Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Social factors affect TKA (total knee arthroplasty) outcomes in osteoarthritis, both at the individual and neighborhood levels. However, prior studies have not evaluated the influence of the proportion of foreign-born individuals within a neighborhood, as reported for other high-cost procedures (1). Our objective was to determine the association of neighborhood foreign-born resident proportion (FBRP) on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years after elective TKA. We examined if this is different between sexes.
Methods: Individual patient-level variables were obtained from a single institution TKA registry from 5/07-1/11, including demographics, baseline and 2 year WOMAC pain and function, and geocodable US addresses. We only included patients living in the hospital’s catchment area – i.e. New York, Connecticut and New Jersey (Figure 1). Individual patient-level variables were then linked to US Census Bureau data at the census tract level. Data was analyzed using univariate and multivariable linear mixed effects models, with census tracts variables treated as random effects. A separate linear mixed-effects model was used to assess the interaction between neighborhood FBRP and gender.
Results: Table 1 describes the 3,898 TKA cases analyzed. In multivariable analyses, patients from neighborhoods with low FBRP (< 10%) had slightly higher baseline and 2-year WOMAC pain and function scores than those with high FBRP (≥ 40%), but these differences were not statistically significant (Table 2). While women had worse baseline and 2-year WOMAC pain and function scores (all p ≤ 0.04), this difference was not significantly influenced by neighborhood FBRP (all pinteraction NS).
Conclusion: Patients coming from high (>40%) FBRP neighborhoods present with worse baseline pain and function. Two years later, worse pain and function persist; however, the difference is not significant. Although sex differences favoring males are notable, these differences are not associated with FBRP. Social factor contributions to healthcare disparities are multidimensional, and future studies examining immigration-related neighborhood characteristics may be warranted.
1) Mojica, C. M., et al., Biomed Res Int 2015:460181.
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Table 1. Baseline characteristics |
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Characteristic |
FBRP* <10% (n=1032) |
FBRP* ≥10 – ≤ 40% (n=2527) |
FBRP* > 40% (n=339) |
p-value (≤ 10% v. > 40%) |
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Patient demographics |
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Age at surgery (years), mean±SD |
67.0±9.2 |
68.1±9.6 |
67.8±9.6 |
0.16 |
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Sex: female, n (%) |
568 (55.0%) |
1538 (60.9%) |
240 (70.8%) |
<0.001 |
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BMI (kg/m2), mean±SD |
30.1±5.7 |
29.9±6.0 |
31.0±6.6 |
0.03 |
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Race, n (%) |
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<0.001 |
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White |
1012 (98.1%) |
2297 (90.9%) |
259 (76.4%) |
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Black |
5 (0.5%) |
128 (5.1%) |
41 (12.1%) |
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Asian |
9 (0.9%) |
47 (1.9%) |
18 (5.3%) |
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Other |
5 (0.5%) |
35 (1.4%) |
16 (4.7%) |
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Unknown |
1 (0.1%) |
20 (0.8%) |
5 (1.5%) |
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Ethnicity, n (%) |
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<0.001 |
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Hispanic |
5 (0.5%) |
35 (1.4%) |
16 (4.7%) |
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Patient status |
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ASA class |
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0.81 |
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I–II |
828 (80.2%) |
2026 (80.2%) |
270 (79.7%) |
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III–IV |
203 (19.7%) |
501 (19.8%) |
69 (20.4%) |
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One or more comorbidities |
267 (25.9%) |
674 (26.7%) |
116 (34.2%) |
0.003 |
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Sociodemographic characteristics |
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Education level (highest), n (%) |
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<0.001 |
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Some high school, high school graduate or some college |
359 (36.0%) |
849 (35.1%) |
158 (49.4%) |
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College graduate or Masters, professional or doctorate degree |
639 (64.0%) |
1569 (64.9%) |
162 (50.6%) |
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Lives alone, n (%) |
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<0.001 |
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No |
863 (84.4%) |
1881 (75.9%) |
229 (69.0%) |
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Yes |
159 (15.6%) |
598 (24.1%) |
103 (31.0%) |
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Census tract characteristics |
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Poverty, n (%) |
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<0.001 |
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< 10% |
975 (94.5%) |
2078 (82.2%) |
122 (36.0%) |
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10% – < 20% |
48 (4.7%) |
300 (11.9%) |
163 (48.1%) |
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≥ 20% |
9 (0.9%) |
149 (5.9%) |
54 (15.9%) |
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Patient-reported outcomes |
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Baseline survey results, mean±SD |
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WOMAC** pain |
54.9±17.6 |
54.7±17.3 |
51.0±18.9 |
<0.001 |
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WOMAC** function |
54.2±16.9 |
54.1±17.7 |
49.1±17.3 |
<0.001 |
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2-year survey results |
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WOMAC** pain, mean±SD |
89.3±14.7 |
87.5±15.7 |
86.5±17.5 |
0.01 |
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WOMAC** function, mean±SD |
86.7±14.9 |
85.4±16.2 |
83.6±17.9 |
0.005 |
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*FBRP – Foreign Born Resident Proportion, **WOMAC-Western Ontario and McMaster Universities Osteoarthritis Index
Methodology: Categorical variables are summarized as frequency (percent). Continuous variables are summarized as mean ± standard deviation. Comparisons of categorical variables were made using chi-squared test. Continuous variables were compared using t-tests (for ≤ 10% v. > 40%) or ANVOA tests (for 3-group comparisons) |
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Table 2. Impact of neighborhood foreign born resident proportion (FBRP) on WOMAC pain and function. |
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Timepoint |
WOMAC** pain estimate ± SD |
p-value |
WOMAC** function estimate ± SD |
p-value |
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Baseline |
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0.36 |
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0.24 |
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FBRP* < 10% |
52.30 ± 3.26 |
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51.71 ± 3.28 |
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FBRP* ≥ 40% |
51.19 ± 3.33 |
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50.31 ± 3.36 |
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2-year |
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0.80 |
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0.97 |
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FBRP* < 10% |
85.08 ± 3.02 |
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85.95 ± 3.11 |
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FBRP* ≥ 40% |
84.81 ± 3.09 |
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85.90 ± 3.18 |
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*FBRP – Foreign Born Resident Proportion, **WOMAC-Western Ontario and McMaster Universities Osteoarthritis Index
Methodology: Multivariable models adjusting for age, sex, ≥ 1 comorbidity, neighborhood poverty percentage (<10%, 10% – < 20%, 20% – < 30%, 30% – < 40%, ≥ 40% [reference group]) |
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To cite this abstract in AMA style:
Mehta BY, Szymonifka J, Dey SA, Grassia S, Mandl LA, Bass AR, Russell LA, Parks ML, Figgie MP, Lee YY, Nguyen JT, Goodman SM. Do Immigrant Communities Play a Role in Total Knee Arthroplasty (TKA) Outcomes? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/do-immigrant-communities-play-a-role-in-total-knee-arthroplasty-tka-outcomes/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-immigrant-communities-play-a-role-in-total-knee-arthroplasty-tka-outcomes/