Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?
Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?
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DOI：
10.1002/acr.23442
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发表时间：
2018-06-01
影响因子：
4.7
通讯作者：
Bass, Anne R.
中科院分区：
文献类型：
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作者：
Goodman, Susan M.;Mandl, Lisa A.;Bass, Anne R.
目标。来自贫困社区的患者接受全膝关节置换术（TKA）的结果更差，但教育是否能减轻贫困的影响尚不清楚。我们评估了教育和贫困对2年安大略省西部和麦克马斯特大学骨关节炎指数（WOMAC）疼痛和功能的影响。来自机构登记的患者水平变量与美国人口普查局数据（普查区[CT]水平）相关联。统计模型包括患者和ct水平变量在多层框架内构建。对每个CT采用单独随机截点的线性混合效应模型来评估教育与贫困在个人和社区层面上对WOMAC得分的相互作用。在3970例TKA患者中，2438例（61%）接受过大专以上教育。未上过大学的患者在基线和2年时的疼痛和功能更差（P = 0.0001）。生活在贫困社区（低于贫困线20%）与更严重的2年疼痛（P = 0.02）和功能（P = 0.006）相关。个体教育和社区贫困之间有很强的相互作用，在2年的WOMAC分数。生活在贫困社区的未上过大学的患者的疼痛评分比上过大学的患者差10分（83.4%比75.7%,P < 0.0001）；在富裕的社区，大学与疼痛程度的1分差异有关。功能相似。在贫困社区，没有上过大学的人两年的WOMAC分数比上过大学的人低10分；在富裕社区，教育对TKA结果没有影响。教育如何保护贫困社区的人值得进一步研究。
Objective. Total knee arthroplasty (TKA) outcomes are worse for patients from poor neighborhoods, but whether education mitigates the effect of poverty is not known. We assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function.Methods. Patient-level variables from an institutional registry were linked to US Census Bureau data (census tract [CT] level). Statistical models including patient and CT-level variables were constructed within multilevel frameworks. Linear mixed-effects models with separate random intercepts for each CT were used to assess the interaction between education and poverty at the individual and community level on WOMAC scores.Results. Of 3,970 TKA patients, 2,438 (61%) had some college or more. Having no college was associated with worse pain and function at baseline and 2 years (P = 0.0001). Living in a poor neighborhood (>20% below poverty line) was associated with worse 2-year pain (P = 0.02) and function (P = 0.006). There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were similar to 10 points worse than those with some college (83.4% versus 75.7%; P < 0.0001); in wealthy communities, college was associated with a 1-point difference in pain. Function was similar.Conclusion. 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.