A Critical Evaluation of Social Determinants of Health in Total Joint Arthroplasty.

Abstract

The social determinants of health (SDOH) have been found to greatly impact patient health outcomes across medical specialties, including orthopaedic surgery. Despite a recent focus on these impacts, there is currently no clear comprehension of how composite and individual SDOH measures impact outcomes following total joint arthroplasty (TJA). With an increasing demand for TJA, understanding and addressing these factors is necessary to improve patient outcomes and reduce overall healthcare costs. This review aimed to evaluate the individual and composite measures that have been associated with TJA outcomes in the existing literature. Key individual metrics include race, income, education level, and insurance status, while composite indices such as the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) provide a broader assessment of socioeconomic and environmental challenges at the community level. We explore the existing data available regarding the impact of these measures, as well as gaps in the literature and areas for future research. Furthermore, we examine interventions that can be implemented within the healthcare system as well as within communities to target specific patient needs and optimize TJA outcomes. A comprehensive approach utilizing both individual and composite metrics is critical in understanding the impact of SDOH. Future studies are needed to understand the interaction between different social determinants, as well as to explore how actionable interventions can be implemented to optimize care for patients in the context of SDOH. By addressing these factors, we can improve outcomes for all patients, reduce healthcare costs, and help create a more equitable healthcare system.