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• W4379798634 abstract "Background With total hip arthroplasty (THA) utilization rising rapidly, [1] it is important to understand social determinants of health (SDOH) that contribute to disparities in THA outcomes. Objectives We sought to explore the relationship of multiple community-level SDOH with 90-day readmission, 90-day mortality, 1-year revision post-THA, and length of stay (LOS) using prediction modelling. Methods Our retrospective study using the Pennsylvania Health Care Cost Containment Council Database included 105,336 patients undergoing THA 2012-2018. Community-level variables include walkability index; median household income; and percent unpaid family workers, without health insurance and not in the labor force, above high school, above college, foreign-born, speaking languages other than English, with computer access, and with internet access. They were extracted from US census via geocoding. We trained explainable boosting machine using Generalized additive models to predict readmission, mortality, LOS, and revision. Resulting mean absolute scores (MAS) were aggregated to measure collective importance of the above “community-factors.” Results Predictive performance was best for mortality (AUROC=0.76); it was moderate for readmission (AUROC=0.66), revision (AUROC=0.58), and LOS (RMSE=0.41, R 2 =0.2). Community factors relatively contributed more to adverse outcomes than race in all models. The top 3 predictors of readmission were discharge location, age, and comorbidities (MAS =0.24, 0.15, 0.13, respectively). The top 3 predictors of mortality were community factors, discharge location, and age (MAS=0.31, 0.24, 0.19, respectively). The top 3 predictors of revision were community factors, discharge location, and comorbidities (MAS=0.03, 0.01, 0.005, respectively). Lastly, the top 3 predictors for LOS were discharge location, community factors, and comorbidities. Conclusion In all THA outcome models, aggregated community factors were more important than individual race in predicting 90-day readmission, 90-day mortality, 1-year revision, and length of stay. Reference [1]Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief . 2015;(186):1-8. “Community” is the aggregate importance score for % householder living alone, % foreign born, % speaking language other than English, % with computer access, % with internet access, national walkability index, % not in labor force without insurance, % above high school, % above college, % with unpaid family workers, and median household income, extracted from American Community Survey or calculated by the National Walkability Index software from patient zip code. Table 1. Patient-level characteristics by outcome Outcome 90-day readmission 90-day mortality Revision No N = 96914 Yes N = 8422 p No N = 105027 Yes N=309 p No N = 103719 Yes N = 1617 p Age 65.0 [58.0; 73.0] 69.0 [60.0; 77.0] **** 65.0 [58.0; 73.0] 77.0 [67.0; 84.0] **** 65.0 [58.0; 73.0] 65.0 [58.0;74.0] NS Sex ** * *** Female 52330 (54.0%) 4647 (55.2%) 56826 (54.1%) 151 (48.9%) 56046 (54.0%) 931 (57.6%) Male 44584 (46.0%) 3775 (44.8%) 48201 (45.9%) 158 (51.1%) 47673 (46.0%) 686 (42.4%) Race **** NS NS Black 6262 (6.47%) 692 (8.22%) 6936 (6.60%) 18 (5.83%) 6835 (6.59%) 119 (7.36%) Other 2956 (3.05%) 186 (2.21%) 3135 (2.98%) 7 (2.27%) 3108 (3.00%) 34 (2.10%) White 87619 (90.5%) 7539 (89.5%) 94874 (90.4%) 284 (91.9%) 93695 (90.4%) 1463 (90.5%) Missing 77 5 82 0 81 1 Length of stay 2.00 [1.00; 3.00] 3.00 [2.00; 3.00] **** 2.00 [1.00; 3.00] 3.00 [2.00; 4.00] **** 2.00 [1.00;3.00] 2.00 [2.00;3.00] **** Elixhauser comorbidity index **** **** **** > 5 4797 (4.95%) 1078 (12.8%) 5792 (5.51%) 83 (26.9%) 5751 (5.54%) 124 (7.67%) 0 16952 (17.5%) 714 (8.48%) 17647 (16.8%) 19 (6.15%) 17488 (16.9%) 178 (11.0%) 1-4 75165 (77.6%) 6630 (78.7%) 81588 (77.7%) 207 (67.0%) 80480 (77.6%) 1315 (81.3%) Categorical variables N(%), continuous variables median[IQR]. **** p < 0.001; *** p < 0.01; ** p < 0.05; * p < 0.1; NS = nonsignificant Acknowledgements: NIL. Disclosure of Interests Bella Mehta Consultant of: Novartis education content development, Yi Yuan: None declared, Diyu Pearce-Fisher: None declared, Kaylee Ho: None declared, Susan Goodman Consultant of: Paid consultant for UCB., Grant/research support from: Research support from Novartis., Michael Parks: None declared, Fei Wang: None declared, Mark Fontana: None declared, Said Ibrahim: None declared, Peter Cram: None declared, Rich Caruna: None declared." @default.
• W4379798634 created "2023-06-09" @default.
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• W4379798634 date "2023-05-30" @default.
• W4379798634 modified "2023-10-17" @default.
• W4379798634 title "POS1380 PLACE NOT RACE: COMMUNITY-LEVEL SOCIAL DETERMINANTS OF HEALTH MAY BE MORE IMPORTANT THAN PATIENT RACE IN TOTAL HIP ARTHROPLASTY OUTCOMES" @default.
• W4379798634 doi "https://doi.org/10.1136/annrheumdis-2023-eular.3825" @default.
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