Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty

• DOI: 10.1007/s11999-016-4919-8
• Publication Date: 2016-06-08T14:27:43Z
• Authors: Susan M. Goodman; Lisa A. Mandl; Michael L. Parks; Meng Zhang; Kelly R. McHugh; Yuo-Yu Lee; Joseph T. Nguyen; Linda A. Russell; Margaret H. Bogardus; Mark P. Figgie; Anne R. Bass
• Keywords: Household income

Background Race is an important predictor of TKA outcomes in the United States; however, analyses race can be confounded by socioeconomic factors, which result difficulty determining root cause disparate after TKA. Questions/purposes We asked: (1) Are and factors at individual level associated with patient-reported pain function 2 years TKA? (2) What interaction between community poverty Methods identified all patients undergoing enrolled a hospital-based registry 2007 2011 who provided 2-year lived New York, Connecticut, or Jersey. Of approached to participate registry, more than 82% consented baseline data, these patients, 72% data. Proportions complete followup were lower among blacks (57%) whites (74%), Medicaid insurance (51%) compared without (72%), college education (67%) those (71%). Our final study cohort consisted 4035 3841 (95%) whom white 194 (5%) black. Using geocoding, we linked individual-level data US census tracts through patient addresses. constructed multivariate linear mixed-effect model multilevel frameworks assess tract on WOMAC scores defined clinically effect as 10 points (which scaled from 1 100 points, higher being better). Results Race, education, expectations, are function; sizes small, below threshold clinical importance. Whites less 10% have similar levels (WOMAC pain, 1.01 ± 1.59 for whites, p = 0.53; function, 2.32 1.56 0.14). worsen increasing poverty, but do so greater extent whites. Disparities evident only poorest communities; decreasing fashion increases. In 40% score 6 3 (worse) (p 0.03) 7 0.01). Conclusions Blacks living communities little outcomes, whereas high there racial disparities. Efforts improve will need address individual- community-level factors. Level Evidence III, therapeutic study.