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Analyzing the Association of the Area Deprivation Index on Patient-Reported Outcomes in Patients Undergoing Hip
Jordan J Cruse1, Hashim J F Shaikh1, James D Brodell1
1Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA.
Background:
Hip arthroscopy is a valuable tool through which intra- and extra-articular hip pathologies may be addressed, with the goal of improving pain and function while preventing osteoarthritis progression. Little data are available regarding the effect of social determinants of health on hip arthroscopy outcomes.
Purpose:
To determine if a patient's lived environment is associated with better or worse postoperative outcomes using the area deprivation index (ADI).
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients undergoing hip arthroscopy between January 1, 2015, and June 30, 2022, at a single institution were identified using Current Procedural Terminology codes. Patients' zip codes were utilized to identify ADI measures. Patients were divided into quartiles of ADI, and the most deprived (ADIHigh) and least deprived (ADILow) quartiles were compared. Pre- and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for the Pain Interference (PI), Physical Function (PF), and Depression domains were obtained. For the PF and PI domains, the minimal clinically important difference (MCID) was defined using an anchor-based approach using previously established cutoffs. For the Depression domain, the MCID was defined using a distribution-based approach and calculated as one-half of the standard deviation of the preoperative PROMIS score. Multivariable logistic regression models were estimated to characterize the association of the ADI with MCID attainment along PROMIS domains.
Results:
A total of 170 patients were included in the analysis of the ADIHigh (n = 85) and ADILow (n = 85) cohorts. Age, body mass index, smoking status, and race did not significantly vary between groups. No significant differences in MCID attainment were observed at any time point in the PF, PI, or Depression domains. However, the ADIHigh cohort had higher mean PI (worse) scores compared with the ADILow cohort at the preoperative, 1-year, and final follow-up (mean, 2.52 years) time points. In multivariable logistic regression analyses, ADI was not associated with the odds of MCID attainment.
Conclusion:
For patients undergoing hip arthroscopy, increased social disadvantage measured by the ADI was not associated with the odds of MCID attainment in any PROMIS domain. This information provides guidance for care providers, researchers, and policymakers to seek and identify other mechanisms that may affect outcomes after hip arthroscopy.
