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Effect of Socioeconomic Disadvantage on Patient-reported Outcomes After Orthopedic Trauma: A Study Using the Area
Haley D Puckett1,2, Jacob S Borgida2,3, Rebekah M Kleinsmith1,2
1Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington.
Background:
Socioeconomic status (SES) is increasingly recognized as a key factor influencing outcomes after orthopedic procedures. The objective of this study was to determine the effect of socioeconomic disadvantage on patient-reported outcomes (PROs) after orthopedic trauma.
Materials And Methods:
A retrospective review of PROs was performed for orthopedic trauma patients from 2018 to 2023. The Area Deprivation Index (ADI) was used as a surrogate for socioeconomic disadvantage. Outcomes included Patient-Reported Outcomes Measurement Information System Global Physical Health and Global Mental Health 10-item short forms (PROMIS 10 GPH and GMH) at 6 weeks, 3 months, 6 months, and 1 year postoperatively. A mixed-model analysis was performed to compare outcomes among ADI cohorts.
Results:
In total, 844 patients were included. Of these, 313 (37.1%) were in the least socioeconomically disadvantaged group. There was a significant difference in the distributions of age, marital status, smoking status, and self-reported race among the five ADI cohorts (P < .002). Patients with an ADI of 1 or 2 (low disadvantage) had significantly higher PROMIS 10 GPH scores compared with their counterparts in ADI Groups 3/4, 5/6, and 9/10, although all groups saw a similar significant improvement from the 6-week to 1-year follow-up.
Conclusion:
Socioeconomic disadvantage has a significant effect on PROMIS 10 GPH and GMH scores following orthopedic trauma procedures. However, patients in all ADI cohorts saw improvements in PROMIS 10 GPH up to 1 year postoperatively. It is important to identify patients in socioeconomically disadvantaged areas and create care pathways to better optimize their improvements postoperatively.