Impact of socioeconomic status on the 90- and 365-day rate of revision and mortality after primary total hip arthroplasty: a cohort study based on 103,901 patients with osteoarthritis from national databases in Denmark
DOI:
https://doi.org/10.1080/17453674.2021.1935487Abstract
Background and purpose — Socioeconomic inequality in health is recognized as an important public health issue. We examined whether socioeconomic status (SES) is associ- ated with revision and mortality rates after total hip arthro- plasty (THA) within 90 and 365 days.
Patients and methods — We obtained SES mark- ers (cohabitation, education, income, and liquid assets) on 103,901 THA patients from Danish health registers (year 1995–2017). The outcomes were any revision (all revisions), specified revision (due to infection, fracture, or dislocation), and mortality. We used Cox regression analysis to estimate adjusted hazard ratio (aHR) of each outcome with 95% con- fidence interval (CI) for each SES marker.
Results — Within 90 days, the aHR for any revision was 1.3 (95% CI 1.1–1.4) for patients living alone vs. cohabit- ing. The aHR was 2.0 (CI 1.4–2.6) for low-income vs. high- income among patients < 65 years. The aHR was 1.2 (CI 0.9–1.7) for low liquid assets among patients > 65 years. Results were consistent for any revision within 365 days as well as for revisions due to infection, fracture, and disloca- tion. The aHR for mortality was 1.4 (CI 1.2–1.6) within 90 days and 1.3 (CI 1.2–1.5) within 365 days for patients living alone vs. cohabiting. Low education, low income, and low liquid assets were associated with increased mortality rate within both 90 and 365 days.
Interpretation — Our results suggest that living alone, low income, and low liquid assets were associated with increased revision and mortality up to 365 days after THA surgery. Optimizing medical conditions prior to surgery and implementing different post-THA support strategies with a focus on vulnerable patients may reduce complications asso- ciated with inequality.
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Copyright (c) 2021 Nina M Edwards, Claus Varnum, Søren Overgaard, Alma B Pedersen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.