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Review
. 2022 Oct 3;4(1):36.
doi: 10.1186/s42836-022-00137-4.

Socioeconomic factors affecting outcomes in total knee and hip arthroplasty: a systematic review on healthcare disparities

Paul M Alvarez  1 , John F McKeon  1 , Andrew I Spitzer  2 , Chad A Krueger  3 , Matthew Pigott  1 , Mengnai Li  1 , Sravya P Vajapey  4
Affiliations
Review

Socioeconomic factors affecting outcomes in total knee and hip arthroplasty: a systematic review on healthcare disparities

Paul M Alvarez et al. Arthroplasty. .

Abstract

Background: Recent studies showed that healthcare disparities exist in use of and outcomes after total joint arthroplasty (TJA). This systematic review was designed to evaluate the currently available evidence regarding the effect socioeconomic factors, like income, insurance type, hospital volume, and geographic location, have on utilization of and outcomes after lower extremity arthroplasty.

Methods: A comprehensive search of the literature was performed by querying the MEDLINE database using keywords such as, but not limited to, "disparities", "arthroplasty", "income", "insurance", "outcomes", and "hospital volume" in all possible combinations. Any study written in English and consisting of level of evidence I-IV published over the last 20 years was considered for inclusion. Quantitative and qualitative analyses were performed on the data.

Results: A total of 44 studies that met inclusion and quality criteria were included for analysis. Hospital volume is inversely correlated with complication rate after TJA. Insurance type may not be a surrogate for socioeconomic status and, instead, represent an independent prognosticator for outcomes after TJA. Patients in the lower-income brackets may have poorer access to TJA and higher readmission risk but have equivalent outcomes after TJA compared to patients in higher income brackets. Rural patients have higher utilization of TJA compared to urban patients.

Conclusion: This systematic review shows that insurance type, socioeconomic status, hospital volume, and geographic location can have significant impact on patients' access to, utilization of, and outcomes after TJA.

Level of evidence: IV.

Keywords: Healthcare disparities; Hip arthroplasty; Hip replacement; Hospital volume; Inequities; Insurance; Knee replacement; Medicaid; Medicare; Outcomes; Socioeconomic.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA study selection algorithm
Fig. 2
Fig. 2
TJA outcomes of Medicaid compared to private/commercial insurance holders
Fig. 3
Fig. 3
TJA outcomes of Medicare compared to private/commercial insurance holders
Fig. 4
Fig. 4
TJA outcomes of lower SES patients compared to higher SES patients
Fig. 5
Fig. 5
Hospital volume is inversely correlated with complication rate, readmissions, mortality, and other negative outcomes after TJA
See this image and copyright information in PMC

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