Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index
Background: Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, but disparities in its utilization exist, particularly by gender, race, socioeconomic status, and geography. Social determinants of health may contribute to these disparities. This study examines the rel...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
|
| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344125000895 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849473448966881280 |
|---|---|
| author | Manasa Pagadala, BA Rachel Bergman, MD T. Jacob Selph, Jr., BS Patricia Franklin, MD, MPH, MBA Adam I. Edelstein, MD Linda I. Suleiman, MD |
| author_facet | Manasa Pagadala, BA Rachel Bergman, MD T. Jacob Selph, Jr., BS Patricia Franklin, MD, MPH, MBA Adam I. Edelstein, MD Linda I. Suleiman, MD |
| author_sort | Manasa Pagadala, BA |
| collection | DOAJ |
| description | Background: Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, but disparities in its utilization exist, particularly by gender, race, socioeconomic status, and geography. Social determinants of health may contribute to these disparities. This study examines the relationship among the Social Vulnerability Index (SVI), a measure of social determinants of health, and the likelihood of receiving a surgeon's recommendation for TKA. Methods: This prospective, observational study included 314 patients with primary knee osteoarthritis deemed “appropriate” for TKA based on the American Academy of Orthopaedic Surgeons Appropriate Use Criteria. Patients were recruited from 4 fellowship-trained arthroplasty surgeons at a single academic hospital in Chicago. The primary outcome was whether patients received a surgeon recommendation for TKA, analyzed in relation to their SVI. Bivariate and multivariable analyses were performed, adjusting for patient demographics, body mass index, Charlson Comorbidity Index, and surgeon factors. Results: Of the 314 patients appropriate for TKA by Appropriate Use Criteria guidelines, 39.2% received a surgeon recommendation. Patients with lower SVI scores were more likely to receive a recommendation (0.6596 vs 0.7556, P = .284). Multivariable analysis showed that lower SVI scores were independently associated with higher odds of a surgeon recommendation (odds ratio [OR]: 0.705, P = .028), particularly in the subcategories of socioeconomic status (OR: 0.754, P = .034) and household characteristics (OR: 0.803, P = .049). Conclusions: Lower SVI scores are associated with increased likelihood of receiving a TKA recommendation, highlighting the impact of social vulnerability on clinical decision-making and the need for further investigation into mitigating biases in surgical decisions. |
| format | Article |
| id | doaj-art-c7195dde2dfd43f5840a52403aa3d105 |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-c7195dde2dfd43f5840a52403aa3d1052025-08-20T03:24:07ZengElsevierArthroplasty Today2352-34412025-06-013310170210.1016/j.artd.2025.101702Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability IndexManasa Pagadala, BA0Rachel Bergman, MD1T. Jacob Selph, Jr., BS2Patricia Franklin, MD, MPH, MBA3Adam I. Edelstein, MD4Linda I. Suleiman, MD5Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Corresponding author. Northwestern University Feinberg School of Medicine, 401 E Ontario Street, Chicago, IL 60611, USA. Tel.: +1 309 732 6317.Division of Orthopaedic Surgery, Northwestern University, Chicago, IL, USANorthwestern University Feinberg School of Medicine, Chicago, IL, USADivision of Orthopaedic Surgery, Northwestern University, Chicago, IL, USADivision of Orthopaedic Surgery, Northwestern University, Chicago, IL, USADivision of Orthopaedic Surgery, Northwestern University, Chicago, IL, USABackground: Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, but disparities in its utilization exist, particularly by gender, race, socioeconomic status, and geography. Social determinants of health may contribute to these disparities. This study examines the relationship among the Social Vulnerability Index (SVI), a measure of social determinants of health, and the likelihood of receiving a surgeon's recommendation for TKA. Methods: This prospective, observational study included 314 patients with primary knee osteoarthritis deemed “appropriate” for TKA based on the American Academy of Orthopaedic Surgeons Appropriate Use Criteria. Patients were recruited from 4 fellowship-trained arthroplasty surgeons at a single academic hospital in Chicago. The primary outcome was whether patients received a surgeon recommendation for TKA, analyzed in relation to their SVI. Bivariate and multivariable analyses were performed, adjusting for patient demographics, body mass index, Charlson Comorbidity Index, and surgeon factors. Results: Of the 314 patients appropriate for TKA by Appropriate Use Criteria guidelines, 39.2% received a surgeon recommendation. Patients with lower SVI scores were more likely to receive a recommendation (0.6596 vs 0.7556, P = .284). Multivariable analysis showed that lower SVI scores were independently associated with higher odds of a surgeon recommendation (odds ratio [OR]: 0.705, P = .028), particularly in the subcategories of socioeconomic status (OR: 0.754, P = .034) and household characteristics (OR: 0.803, P = .049). Conclusions: Lower SVI scores are associated with increased likelihood of receiving a TKA recommendation, highlighting the impact of social vulnerability on clinical decision-making and the need for further investigation into mitigating biases in surgical decisions.http://www.sciencedirect.com/science/article/pii/S2352344125000895Social vulnerability indexTotal knee arthroplastyHealthcare equityOsteoarthritis |
| spellingShingle | Manasa Pagadala, BA Rachel Bergman, MD T. Jacob Selph, Jr., BS Patricia Franklin, MD, MPH, MBA Adam I. Edelstein, MD Linda I. Suleiman, MD Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index Arthroplasty Today Social vulnerability index Total knee arthroplasty Healthcare equity Osteoarthritis |
| title | Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index |
| title_full | Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index |
| title_fullStr | Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index |
| title_full_unstemmed | Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index |
| title_short | Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index |
| title_sort | evaluating the disparate use of knee arthroplasty among minorities using social vulnerability index |
| topic | Social vulnerability index Total knee arthroplasty Healthcare equity Osteoarthritis |
| url | http://www.sciencedirect.com/science/article/pii/S2352344125000895 |
| work_keys_str_mv | AT manasapagadalaba evaluatingthedisparateuseofkneearthroplastyamongminoritiesusingsocialvulnerabilityindex AT rachelbergmanmd evaluatingthedisparateuseofkneearthroplastyamongminoritiesusingsocialvulnerabilityindex AT tjacobselphjrbs evaluatingthedisparateuseofkneearthroplastyamongminoritiesusingsocialvulnerabilityindex AT patriciafranklinmdmphmba evaluatingthedisparateuseofkneearthroplastyamongminoritiesusingsocialvulnerabilityindex AT adamiedelsteinmd evaluatingthedisparateuseofkneearthroplastyamongminoritiesusingsocialvulnerabilityindex AT lindaisuleimanmd evaluatingthedisparateuseofkneearthroplastyamongminoritiesusingsocialvulnerabilityindex |