Disparities in Social Determinants of Health Associated With Decreased Likelihood of Receiving Total Joint Arthroplasty

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INTRODUCTION: Knee osteoarthritis and hip osteoarthritis (OA) are orthopaedic conditions for which total joint arthroplasty (TJA) is the definitive treatment. The correlation of social determinants of health (SDOH) disparities with access to specialized health care such as TJA is of increasing interest. At our institution, SDOH screening was implemented in 2020. The purpose of this study was to identify whether patients with OA who screened positive for SDOH hardship (SDOH positive) were less likely to receive a subsequent TJA. METHODS: Patients with diagnosis of knee or hip OA who underwent SDOH screening from 2020 to 2023 were identified from our institutional record. The correlation of SDOH-positive screening relative to not screening positive (SDOH negative) with the likelihood of receiving TJA was assessed. The incidence of TJA in these two cohorts was evaluated using multivariable logistic regression controlling for age, sex, race, and ethnicity. RESULTS: A total of 2,981 patients were identified fitting the study criteria. The number of SDOH-positive patients was 1,122 (37.6%), and the number of SDOH-negative patients was 1,859 (62.4%). The SDOH-positive group had a significantly lower rate of TJA (9.9% vs. 14.8%, P < 0.0001). When individual SDOH were assessed, transportation insecurity, financial strain, and food insecurity were associated with decreased TJA incidence, with increasing financial strain corresponding to additional decreases in TJA incidence. On multivariable analysis, SDOH-positive status was identified as an independent negative predictor of TJA. DISCUSSION: Patients with knee or hip OA screening positive for SDOH disparities had decreased odds of receiving a subsequent TJA. As screening becomes increasingly more common, these findings illustrate how SDOH disparities correlate with access to orthopaedic care and demonstrate the need for intervention after screening, especially in SDOH categories where organizations can provide resources and support, such as access to transportation and food.

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