Effect of Social Deprivation on Treatment Strategy and Patient-Reported Outcomes of Proximal Humerus Fractures

Treatment approaches and functional outcomes have been shown to be influenced by a patient's socioeconomic status in certain orthopaedic pathologies. In patients with proximal humerus fractures (PHFs), this study aimed to evaluate the relationship between social deprivation and (1) treatment strategy-including the choice between surgical and nonsurgical management, as well as the type of surgical intervention-and (2) patient-reported outcomes.

We retrospectively reviewed 275 displaced PHFs from a level 1 trauma center. Using the Area Deprivation Index (ADI), patients were assigned social deprivation scores ranging from 0 to 100, with higher scores representing greater deprivation. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure the domains of Physical Function, Upper Extremity, Pain Interference, Depression, and Anxiety. PROMIS scores were grouped into 6-week, 3-month, 6-month, and 1-year follow-up groups, with scores analyzed separately at each time point. The associations between ADI and treatment strategy and PROMIS outcomes were determined using multivariable logistic regression and multivariable linear regression, respectively.

ADI showed no significant association with surgical versus nonsurgical treatment (odds ratio = 0.998 [95% confidence interval, 0.987 to 1.010], P = 0.790) or type of surgical treatment (odds ratio = 1.009 [confidence interval, 0.994 to 1.024], reverse total shoulder arthroplasty vs locking compression plate, P = 0.251). In the 6-week, 3-month, 6-month, and 1-year follow-up analyses, ADI showed no significant associations with PROMIS Physical Function, Upper Extremity, Pain Interference, Depression, or Anxiety.

This study showed that social deprivation was not markedly associated with treatment strategy or patient-reported outcomes in patients with PHFs. Additional prospective research is needed to clarify the impact of social deprivation on patients with PHFs and to determine the appropriate role of area-based deprivation indices in orthopaedic care.