评估种族和收入是否可预测 TJA 前后的患者报告的结果测量（PROM），以及是否可预测达到最小临床重要差异（MCID）的可能性。
我们回顾性分析了 2018 年 1 月至 2021 年 3 月期间在单一医疗保健系统中接受初次 TJA 的 1371 名患者。收集了术前和术后患者报告的结局测量信息系统（PROMIS）心理健康、PROMIS 身体机能（PF10a）以及膝关节损伤和骨关节炎结果评分（KOOS）或髋关节残疾和骨关节炎结果评分（HOOS）的 PROM 评分。将人口统计学和合并症数据作为解释变量。多变量回归用于分析预测变量与 PROM 评分之间的关联。
与白人相比，非白人的平均术前 PROM 评分较低。家庭收入中位数的增加与较高的术前 PROM 评分相关。非白人种族与较低的 PROMIS 心理健康和 KOOS 评分相关，但与 PF10a 或 HOOS 评分无关。只有非白人种族与 PF10a 达到 MCID 的可能性降低有关。种族和收入均不能预测 KOOS 和 HOOS 达到 MCID 的可能性。
非白人种族/民族和较低的收入与初次 TJA 前较低的术前 PROM 相关。需要进一步研究以确定这种差异的原因，并纠正这种差异。
