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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Candace H Feldman, Yan Dong, Jeffrey N Katz, Laurel A Donnell-Fink, Elena Losina
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-015-0475-8) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
Zusatzmaterial
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
Literatur
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