The online version of this article (doi:10.1186/s12891-015-0475-8) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
CHF, YD, JNK, LDF, EL contributed to the conception and design of this study. CHF, YD, JNK, LDF, EL participated in the acquisition of data. CHF, YD, JNK, EL participated in the analysis and interpretation of data. All authors read and approved the final manuscript.
Patients with higher socioeconomic status (SES) are shown to have better total knee arthroplasty (TKA) outcomes compared to those with lower SES. The relationship between SES and factors that influence TKA use is understudied. We examined the association between SES and pain, function and pain catastrophizing at presentation for TKA.
In patients undergoing TKA at an academic center, we obtained preoperative pain and functional status (WOMAC Index 0–100, 100 worst), pain catastrophizing (PCS, ≥16 high), and mental health (MHI-5, <68 poor). We described individual-level SES using education as a proxy, and area-level SES using a validated composite index linking geocoded addresses to U.S. Census data. We measured associations between these indicators and pain, function and pain catastrophizing, adjusting for age, sex and BMI.
Among 316 patients, mean age was 65.9 (SD 8.7), 59% were female, and 88% were Caucasian; 17% achieved less than college education and 62% were college graduates. The median area SES index score was 59 (U.S. median 51). Bivariable analyses demonstrated associations between higher individual- and area-level SES and lower pain, higher function and less pain catastrophizing (all p<0.05). Adjusted analyses demonstrated statistically significant associations between higher individual- and area-level SES and better function and less pain.
In this cohort, patients with higher individual- and area-level SES had lower pain and higher function at the time of TKA than lower SES patients. Further research is needed to assess what constitutes appropriate levels of pain and function to undergo TKA in these higher SES groups.
Additional file 1: Table S1. Unadjusted and adjusted models indicating the percentage and 95% CI of subjects with high pain (WOMAC >55), low function (WOMAC >55) or high pain catastrophizing (PCS ≥16) stratified by individual-level SES.12891_2015_475_MOESM1_ESM.docx
Additional file 2: Table S2. Unadjusted and adjusted models indicating the percentage and 95% CI of subjects with high pain (WOMAC >55), low function (WOMAC >55) or high pain catastrophizing (PCS ≥16) stratified by area-level SES.12891_2015_475_MOESM2_ESM.docx
Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, et al. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003;85-A(1):27–32. PubMed
Dunlop DD, Song J, Manheim LM, Chang RW. Racial disparities in joint replacement use among older adults. Med Care. 2003;41(2):288–98. PubMed
Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors. Med Care. 2002;40(1 Suppl):I44–51. PubMed
Desmeules F, Dionne CE, Belzile EL, Bourbonnais R, Champagne F, Fremont P. Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study. BMC Sports Sci Med Rehabil. 2013;5:2. PubMedPubMedCentralCrossRef
Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project. Am J Epidemiol. 2002;156(5):471–82. PubMedCrossRef
Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures–the public health disparities geocoding project. Am J Public Health. 2003;93(10):1655–71. PubMedPubMedCentralCrossRef
Chapter 3: Creation of New Race-Ethnicity Codes and SES Indicators for Medicare Beneficiaries [ http://archive.ahrq.gov/research/findings/final-reports/medicareindicators/index.html]
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40. PubMed
Sullivan MJLBS, Pivik J. The Pain Catastrophizing Scale: Development and Validation. Psychol Assess. 1995;7:524–32. CrossRef
Klebanov P, Brooks-Gunn J, Duncan G. Does neighborhood and family poverty affect Mother’s parenting, mental health and social support? J Marriage Fam. 1994;56(2):441–55. CrossRef
Philbin EF, McCullough PA, DiSalvo TG, Dec GW, Jenkins PL, Weaver WD. Socioeconomic status is an important determinant of the use of invasive procedures after acute myocardial infarction in New York State. Circulation. 2000;102(19 Suppl 3):III107–15. PubMed
Callahan LF, Cleveland RJ, Shreffler J, Schwartz TA, Schoster B, Randolph R, et al. Associations of educational attainment, occupation and community poverty with knee osteoarthritis in the Johnston County (North Carolina) osteoarthritis project. Arthritis Res Ther. 2011;13(5):R169. PubMedPubMedCentralCrossRef
Kim HJ, Kim SC, Kang KT, Chang BS, Lee CK, Yeom JS. Influence of educational attainment on pain intensity and disability in patients with lumbar spinal stenosis: mediation effect of pain catastrophizing. Spine (Phila Pa 1976). 2014;39(10):E637–44. CrossRef
- Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty
Candace H Feldman
Jeffrey N Katz
Laurel A Donnell-Fink
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II