Greater socioeconomic deprivation predicts worse functional status two years after orthopaedic surgery, but not magnitude of change from baseline.

Abstract

The purpose of this study was to analyze if Area Deprivation Index (ADI), as a geography-based proxy for socioeconomic status (SES), is associated with differences in patient-reported outcomes (PROs) 2 years after outpatient orthopaedic surgery. Patients undergoing outpatient orthopaedic surgery from June 2015 to November 2018 were administered Patient-Reported Outcomes Measurement Information System (PROMIS) and joint-specific surveys at baseline and 2 years postoperatively. ADI was computed from home address. Tests of association were used to characterize 2-year PROs dependence on ADI. This informed covariate selection for multivariable linear regression examined PRO change over 2 years with ADI in the context of other self-reported socioeconomic covariates. Enrollment was 2117 patients, 1483 (70 %) completed follow-up. Lower SES as measured by home address was associated with lower function and less improvement from baseline at 2 years postoperatively. This trend was most apparent in PROMIS instruments. SES as approximated by ADI is associated with PROs at 2 years after outpatient orthopaedic surgery for a subset of PROs. ADI should be considered for inclusion in statistical models using an SES-sensitive PRO as an outcome, understanding that model performance may also depend on if a single value or change over time is being estimated.