Barriers to Total Joint Arthroplasty: A Comparison of High-Poverty and Low-Poverty Communities.

Abstract

Our aim was to determine the most significant barriers to total joint arthroplasty (TJA) for people living in high-poverty communities relative to low-poverty communities. We created a 21-question survey based on interviews with underrepresented minority patients with osteoarthritis targeting five barriers to TJA: trust in surgeon, recovery concerns, cost and/or insurance issues, fear of poor surgical outcomes, and timing considerations. Participants rated the importance of each barrier on a 5-point Likert scale, dichotomized into "very or extremely important" and "not as important." The survey was distributed at New York City clinics and nationally through an arthritis advocacy group. We used geocoding to link addresses to census tracts, defining high-poverty communities as those with ≥20% of residents living below the poverty level. Logistic regression models assessed the association between community poverty status and rating barriers as very or extremely important, with adjustment for demographic and clinical factors. Of the 702 survey participants, 16.8% were residents of high-poverty communities. After adjustment, participants from high-poverty communities were more likely to rate trust in surgeon (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.24-2.82) and fear of poor surgical outcome (aOR 1.68, 95% CI 1.08-2.61) as very or extremely important. People from high-poverty communities identified lack of trust in surgeons and fear of poor surgical outcomes as more significant barriers to TJA compared to people from low-poverty communities.