Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Healthcare disparities are recognized for surgical outcomes in patients with Limited English Proficiency (LEP) (1). The purpose of this study is to assess the association of LEP on Total Knee (TKR) and Total Hip Replacement (THR) outcomes.
Methods:
Individual patient-level variables – namely, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years after elective TKR and THR – were collected from a single institution registry between 5/07 and 2/11 and analyzed. We used census tract LEP -“Less than very well” as recommended for screening individuals. We obtained census level data using patients’ geocodable addresses (2). Only patients from closest states (NY, NJ and CT) were included (Figure 1). Data was analyzed using univariate and multivariable linear mixed effects models, with census tracts variables treated as random effects.
Results:
Table 1 describes the characteristics of the patients with THR and TKR. In univariable analyses, for every percent increase in LEP, the WOMAC scores at baseline and 2 year decreased significantly (p-value<0.001). However when adjusted for neighborhood poverty age, BMI, sex, comorbidities, and the Gini coefficient these changes were not statistically significant, suggesting potential confounders (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 LEP (all p_interaction=NS).
Conclusion:
Patients from LEP neighborhoods have worse pain and function scores in unadjusted models. However when adjusted for potential confounders, the difference is not significant. Community factors contributing to healthcare disparities are multidimensional; thus, further studies examining individual LEP data would be warranted.
1. John-Baptiste et al., J Gen Int Med. Mar 2004; 19(3):221-228.
2. Karliner et al., J Gen Int Med. Oct 2008; 23(10):1555-1560.
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Table 1. Total Joint Replacement Patient characteristics |
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Characteristic |
Total Hip Replacement (N=4009) |
Total Knee Replacement (N=3898) |
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Patient demographics |
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Age at surgery (years), mean ± SD |
65.6 ± 10.6 |
67.8 ± 9.5 |
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Sex: female, n (%) |
2160 (53.9%) |
2346 (60.2%) |
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BMI (kg/m2) |
27.9 ± 5.4 |
30.0 ± 5.9 |
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Race, n (%) |
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White |
3794 (94.6%) |
3568 (91.5%) |
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Black |
131 (3.3%) |
174 (4.5%) |
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Asian |
25 (0.6%) |
74 (1.9%) |
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Other |
43 (1.1%) |
56 (1.4%) |
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Unknown |
16 (0.4%) |
26 (0.7%) |
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Hispanic ethnicity, n (%) |
102 (2.5%) |
129 (3.3%) |
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Patient status |
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ASA class |
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I–II |
3307 (82.5%) |
3124 (80.1%) |
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III–IV |
700 (17.5%) |
773 (19.8%) |
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One or more comorbidities |
895 (22.3%) |
1057 (27.1%) |
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Census tract characteristics |
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Poverty, n (%) |
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< 10% |
3325 (82.9%) |
2787 (71.5%) |
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10% – < 20% |
507 (12.7%) |
511 (13.1%) |
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20% – < 30% |
115 (2.9%) |
129 (3.3%) |
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30% – < 40% |
49 (1.2%) |
56 (1.4%) |
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≥ 40% |
13 (0.3%) |
27 (0.7%) |
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Percent poverty, mean ± SD |
6.2 ± 6.5 |
6.6 ± 7.2 |
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Limited English Proficiency (LEP), n (%) |
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< 10% |
2981 (74.4%) |
2787 (71.5%) |
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10% – < 20% |
614 (15.3%) |
650 (16.7%) |
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20% – < 30% |
209 (5.2%) |
251 (6.4%) |
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30% – < 40% |
120 (3.0%) |
113 (2.9%) |
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≥ 40% |
85 (2.1%) |
97 (2.5%) |
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Percent LEP, mean ± SD |
8.6 ± 9.6 |
9.2 ± 10.0 |
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Gini coefficient, mean ± SD |
0.45 ± 0.07 |
0.45 ± 0.07 |
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Patient-reported outcomes |
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Baseline survey results, mean ± SD |
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WOMAC pain |
53.3 ± 17.8 |
54.4 ± 17.5 |
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WOMAC function |
49.5 ± 18.0 |
53.7 ± 17.6 |
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2-year survey results |
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WOMAC pain, mean ± SD |
93.7 ± 11.3 |
87.9 ± 15.6 |
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WOMAC function, mean ± SD |
91.1 ± 13.1 |
85.6 ± 16.1 |
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Methodology: Categorical variables are summarized as frequency (percent). Continuous variables are summarized as mean ± standard deviation |
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Table 2. Impact of every 10% change in neighborhood limited English proficiency on WOMAC pain and function |
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Time-point |
WOMAC pain Estimate ± SE |
p-value |
WOMAC function Estimate ± SE |
p-value |
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Total Hip Replacement |
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Baseline (Univariate) |
-1.4 ± 0.3 |
<0.001 |
-1.7 ± 0.3 |
<0.001 |
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2-year (Univariate) |
-0.9 ± 0.2 |
<0.001 |
-1.2 ± 0.2 |
<0.001 |
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Baseline (Multivariable) |
-0.6 ± 0.3 |
0.10 |
-0.6 ± 0.3 |
0.07 |
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2-year (Multivariable) |
-0.4 ± 0.2 |
0.054 |
-0.6 ± 0.3 |
0.01 |
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Total Knee Replacement |
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Baseline (Univariate) |
-1.7 ± 0.3 |
<0.001 |
-1.8 ± 0.3 |
<0.001 |
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2-year (Univariate) |
-1.0 ± 0.3 |
<0.001 |
-1.1 ± 0.3 |
<0.001 |
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Baseline (Multivariable) |
-0.8 ± 0.3 |
0.02 |
-0.5 ± 0.3 |
0.13 |
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2-year (Multivariable) |
-0.2 ± 0.3 |
0.43 |
-0.2 ± 0.3 |
0.54 |
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Methodology: Univariate and multivariable linear mixed-effects models were analyzed, with census tracts treated as random effects. In addition to neighborhood Limited English Proficiency, variables included in the model were: age, BMI, sex, ≥ 1 comorbidity, neighborhood percent poverty (<10%, 10% – < 20%, 20% – < 30%, 30% – < 40%, ≥ 40% [reference group]), neighborhood Gini coefficient was also included. |
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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. English Language Proficiency and Total Joint Replacement Outcomes: Is There a Relationship? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/english-language-proficiency-and-total-joint-replacement-outcomes-is-there-a-relationship/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/english-language-proficiency-and-total-joint-replacement-outcomes-is-there-a-relationship/