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Influence of Area Deprivation Index and Social Vulnerability Index on PROMIS Outcomes and MCID Achievement Following
Patrick Castle1, Omkar N Prabhavalkar1, Melissa R Holloway1
1Department of Orthopaedics and Physical Performance Division of Sports Medicine, University of Rochester Medical Center, Rochester, New York, USA.
Background:
Anterior cruciate ligament (ACL) reconstruction typically yields excellent outcomes, but recent attention has turned to how social determinants of health affect recovery. This study evaluates the association of the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) with scores on the Patient-Reported Outcomes Measurement Information System (PROMIS) and the likelihood of patients undergoing ACL reconstruction surgery achieving the minimal clinically important difference (MCID) postoperatively.
Hypothesis:
Greater social deprivation and vulnerability correlate with worse outcomes and lower odds of achieving the MCID after ACL reconstruction surgery.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
The authors retrospectively reviewed patients aged ≥13 years who underwent arthroscopic ACL reconstruction between 2015 and 2023 and completed preoperative and ≥6-month postoperative PROMIS surveys. ADI and SVI scores were based on geocoded addresses and zip codes, respectively, and divided into quartiles based on percentile rank (0-25th, 25th-50th, 50th-75th, and 75th-100th). The least deprived quartile was quartile 1 and the most was quartile 4. Statistical analyses included analysis of variance, chi-square test, and logistic regression to assess associations with PROMIS scores and MCID achievement.
Results:
A total of 576 patients met inclusion criteria (mean ± SD age, 27.9 ± 11.7 years). ADI and SVI quartiles were evenly distributed. Significant differences were found in race, body mass index, insurance status, and smoking history across quartiles. Patients in the highest ADI/SVI quartiles had higher body mass index, more Black representation, and greater use of public insurance. Preoperative PROMIS scores were mostly similar, except for higher pain interference in the most deprived quartile. Postoperative improvements were significant across all domains after surgery (P < .05). ADI quartile 4 had worse pain interference and depression scores as compared with the less deprived quartiles. MCID achievement was generally high, but logistic regression showed lower odds of achieving the MCID for pain interference in ADI quartile 4 after ACL reconstruction surgery (odds ratio, 0.55; P = .018).
Conclusion:
Despite socioeconomic disparities, ACL reconstruction surgery led to meaningful improvements in function and mental health outcomes. Although patients in higher ADI quartiles demonstrated worse postoperative pain interference and depression scores, overall MCID achievement was not associated with ADI or SVI, suggesting that ACL reconstruction benefits patients across socioeconomic backgrounds. These findings suggest that social determinants of health may influence the magnitude of postoperative outcomes, but patients of varying socioeconomic backgrounds benefit from ACL reconstruction surgery.
