Summary

Hip arthroscopy patients from neighborhoods with greater ADI scores experience worse healthcare accessibility and inferior long-term functional outcomes at minimum 8-year follow-up.

Abstract

Introduction

The purpose of this study was to investigate the effects of neighborhood-level socioeconomic disadvantage on healthcare accessibility and long-term functional outcomes for patients undergoing hip arthroscopy. We hypothesize that disadvantaged patients achieve significantly worse healthcare accessibility and long-term functional outcomes.

Methods

This retrospective analysis queried patients ≥18 years old with minimum 8-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. Utilizing the ADI score as a validated measurement of neighborhood-level socioeconomic disadvantage, the study population was divided into quartiles. Patients in the least and most disadvantaged quartiles represented the ADI Low and ADI High cohorts, respectively. Healthcare accessibility and socioeconomic disadvantage were compared between ADI cohorts using rural classification, health professional shortage area designation (HPSA), medically underserved area/population (MUA/P) designation, insurance status, level of education, and household income. Collected PROMs included mHHS, HOS-ADL, HOS-SSS, NAHS, iHOT-33, pain levels, patient satisfaction, and rates of conversion to THA.

Results

The ADI Low and ADI High cohorts had a total of 43 patients, each. A greater proportion of ADI High patients resided in rural communities (P=0.026), primary care HPSAs (P=0.024), and MUA/Ps (P=0.019). At a patient level, the ADI High cohort had lower levels of insurance coverage (P=0.035), education (P=0.002), and household income (P=0.002). At minimum 8-year follow-up, ADI High patients reported significantly worse scores for all PROMs except for HOS-SSS groups (77.9±24.7 vs 72.6±28.9; P=0.371). Despite having significantly worse PROMs, ADI High patients converted to THA at a statistically similar rate to ADI Low patients (ADI High: 5 [11.6%] vs. ADI Low: 9 [20.9%]; P=0.243). Lastly, ADI High patients were 10.4 and 11.4 times less likely to achieve PASS for mHHS (ADI High vs. ADI Low, OR: 0.09; P=0.007) and HOS-ADL (ADI High vs. ADI Low, OR: 0.10; P=0.018), respectively.

Conclusions

Hip arthroscopy patients from neighborhoods with greater ADI scores experience worse healthcare accessibility and inferior long-term functional outcomes at minimum 8-year follow-up. While it is important that orthopaedic surgeons understand the consequential effects of SDOH on long-term musculoskeletal health, these findings have far greater implications. Orthopaedic surgeons nationwide must collaborate with patients, hospital systems, and local/state governments to reform healthcare policies that have contributed to these disparities.