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

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Background and purpose — Socioeconomic inequality in health is recognized as an important public health issue. We examined whether socioeconomic status (SES) is associated with revision and mortality rates after total hip arthroplasty (THA) within 90 and 365 days. Patients and methods — We obtained SES markers (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% confidence 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. cohabiting. 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 dislocation. 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 associated with inequality.

OriginalsprogEngelsk
TidsskriftActa Orthopaedica
Vol/bind92
Udgave nummer5
Sider (fra-til) 581-588
ISSN1745-3674
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
The study was approved by the Danish Data Protection Agency (journal number 2015-57-0002) and Aarhus University (journal number 2016-051-000001). We would like to acknowledge the support from Helsefonden, the Orthopaedic Research Fund, the AP Møller Fund, and the Aase and Ejnar Danielsens Fund. The funders had no role in the study design, data collection and analysis, or in the preparation of the manuscript. The authors report no conflict of interest.

Publisher Copyright:
© 2021 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

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