Neighborhood-Level Socioeconomic Deprivation, Rurality, and Long-Term Outcomes of Patients Undergoing Total Joint Arthroplasty: Analysis from a Large, Tertiary Care Hospital.
Neighborhood-Level Socioeconomic Deprivation, Rurality, and Long-Term Outcomes of Patients Undergoing Total Joint Arthroplasty: Analysis from a Large, Tertiary Care Hospital.
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DOI：
10.1016/j.mayocpiqo.2022.06.001
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发表时间：
2022-08
期刊：
影响因子：
--
通讯作者：
Maradit Kremers, Hilal
中科院分区：
文献类型：
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作者：
Kamath, Celia C;O'Byrne, Thomas J;Lewallen, David G;Berry, Daniel J;Maradit Kremers, Hilal
评估社区水平的社会经济地位因素（面积剥夺指数[ADI]和农村分类）及其与个人水平的社会经济地位（教育水平）的相互作用对全关节置换术（TJA）手术后长期结局的影响。这是一项对2000年1月1日至2019年12月31日期间在三级医院对患者进行的46，828例TJA手术进行的队列研究。考克斯比例风险模型被用来检查ADI和农村之间的关系，以及它们与个人水平的假体周围关节感染、翻修手术和死亡率风险教育之间的相互作用。在手术时，2589名（6%）患者生活在最贫困的社区（ADI五分位数>80%），10,728名（23%）生活在偏远的小城镇。来自最贫困社区的患者更有可能经历翻修手术（风险比，[HR]，1.39; 95% CI，1.10-1.76）和死亡率（HR，1.24; 95% CI，1.09-1.42）。来自小城镇的患者也更有可能接受翻修手术（HR，1.14; 95% CI，1.01-1.28）。ADI最高的3个五分位数的患者的死亡风险比ADI最低的五分位数的患者高13%、18%和24%。教育梯度在最贫困的社区比在最贫困的社区更显着。邻里劣势和农村与翻修手术的风险呈负相关，并且与死亡风险的个人水平教育相互作用。有必要采取人口一级的卫生干预措施，以减轻TJA地区的社会经济不利因素。
To assess the impact of neighborhood-level socioeconomic status factors (area deprivation index [ADI] and rural classification) and their interaction with individual-level socioeconomic status (education-level) on long-term outcomes following total joint arthroplasty (TJA) surgery. This was a cohort study of 46,828 TJA surgeries performed on patients at a tertiary care hospital between January 1, 2000 and December 31, 2019. Cox proportional hazards models were used to examine the association between ADI and rurality and their interaction with individual-level education on the risk of periprosthetic joint infections, revision surgery, and mortality. At the time of surgery, 2589 (6%) patients lived in the most deprived neighborhoods (ADI quintile >80%) and 10,728 (23%) lived in small isolated rural towns. Patients from the most deprived neighborhoods were more likely to experience revision surgery (hazard ratio, [HR], 1.39; 95% CI, 1.10-1.76) and mortality (HR, 1.24; 95% CI, 1.09-1.42). Patients from small rural towns were also more likely to undergo revision surgery (HR, 1.14; 95% CI, 1.01-1.28). The mortality risk was 13%, 18%, and 24% higher for patients in the 3 highest ADI quintiles than those from the lowest quintile. Education gradient was more notable in the least deprived neighborhoods than in the most deprived neighborhoods. Neighborhood disadvantage and rurality are negatively associated with the risk of revision surgery and both independently and in interaction with individual-level education with the risk of mortality. There is a need for population-level health interventions to mitigate area-based socioeconomic disadvantages in TJA.