Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty

Area of Science:

• Orthopedic surgery
• Health disparities research
• Sociomedical sciences

Background:

• Race is a known predictor of total knee arthroplasty (TKA) outcomes in the US.
• Socioeconomic factors can confound race-based analyses, complicating the understanding of outcome disparities.
• Identifying the root causes of disparate TKA outcomes is crucial for equitable patient care.

Purpose of the Study:

• To investigate the association between individual-level race, socioeconomic factors, and patient-reported pain and function 2 years after TKA.
• To examine the interaction between race and community poverty on TKA patient-reported outcomes.

Main Methods:

• Analysis of TKA patients from a hospital registry (2007-2011) in NY, CT, and NJ, with 2-year follow-up data.
• Linking individual patient data with US census tract poverty data via geocoding.
• Utilizing a multivariate linear mixed-effect model to assess the interaction between race and community poverty on WOMAC pain and function scores.

Main Results:

• Individual race and socioeconomic factors showed small associations with 2-year TKA outcomes, below clinical importance thresholds.
• Similar pain and function scores were reported by black and white patients in low-poverty (<10%) census tracts.
• Increasing community poverty exacerbated TKA pain and function decline, particularly for black patients, with significant disparities observed in high-poverty (>40%) areas.

Conclusions:

• Racial disparities in TKA outcomes are primarily evident in high-poverty communities, not in areas with little poverty.
• Addressing both individual and community-level socioeconomic factors is essential to improve TKA outcomes for black patients.