A Proposed Conceptual Framework and Narrative Systematic Review of the Social Determinants of Health in Hip and Knee Arthroplasty.

OBJECTIVE

There is growing evidence on the relationship between social determinants of health (SDOH) dimensions and utilization and outcomes of joint arthroplasty; however, this literature is not currently guided by a conceptual framework that is specific to this patient population. The purposes of our study were to (1) present a comprehensive evidence-driven conceptual framework of SDOH specific to hip and knee arthroplasty and (2) conduct a narrative systematic review of SDOH literature to assess the extent of SDOH coverage and inform the likely directionality of association between proposed variables and joint arthroplasty outcomes.

METHODS

Existing SDOH conceptual frameworks were reviewed to identify all domains relevant to joint arthroplasty. A systematic narrative review of the hip/knee arthroplasty literature was then conducted in PubMed in accordance with PRISMA principles to inform the extent to which SDOH dimensions are covered and the directionality of associations.

RESULTS

The final proposed conceptual framework identified seven dimensions from both Healthy People 2030 and Luong et al. Our narrative review found 25 articles, and most examined about half of the proposed SDOH domains. Only two of 26 studies accounted for all seven domains. The directionality of multivariable associations was reasonably consistent across studies for person-level dimensions but generally not for Healthy People 2030 dimensions.

CONCLUSION

Our proposed conceptual framework is the first to describe a comprehensive set of SDOH dimensions. Application of the framework to future research will likely lead to a comprehensive assessment of the role of SDOH in potentially influencing a variety of arthroplasty outcomes.