Benyamini Brian, Hadad Matthew J, Pasqualini Ignacio, Khan Shujaa T, Jin Yuxuan, Piuzzi Nicolas S
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2025 Apr;40(4):837-847. doi: 10.1016/j.arth.2024.10.007. Epub 2024 Oct 16.
The impact of socioeconomic status on achievement of clinically relevant patient-reported outcome measure (PROM) improvements and satisfaction after total hip arthroplasty (THA) is unknown. Area Deprivation Index (ADI) is a metric that can be used as a proxy for a patient's neighborhood socioeconomic status. This study aimed to assess the association between ADI and failure to achieve: (1) clinically relevant improvements in PROMs; and (2) self-reported satisfaction at 1 year following THA.
A prospective cohort of 7,506 patients who underwent primary unilateral THA from January 2016 to July 2021 was included. The ADI was stratified into quintiles based on their distribution in our sample. Multivariable logistic regression models were created to investigate the effect of ADI on 1-year PROMs. The included PROMs were the Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain, Physical Function Shortform (PS), and Joint Replacement (JR). Clinically relevant improvements were assessed through minimal clinically important difference and patient acceptable symptom state threshold achievement.
There was no significant association between ADI and failure to achieve minimal clinically important difference for HOOS pain (P = 0.42), PS (P = 0.91), or JR (P = 0.20). However, higher ADI scores were independently associated with increased odds of failing to achieve patient acceptable symptom state for HOOS Pain (P = 0.002), PS (P = 0.003), and JR (P = 0.017). The ADI was not associated with failure to achieve patient satisfaction at 1 year (P = 0.93).
Greater neighborhood socioeconomic disadvantage was associated with decreased odds of achieving clinically relevant improvement in patient-perceived symptomatic state, but not associated with patients' perception of their overall pain and function 1 year after THA. Targeted interventions to address access and care pathways for low socioeconomic status patients may present an opportunity to improve patient-perceived outcomes following THA.
Level III.
社会经济地位对全髋关节置换术（THA）后实现临床相关的患者报告结局指标（PROM）改善及满意度的影响尚不清楚。地区贫困指数（ADI）是一种可用于代表患者社区社会经济地位的指标。本研究旨在评估ADI与未能实现以下两点之间的关联：（1）PROM的临床相关改善；（2）THA术后1年的自我报告满意度。
纳入2016年1月至2021年7月期间接受初次单侧THA的7506例患者的前瞻性队列。根据ADI在我们样本中的分布将其分为五等份。建立多变量逻辑回归模型以研究ADI对1年PROM的影响。纳入的PROM包括髋关节残疾和骨关节炎结局评分（HOOS）疼痛、身体功能简表（PS）和关节置换（JR）。通过最小临床重要差异和达到患者可接受症状状态阈值来评估临床相关改善情况。
ADI与未能达到HOOS疼痛（P = 0.42）、PS（P = 0.91）或JR（P = 0.20）的最小临床重要差异之间无显著关联。然而，较高的ADI评分与未能达到HOOS疼痛（P = 0.002）、PS（P = 0.003）和JR（P = 0.017）的患者可接受症状状态的几率增加独立相关。ADI与1年时未达到患者满意度无关（P = 0.93）。
社区社会经济劣势越大，患者自我感知症状状态实现临床相关改善的几率越低，但与THA术后1年患者对其总体疼痛和功能的感知无关。针对低社会经济地位患者的获取途径和护理路径的针对性干预措施可能为改善THA术后患者自我感知结局提供机会。
三级。
