Income and Insurance Status Impact Access to Health Care for Hip Osteoarthritis

Association of Geographic Social Vulnerability With Race-Based Differences in the Utilization of Total Hip Arthroplasty Surgeries for Medicare Beneficiaries

BACKGROUND

Racial disparities exist in the utilization of total hip arthroplasties (THAs). The social vulnerability index (SVI), which measures geographic-level disadvantage and includes themes, such as socioeconomic status, minority status, and language, may partially explain disparities in THA use. Our objectives were to determine the association of the composite SVI with THA use for (1) White Medicare beneficiaries, (2) Black Medicare beneficiaries, and (3) the difference in THA use between White and Black beneficiaries. We also determined the association of SVI themes with these THA-use endpoints.

METHODS

We used 2013 to 2019 Medicare data to calculate age- and sex-standardized THA use rates for 306 hospital referral regions (HRRs). We estimated multivariable linear regression models to determine the association of the composite SVI and its four themes with THA utilization and with differences in use rates.

RESULTS

Living in HRRs with the highest SVI (most vulnerable, quartile 4) was associated with lower hip arthroplasty rates for both White and Black beneficiaries (e.g., quartile 4 for White beneficiaries: -0.9, 95% confidence interval [95% CI]: -1.2 to -0.7, P < 0.001; quartile 4 for Black beneficiaries: -0.9, 95% CI: -1.3 to -0.5, P < 0.001) compared to beneficiaries in the least vulnerable HRRs (quartile 1). Higher vulnerability in minority status and language (theme 3) was associated with lower THA utilization for Black beneficiaries only (e.g., quartile 4 for Black beneficiaries: -0.9, 95% CI: -1.2 to -0.5, P < 0.001) and was associated with widening of the White-Black difference in THA utilization (e.g., quartile 4: 0.7, 95% CI: 0.3 to 1.1, P < 0.001).

CONCLUSIONS

Higher composite SVI is associated with lower THA utilization for both White and Black beneficiaries. Higher vulnerability in minority status and language is associated with the widening of the disparity in THA rates. Our findings highlight important mechanisms that need to be addressed to ensure equity in THA access.

Barriers to Health Care Affordability Among Parents of Children with Atopic Dermatitis

Abstracts: Background: Pediatric atopic dermatitis (AD) can pose a significant financial burden to families. However, no studies exist that assess the impact of pediatric AD on health care access/affordability at the parental level. Objective: Explore the effects of childhood AD on parental access to health care and the socioeconomic factors that might exacerbate these problems. Methods: The National Health Interview Survey was used to analyze 48,329,314 participants who answered the validated question on pediatric AD. Multivariable logistic regression analyses were performed to assess the association between pediatric AD and parental access to care. Results: Parents of children with AD were more likely to have difficulty accessing prescription medications (aOR: 1.47; [95% CI 1.31-1.65]), follow-up care (1.36; [95% CI 1.17-1.57]), specialist care (aOR: 1.53; [95% CI 1.33-1.75]), and more likely to purchase medications from abroad (aOR: 1.35; [95% CI 1.09-1.67]) relative to their counterparts with children without AD. Within the AD cohort, uninsured or lower income participants had higher odds of facing these barriers to care. Conclusions: Parents of children with AD are more likely to face barriers in health care access, and significant disparities exist based on sociodemographic characteristics.

Insights into Hip pain using Hip X-ray: Epidemiological study of 8,898,044 Koreans

Hip pain is a prevalent degenerative joint symptoms, imposing a significant global health burden. Hip pain is experiencing an increase in incidences in Korea due to its aging society, and the social burden of hip pain continues to rise as the hip joint is crucial for gait and balance. This study assessed the epidemiology of hip pain in Korea using data from the fifth version of Korea National Health and Nutrition Examination Survey (KNHANES V-5). The research analyzed data from 8,898,044 Koreans to evaluate the prevalence and characteristics of hip pain and abnormal hip X-ray. Variables encompassed medical, demographic, mental, social, and musculoskeletal factors. Descriptive analysis and propensity score matching analyses unveiled characteristics of Koreans experiencing hip pain or showing abnormal hip x-ray. The study provides insights into the epidemiology of hip pain in the entire Korean population, and further suggesting the effective management of hip pain.

Factors Influencing Patient Satisfaction with Total Joint Replacement Surgery

Background

Replacement arthroplasty surgery is a surgical procedure that is needed to restore the activity of a joint. Patient satisfaction regarding arthroplasty surgery is influenced by post-operative complication rate, ability to afford care, and quality of interaction. In this study, we assessed patients' postoperative complications, mobility, and pain management as proxies for their overall satisfaction with total joint replacement (TJR).

Methods

An anonymous web-based survey was conducted for patients who had undergone any total joint replacement surgery in the US. Respondents were adults living in the United States.

Results

180 individuals met the inclusion criteria and responded to the survey. Age, education, gender, and race were fitted against the patient satisfaction level with the surgeon. While education [P=0.4720], gender [P=0.5097 ], and race [P=0.8183] were not significant, age in years [P=0.02340] was predictive of overall satisfaction levels [R2=0.0213]. When controlling for BMI, infection [P=0.0164], nerve damage [P=0.0250], delayed healing [P=0.0024], hematoma [P=0.0497], were more likely to occur in participants who have had a knee replacement, as compared to shoulder and hip replacement surgery. When controlling for mobility before surgery vs. mobility after surgery [P=0.0114], patients who selected the highest level of mobility before surgery were likely to select the highest level of mobility after surgery. Medicaid, Medicare, private insurance, employer-based insurance, and no insurance were fitted against the patient's self-reported difficulty in paying for their treatment/care. Although employer-based insurance [P=0.0790] was not significant in predicting difficulty in paying for the surgery, patients with Medicaid [P=0.0280], Medicare [P=0.0200], or private insurance [P=0.0343] did.

Conclusion

In this cohort, older patients were associated with having improved satisfaction with the surgeon who performed their joint replacement. Complications were higher in patients who underwent a knee arthroplasty compared to a shoulder or hip arthroplasty.