Katherine A Woolley, Nicole J Newman-Hung, Mikayla Mefford, Charlotte F Wahle, Emma D Grellinger, Chloe Dlott, Hannah Chi, Nicholas J Jackson, Stephanie E Wong, Lauren E Wessel, Alexandra I Stavrakis
{"title":"性别、种族/民族和社区社会经济劣势对全髋关节置换术使用的影响：一项多中心队列研究","authors":"Katherine A Woolley, Nicole J Newman-Hung, Mikayla Mefford, Charlotte F Wahle, Emma D Grellinger, Chloe Dlott, Hannah Chi, Nicholas J Jackson, Stephanie E Wong, Lauren E Wessel, Alexandra I Stavrakis","doi":"10.5435/JAAOSGlobal-D-25-00054","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in the management of hip osteoarthritis (OA) exist across sex, race/ethnicity, and socioeconomic status, but their combined effect on total hip arthroplasty (THA) utilization remains unclear. This study evaluates differences in presentation, nonsurgical treatments, and THA rates across two academic centers.</p><p><strong>Methods: </strong>Patients with primary hip OA seen in 2002 at two tertiary academic centers were included. Demographics, Kellgren-Lawrence grade, Charlson Comorbidity Index (CCI), and nonsurgical treatments were collected. Socioeconomic status was assessed using the social deprivation index, stratified into quartiles (Q4 = most deprived). Chi square, analysis of variance, and t-tests compared demographics and utilization rates. A multivariable model analyzed factors influencing THA likelihood.</p><p><strong>Results: </strong>Among 456 patients, 328 were recommended for THA for primary hip OA, 63% were female, 6% were Asian, 6% Black, 23% other, 3% unknown, 54% White, and 8% Hispanic. Female patients were older (70.3 ± 8.6 vs. 68.1 ± 9.7 years, P = 0.03). Hispanic patients were younger (62.2 ± 12.1 vs. 70.1 ± 8.7 years, P = 0.0020) with lower CCI (2.20 ± 1.52 vs. 2.93 ± 1.49 vs. 3.28 ± 1.69 P = 0.027). Social deprivation index Q4 patients had greater physical therapy utilization (Q4 79% vs. Q1 62%, P = 0.006). Overall, 79% of patients who were offered THA underwent surgery, with multivariate analysis revealing lower likelihood among females, Black, Asian, and Hispanic patients with higher CCI (P < 0.001), whereas socioeconomically disadvantaged patients were more likely to undergo THA (P < 0.05).</p><p><strong>Conclusion: </strong>Although THA utilization was high, disparities in presentation age, nonsurgical treatments, and comorbidities suggest differing challenges across populations. Future research should explore drivers of these disparities.</p><p><strong>Level of evidence: </strong>IV retrospective cohort.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494306/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Effect of Sex, Race/Ethnicity, and Neighborhood Socioeconomic Disadvantage on Total Hip Arthroplasty Utilization: A Multicenter Cohort Study.\",\"authors\":\"Katherine A Woolley, Nicole J Newman-Hung, Mikayla Mefford, Charlotte F Wahle, Emma D Grellinger, Chloe Dlott, Hannah Chi, Nicholas J Jackson, Stephanie E Wong, Lauren E Wessel, Alexandra I Stavrakis\",\"doi\":\"10.5435/JAAOSGlobal-D-25-00054\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Disparities in the management of hip osteoarthritis (OA) exist across sex, race/ethnicity, and socioeconomic status, but their combined effect on total hip arthroplasty (THA) utilization remains unclear. This study evaluates differences in presentation, nonsurgical treatments, and THA rates across two academic centers.</p><p><strong>Methods: </strong>Patients with primary hip OA seen in 2002 at two tertiary academic centers were included. Demographics, Kellgren-Lawrence grade, Charlson Comorbidity Index (CCI), and nonsurgical treatments were collected. Socioeconomic status was assessed using the social deprivation index, stratified into quartiles (Q4 = most deprived). Chi square, analysis of variance, and t-tests compared demographics and utilization rates. A multivariable model analyzed factors influencing THA likelihood.</p><p><strong>Results: </strong>Among 456 patients, 328 were recommended for THA for primary hip OA, 63% were female, 6% were Asian, 6% Black, 23% other, 3% unknown, 54% White, and 8% Hispanic. Female patients were older (70.3 ± 8.6 vs. 68.1 ± 9.7 years, P = 0.03). Hispanic patients were younger (62.2 ± 12.1 vs. 70.1 ± 8.7 years, P = 0.0020) with lower CCI (2.20 ± 1.52 vs. 2.93 ± 1.49 vs. 3.28 ± 1.69 P = 0.027). Social deprivation index Q4 patients had greater physical therapy utilization (Q4 79% vs. Q1 62%, P = 0.006). Overall, 79% of patients who were offered THA underwent surgery, with multivariate analysis revealing lower likelihood among females, Black, Asian, and Hispanic patients with higher CCI (P < 0.001), whereas socioeconomically disadvantaged patients were more likely to undergo THA (P < 0.05).</p><p><strong>Conclusion: </strong>Although THA utilization was high, disparities in presentation age, nonsurgical treatments, and comorbidities suggest differing challenges across populations. 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引用次数: 0
摘要
导论：髋骨关节炎（OA）的治疗存在性别、种族/民族和社会经济地位的差异，但它们对全髋关节置换术（THA）使用的综合影响尚不清楚。本研究评估了两个学术中心在表现、非手术治疗和THA率方面的差异。方法：纳入2002年在两个三级学术中心就诊的原发性髋关节骨关节炎患者。统计数据、Kellgren-Lawrence评分、Charlson合并症指数（CCI）和非手术治疗情况。社会经济地位的评估使用社会剥夺指数，分层为四分位数（Q4 =最贫困）。卡方、方差分析和t检验比较了人口统计数据和利用率。一个多变量模型分析了影响THA可能性的因素。结果：在456例患者中，328例因原发性髋关节OA推荐行THA，其中63%为女性，6%为亚洲人，6%为黑人，23%为其他，3%为未知，54%为白人，8%为西班牙裔。女性患者年龄较大（70.3±8.6∶68.1±9.7,P = 0.03）。西班牙裔患者较年轻（62.2±12.1岁比70.1±8.7岁，P = 0.0020）， CCI较低（2.20±1.52比2.93±1.49比3.28±1.69 P = 0.027）。社会剥夺指数Q4患者有更高的物理治疗利用率（Q4 79% vs. Q1 62%, P = 0.006）。总体而言，79%接受THA治疗的患者接受了手术，多因素分析显示，女性、黑人、亚洲人和西班牙裔患者CCI较高的可能性较低（P < 0.001），而社会经济条件较差的患者更有可能接受THA治疗（P < 0.05）。结论：尽管THA的使用率很高，但在表现年龄、非手术治疗和合并症方面的差异表明不同人群面临不同的挑战。未来的研究应该探索这些差异的驱动因素。证据水平：IV回顾性队列。
The Effect of Sex, Race/Ethnicity, and Neighborhood Socioeconomic Disadvantage on Total Hip Arthroplasty Utilization: A Multicenter Cohort Study.
Introduction: Disparities in the management of hip osteoarthritis (OA) exist across sex, race/ethnicity, and socioeconomic status, but their combined effect on total hip arthroplasty (THA) utilization remains unclear. This study evaluates differences in presentation, nonsurgical treatments, and THA rates across two academic centers.
Methods: Patients with primary hip OA seen in 2002 at two tertiary academic centers were included. Demographics, Kellgren-Lawrence grade, Charlson Comorbidity Index (CCI), and nonsurgical treatments were collected. Socioeconomic status was assessed using the social deprivation index, stratified into quartiles (Q4 = most deprived). Chi square, analysis of variance, and t-tests compared demographics and utilization rates. A multivariable model analyzed factors influencing THA likelihood.
Results: Among 456 patients, 328 were recommended for THA for primary hip OA, 63% were female, 6% were Asian, 6% Black, 23% other, 3% unknown, 54% White, and 8% Hispanic. Female patients were older (70.3 ± 8.6 vs. 68.1 ± 9.7 years, P = 0.03). Hispanic patients were younger (62.2 ± 12.1 vs. 70.1 ± 8.7 years, P = 0.0020) with lower CCI (2.20 ± 1.52 vs. 2.93 ± 1.49 vs. 3.28 ± 1.69 P = 0.027). Social deprivation index Q4 patients had greater physical therapy utilization (Q4 79% vs. Q1 62%, P = 0.006). Overall, 79% of patients who were offered THA underwent surgery, with multivariate analysis revealing lower likelihood among females, Black, Asian, and Hispanic patients with higher CCI (P < 0.001), whereas socioeconomically disadvantaged patients were more likely to undergo THA (P < 0.05).
Conclusion: Although THA utilization was high, disparities in presentation age, nonsurgical treatments, and comorbidities suggest differing challenges across populations. Future research should explore drivers of these disparities.
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