Distressed Communities Index and Utilization of Total-Hip Replacement in Maryland

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.061

Nadia O. Hackett BS, Oluwasegun Akinyemi MD, MS, PhD, Rolanda Willacy MD, Damon Ross BS, Lucia Guo BS, Tegshjargal Baasansukh BS, Lakin Hatcher BA, Michael Joly MD

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引用次数: 0

Abstract

Background

Neighborhood socioeconomic status (nSES) is a critical determinant of healthcare access and outcomes. The Distressed Communities Index (DCI) is a composite measure of economic well-being, yet its association with orthopedic surgical utilization remains unclear.

Objective

This study examines the relationship between DCI and the utilization of total hip replacement (THR) in Maryland, as well as its impact on post-surgical outcomes, including prolonged hospital stay and readmission rates.

Methods

We conducted a retrospective analysis using the Maryland State Inpatient Database (2016–2020). Adults aged 18 to 90 years undergoing THR were included. Multiple imputation was employed to address missing data, and logistic regression models were used to assess the association between DCI and THR utilization, extended hospital stay, and 30-day readmission rates. Models were adjusted for demographic and clinical covariates.

Results

Among the 61,228 THR cases, the majority were White (74.2%) and female (58.9%), with a mean age of 72.5 ± 14.2 years. Individuals from the most socioeconomically distressed neighborhoods were significantly less likely to undergo THR compared to those from more affluent areas (OR=0.89, 95% CI 0.86- 0.92, p <0.001). Additionally, patients from highly distressed communities had a higher likelihood of experiencing prolonged hospital stays post-surgery (OR=1.13, 95% CI 1.04- 1.23, p=0.04). However, no significant association was found between DCI and 30-day readmission rates following THR.

Conclusion

Our findings suggest that socioeconomic disadvantage, as captured by the DCI, is associated with disparities in THR utilization and post-surgical hospital stay in Maryland.

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马里兰州全髋关节置换术的贫困社区指数和使用率

社区社会经济地位（nSES）是医疗保健获取和结果的关键决定因素。贫困社区指数（DCI）是经济福利的综合衡量标准，但其与骨科手术利用的关系尚不清楚。目的本研究探讨DCI与马里兰州全髋关节置换术（THR）使用率之间的关系，以及其对术后结果的影响，包括住院时间延长和再入院率。方法使用马里兰州住院患者数据库（2016-2020）进行回顾性分析。年龄在18至90岁之间接受THR的成年人被纳入研究对象。采用多重代入来解决缺失数据，并使用逻辑回归模型来评估DCI与THR利用率、延长住院时间和30天再入院率之间的关系。根据人口统计学和临床协变量对模型进行了调整。结果61228例THR患者以白人（74.2%）和女性（58.9%）居多，平均年龄72.5±14.2岁。与来自较富裕地区的个体相比，来自社会经济最贫困社区的个体接受THR的可能性显着降低（OR=0.89, 95% CI 0.86- 0.92, p <0.001）。此外，来自高度痛苦社区的患者术后住院时间延长的可能性更高（OR=1.13, 95% CI 1.04- 1.23, p=0.04）。然而，未发现DCI与THR后30天再入院率之间存在显著关联。结论：我们的研究结果表明，DCI所捕获的社会经济劣势与马里兰州THR利用和术后住院时间的差异有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.