The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee: A Population-Based Cohort Study

Nordenvall, Richard; Marcano, Alejandro I.; Adami, Johanna; Palme, Mårten; Mattila, Ville M.; Bahmanyar, Shahram; Felländer‐Tsai, Li

doi:10.1177/0363546516672651

Cited by 28 publications

(25 citation statements)

References 99 publications

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“…Previous studies on primary ACLR reported that younger age, lower socioeconomic status, and public insurance are all associated with delays in care and additional surgeries at time of primary reconstruction. 9,10,30,31 In our study, insurance was evaluated as a potential risk factor for subsequent (revision or contralateral) ACLR. We found no difference in subsequent (revision or contralateral) ACLR risk between public and private insurance in the overall cohort.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Early Subsequent (Revision or Contralateral) ACL Reconstruction: A Retrospective Database Study

Gallo

Bolia²,

Jalali

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Many factors contribute to the risk for subsequent anterior cruciate ligament reconstruction (ACLR) within 2 years from the index procedure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to evaluate the incidence of subsequent (revision or contralateral) ACLR at 2 years in a large cohort and (2) to explore the association between patient-specific factors and early subsequent ACLR risk by age group. We hypothesize that 2-year subsequent (revision or contralateral) ACLR rates will be low and that risk factors for subsequent (revision or contralateral) ACLR will vary depending on a patient’s age group. Study Design: Case-control study; Level of evidence, 3. Methods: The California Office of Statewide Health Planning and Development Ambulatory Surgery Database was retrospectively reviewed to assess the incidence of 2-year subsequent (revision or contralateral) ACLR and to identify patient-specific risk factors for early subsequent (revision or contralateral) ACLR by age group between 2005 and 2014. Results: Of 94,108 patients included, the rate of subsequent (revision or contralateral) ACLR was highest in patients younger than 21 years (2.4 per 100 person-years; 95% CI, 2.3-2.6) and lowest in those older than 40 years (1.3 per 100 person-years; 95% CI, 1.2-1.4). Younger age, white race (compared with Hispanic in all age groups and Asian in age <21 or >40 years), private insurance if age younger than 21 years, public insurance or worker's compensation claims if age older than 30 years were significantly associated with an increased risk of subsequent (revision or contralateral) ACLR at 2 years. Conclusion: Results of the present study provide insight into subsequent (revision or contralateral) ACL reconstruction, which can be used to assess and modify treatment for at-risk patients and highlight the need for data mining to generate clinically applicable research using national and international databases.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Early Subsequent (Revision or Contralateral) ACL Reconstruction: A Retrospective Database Study

Gallo

Bolia²,

Jalali

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…13 In a Swedish study that examined the relationships between education level, household income, and likelihood of undergoing surgical treatment for cruciate ligament injury, the investigators found that patients with higher family income and/or education level were more likely to undergo surgical treatment. 16…”

Section: Discussionmentioning

confidence: 99%

Neighborhood Socioeconomic Status Affects Patient-Reported Outcome 2 Years After ACL Reconstruction

Jones

Reinke

Zajichek

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Lower socioeconomic status (SES) is associated with worse patient-reported outcome (PRO) after orthopaedic procedures. In patients with anterior cruciate ligament (ACL) reconstruction, evaluating SES by use of traditional measures such as years of education or occupation is problematic because this group has a large proportion of younger patients. We hypothesized that lower education level and lower values for SES would predict worse PRO at 2 years after ACL reconstruction and that the effect of education level would vary with patient age.Purpose:To compare the performance of multivariable models that use traditional measures of SES with models that use an index of neighborhood SES derived from United States (US) Census data.Study Design:Cohort study; Level of evidence, 3.Methods:A cohort of 675 patients (45% female; median age, 20 years), were prospectively enrolled and evaluated 2 years after ACL reconstruction with questionnaires including the International Knee Documentation Committee (IKDC) questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Marx activity rating scale (Marx). In addition, a new variable was generated for this study, the SES index, which used geocoding performed retrospectively to identify the census tract of residence for each participant at the time of enrollment and extract neighborhood SES measures from the 2000 US Census Descriptive Statistics. Multivariable models were constructed that included traditional measures of SES as well as the SES index, and the quality of models was compared through use of the likelihood ratio test.Results:Lower SES index was associated with worse PRO for all measures. Models that included the SES index explained more variability than models with traditional SES. In addition, a statistically significant variation was found regarding the impact of education on PRO based on patient age for the IKDC score, the Marx scale, and 4 of the 5 KOOS subscales.Conclusion:This study demonstrates that lower neighborhood SES is associated with worse PRO after ACL reconstruction and that age and education have a significant interaction in this patient population. Future studies in patients who have undergone ACL reconstruction should attempt to account for neighborhood SES when adjusting for confounding factors; further, targeting patients from areas with lower neighborhood SES with special interventions may offer an opportunity to improve their outcomes.

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“…Socioeconomic factors have been shown to be associated with stoma reversal rate [ 15 , 17 , 18 ]. Income, education and occupation are well-known variables used for classification of socioeconomic status [ 19 , 20 ]. Kuryba et al [ 15 ] evaluated factors affecting stoma reversal rate in 4879 rectal cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Loop-ileostomy reversal—patient-related characteristics influencing time to closure

Gustafsson

Gunnarsson

Dahlstrand

et al. 2018

Int J Colorectal Dis

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PurposeTo identify factors associated with timing of stoma reversal after rectal cancer surgery in a large Swedish register-based cohort.MethodsThree thousand five hundred sixty-four patients with rectal cancer who received a protective stoma during surgery in 2007–2013 were identified in the Swedish colorectal cancer register. Time to stoma reversal was evaluated over a follow-up period of one and a half years. Factors associated with timing of stoma reversal were analysed using Cox regression analysis. Reversal within 9 months (12 months if adjuvant chemotherapy) was considered latest expected time to closure.ResultsStoma reversal was performed in 2954 (82.9%) patients during follow-up. Patients with post-secondary education had an increased chance for early stoma reversal (HR 1.13; 95% CI 1.02–1.25). Postoperative complications (0.67; 0.62–0.73), adjuvant chemotherapy (0.63; 0.57–0.69), more advanced cancer stage (stage III 0.74; 0.66–0.83 and stage IV 0.38; 0.32–0.46) and higher ASA score (0.80; 0.71–0.90 for ASA 3–4) were associated with longer time to reversal. Two thousand four hundred thirty-seven (68.4%) patients had stoma reversal within latest expected time to closure. Factors associated to decreased chance of timely reversal were more advanced cancer stage (stage III 0.64; 0.50–0.81 and stage IV 0.19; 0.13–0.27), postoperative complications (0.50; 0.42–0.59) and higher ASA score (0.77; 0.61–0.96 for ASA 3–4).ConclusionsPatients with a high level of education had a higher chance of timely reversal but medical factors had a stronger association to time to reversal. Patients with advanced rectal cancer are at high risk for non-reversal and should be considered for permanent stoma.

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The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee: A Population-Based Cohort Study

Cited by 28 publications

References 99 publications

Risk Factors for Early Subsequent (Revision or Contralateral) ACL Reconstruction: A Retrospective Database Study

Risk Factors for Early Subsequent (Revision or Contralateral) ACL Reconstruction: A Retrospective Database Study

Neighborhood Socioeconomic Status Affects Patient-Reported Outcome 2 Years After ACL Reconstruction

Loop-ileostomy reversal—patient-related characteristics influencing time to closure

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