Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?

Goodman, Susan M.; Mandl, Lisa A.; Mehta, Bella; Navarro‐Millán, Iris; Russell, Linda; Parks, Michael L.; Dey, Shirin A; Crego, Daisy; Figgie, Mark P.; Nguyen, Joseph; Szymonifka, Jackie; Zhang, Meng; Bass, Anne R.

doi:10.1002/acr.23442

Cited by 33 publications

(25 citation statements)

References 32 publications

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“…Of the status markers, neither objective nor subjective social status indices during childhood or present day significantly related to temporal summation across groups. This finding differs from prior work describing significant relationships between social status and physical pain 8 , 28 , 30 , 32 , 40 , 44 , 48 , 57 , 62 , 66 , 81 , 87 and temporal summation. 38 Instead, downward changes in objective (ie, family household income decreased over time) and subjective social status (ie, subjective social status decreased over time) across the lifespan—such that individuals reported a decrease in status since childhood—significantly correlated with greater temporal summation for Latinx-Americans.…”

Section: Discussioncontrasting

confidence: 99%

“…Low social status relates to poorer physical health, 1 , 2 , 21 , 94 including for Latinx-Americans. 34 , 36 , 73 For pain, objective 8 , 28 , 30 , 32 , 40 , 44 , 48 , 57 , 62 , 81 and subjective social status markers 87 relate with greater chronic pain rates and severity, along with worse pain outcomes. 8 , 28 , 30 , 44 , 57 , 62 , 81 Poverty status likewise inversely correlates with temporal summation among middle-to-older aged adults with knee osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

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Greater mechanical temporal summation of pain in Latinx-Americans and the role of adverse life experiences

Rassu

Luedke

Nanavaty

et al. 2020

PR9

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Greater mechanical temporal summation of pain in Latinx-Americans and the role of adverse life experiences

Rassu

Luedke

Nanavaty

et al. 2020

PR9

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“…While minority status was not found to be a significant predictor of any RA disease outcomes, this may be due to the characteristics of the present cohort. The cohort consisted of majority White females with some college education or higher, and we have previously demonstrated that education can mitigate the effects of poverty on arthroplasty outcomes, but in this study, both white and minority patients had similar education, limiting the potential for introducing bias [2]. As most patients receive care in community hospitals where a broader range of education and individual level income exists our results may not be generalizable.…”

Section: Discussionmentioning

confidence: 73%

“…Interactions between social factors may be complex. For instance, race and poverty are associated with worse arthroplasty outcomes, but education may mitigate the effect of poverty within poor communities [2]. In addition, worse arthroplasty outcomes associated with Black race are not seen for Black patients residing in communities with less than 10% poverty [3].…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in pre-operative pain, function and disease activity for patients with rheumatoid arthritis undergoing Total knee or Total hip Arthroplasty: a New York based study

Hirsch¹,

Mehta

Finik

et al. 2020

BMC Rheumatol

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Background: Black and Hispanic patients with osteoarthritis have more pain and worse function than Whites at the time of arthroplasty. Whether this is true for patients with rheumatoid arthritis (RA) is unknown. Methods: This cross-sectional study used data on RA patients acquired between October 2013 and November 2018 prior to elective total knee (TKA) or hip arthroplasty (THA). Pain, function, and disease activity were assessed using the visual analogue scale (VAS), the Multidimensional Health Assessment Questionnaire (MDHAQ), and the Disease Activity Score (DAS28-ESR). We linked the cases to census tracts using geocoding to determine the community poverty level. Race, education, income, insurance and medications were collected via self-report. Using multivariable linear and logistic models we examined whether minority status predicted pain, function and RA disease activity at the time of arthroplasty. Results: Thirty seven (23%) of the 164 patients were Black or Hispanic (minorities). The MDHAQ and DAS28-ESR were not significantly worse while VAS pain score was significantly worse in minority patients (p = 0.03). There was no significant difference in education between the groups. Insurance varied significantly; 29% of minority patients had Medicaid vs. 0% of Whites (p < 0.0001). In the multivariable analyses minority status was not significantly associated with DAS28-ESR [p = 0.66], MDHAQ [p = 0.26], or VAS pain [p = 0.18]. Conclusions: For Black and/or Hispanic patients with RA undergoing THA or TKA at a high-volume specialty hospital, unlike Black or Hispanic patients with osteoarthritis (OA), there was no association with worse pain, function, or RA disease activity at the time of elective arthroplasty.

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“…Blacks are at increased risk of total knee replacement (TKR) revision compared to whites , and blacks report significantly more pain and worse function 2 years after TKR . We previously showed that racial disparities in patient‐reported outcomes are strongly influenced by community poverty and education . Whether disparities in TKR revision risk are related to poverty is unknown.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Bass

Mehta

Szymonifka

et al. 2019

Arthritis Care & Research

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Objective To determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Methods Black and white New York state residents, enrolled in a prospective single‐institution TKR registry January 1, 2008 to February 6, 2012, who underwent primary unilateral TKR (n = 4,062) were linked to the New York Statewide Planning and Research Cooperative System database (January 1, 2008 to December 31, 2014) to capture revisions performed at outside institutions. Patients were linked by geocoded addresses to residential census tracts. Multivariable Cox regression was used to assess predictors of TKR revision. Multivariable logistic regression was used to analyze predictors of TKR failure, defined as TKR revision in New York state ≤2 years after surgery, or as Hospital for Special Surgery (HSS) TKR quality of life score “not improved” or “worsened” 2 years after surgery. Results The mean ± SD age was 68.4 ± 10 years, 64% of patients were female, 8% lived in census tracts with >20% of the population under the poverty line, and 9% were black. Median follow‐up time was 5.3 years. A total of 3% of patients (122 of 4,062) required revision a median 454 days (interquartile range 215–829) after surgery. TKR revision risk was higher in blacks than whites, with a hazard ratio of 1.69 (95% confidence interval 1.01–2.81), but in multivariable analysis, only younger age, male sex, and constrained prosthesis were predictors of TKR revision. TKR failure occurred in 200 of 2,832 cases (7%) with 2‐year surveys. Risk factors for TKR failure were non‐osteoarthritis TKR indication, low surgeon volume, and low HSS Expectations Survey score, but not black race. Community poverty was not associated with TKR revision or failure. Conclusion There was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.

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Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?

Abstract: In poor communities, those without college attain 2-year WOMAC scores that are 10 points worse than those with some college; education has no impact on TKA outcomes in wealthy communities. How education protects those in impoverished communities warrants further study.

Cited by 33 publications

References 32 publications

Greater mechanical temporal summation of pain in Latinx-Americans and the role of adverse life experiences

Greater mechanical temporal summation of pain in Latinx-Americans and the role of adverse life experiences

Racial disparities in pre-operative pain, function and disease activity for patients with rheumatoid arthritis undergoing Total knee or Total hip Arthroplasty: a New York based study

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

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