Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index

TL;DR

This study finds that patients with lower social vulnerability scores are more likely to receive recommendations for knee replacement surgery, suggesting social factors influence clinical decisions.

Contribution

The study demonstrates a novel association between the Social Vulnerability Index and surgeon recommendations for total knee arthroplasty.

Findings

Lower Social Vulnerability Index scores were independently associated with higher odds of receiving a TKA recommendation.

Socioeconomic status and household characteristics subcategories of SVI were significantly linked to surgeon recommendations.

Only 39.2% of patients appropriate for TKA received a surgeon recommendation, indicating potential disparities in care.

Abstract

Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, but disparities in its utilization exist, particularly by gender, race, socioeconomic status, and geography. Social determinants of health may contribute to these disparities. This study examines the relationship among the Social Vulnerability Index (SVI), a measure of social determinants of health, and the likelihood of receiving a surgeon's recommendation for TKA.

This prospective, observational study included 314 patients with primary knee osteoarthritis deemed “appropriate” for TKA based on the American Academy of Orthopaedic Surgeons Appropriate Use Criteria. Patients were recruited from 4 fellowship-trained arthroplasty surgeons at a single academic hospital in Chicago. The primary outcome was whether patients received a surgeon recommendation for TKA, analyzed in relation to their SVI. Bivariate and multivariable analyses were performed, adjusting for patient demographics, body mass index, Charlson Comorbidity Index, and surgeon factors.

Of the 314 patients appropriate for TKA by Appropriate Use Criteria guidelines, 39.2% received a surgeon recommendation. Patients with lower SVI scores were more likely to receive a recommendation (0.6596 vs 0.7556, P = .284). Multivariable analysis showed that lower SVI scores were independently associated with higher odds of a surgeon recommendation (odds ratio [OR]: 0.705, P = .028), particularly in the subcategories of socioeconomic status (OR: 0.754, P = .034) and household characteristics (OR: 0.803, P = .049).

Lower SVI scores are associated with increased likelihood of receiving a TKA recommendation, highlighting the impact of social vulnerability on clinical decision-making and the need for further investigation into mitigating biases in surgical decisions.

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