Background 

To capture various social determinants of health, recent analyses have used comprehensive measures of socioeconomic disadvantage such as deprivation and vulnerability indices. Given that studies evaluating the effects of social deprivation on total joint arthroplasty (TJA) have yielded mixed results, a systematic review of this relationship might help answer questions about usage, complications, and results after surgery among patients in different socioeconomic groups and help guide targeted approaches to ensure health equity.

Questions/purposes 

We asked: How is social deprivation associated with TJA (1) usage, (2) adverse events including discharge deposition and length of stay, and (3) patient-reported outcome measures (PROMs)?

Methods 

A comprehensive review of the PubMed, EBSCO host, Medline, and Google Scholar electronic databases was conducted to identify all studies that evaluated social deprivation and TJA between January 1, 2000, and March 1, 2022. Studies were included if they evaluated comprehensive measures of socioeconomic deprivation rather than individual social determinants of health. Nineteen articles were included in our final analysis with a total of 757,522 patients. In addition to characteristics of included studies (such as patient population, procedure evaluated, and utilized social deprivation metric), we recorded TJA usage, adverse events, and PROM values as reported by each article. Two reviewers independently evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean ± SD MINORS score was 13 ± 1 of 16, with higher scores representing better study quality. All the articles included are noncomparative studies. Given the heterogeneity of the included studies, a meta-analysis was not performed and results were instead presented descriptively.

Results 

Although there were inconsistencies among the included articles, higher levels of social deprivation were associated with lower TJA usage even after controlling for various confounding variables. Similarly, there was agreement among studies regarding higher proportion of nonhome discharge for patients with more social deprivation. Although there was limited agreement across studies regarding whether patients with more social deprivation had differences in their baseline and postoperative PROMs scores, patients with more social deprivation had lower improvements from baseline for most of the included articles.

Conclusion 

These findings encourage continued efforts focusing on appropriate patient education regarding expectations related to functional improvement and the postoperative recovery process, as well as resources available for further information and social support. We suggest linking patient data to deprivation measures such as the Area Deprivation Index to help encourage shared decision-making strategies that focus on health literacy and common barriers related to access. Given the potential influence social deprivation may have on the outcome and utilization of TJA, hospitals should identify methods to determine patients who are more socially deprived and provide targeted interventions to help patients overcome any social deprivation they are facing. We encourage physicians to maintain close communication with patients whose circumstances include more severe levels of social deprivation to ensure they have access to the appropriate resources. Additionally, as multiple social deprivation metrics are being used in research, future studies should identify a consistent metric to ensure all patients that are socially deprived are reliably identified to receive appropriate treatment.

Level of Evidence 

Level III, therapeutic study.

中文翻译：

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社会剥夺是否与全关节置换术的使用、不良事件和患者报告的结果测量有关？系统回顾

 背景

为了捕捉健康的各种社会决定因素，最近的分析使用了社会经济劣势的综合衡量标准，例如剥夺和脆弱性指数。鉴于评估社会剥夺对全关节置换术（TJA）影响的研究得出了不同的结果，对这种关系的系统回顾可能有助于回答有关不同社会经济群体患者的使用、并发症和术后结果的问题，并有助于指导有针对性的治疗确保健康公平的方法。

 问题/目的

我们询问：社会剥夺与 TJA (1) 使用、(2) 不良事件（包括出院沉积和住院时间）以及 (3) 患者报告的结果测量 (PROM) 有何关系？

 方法

对 PubMed、EBSCO 主机、Medline 和 Google Scholar 电子数据库进行了全面审查，以确定 2000 年 1 月 1 日至 2022 年 3 月 1 日期间评估社会剥夺和 TJA 的所有研究。社会经济剥夺而不是个人健康的社会决定因素。我们的最终分析中纳入了 19 篇文章，总计 757,522 名患者。除了纳入研究的特征（例如患者群体、评估的程序和使用的社会剥夺指标）之外，我们还记录了每篇文章报告的 TJA 使用情况、不良事件和 PROM 值。两名评审员使用非随机研究方法学指数 (MINORS) 工具独立评估纳入研究的质量。平均±SD未成年人分数为13±1（共16分），分数越高代表学习质量越好。纳入的所有文章均为非比较研究。鉴于纳入研究的异质性，未进行荟萃分析，而是以描述性方式呈现结果。

 结果

尽管纳入的文章之间存在不一致，但即使在控制了各种混杂变量之后，较高水平的社会剥夺也与较低的 TJA 使用率相关。同样，有关社会剥夺程度较高的患者非回家出院比例较高的研究也达成了一致。尽管对于社交剥夺较多的患者的基线和术后 PROM 评分是否存在差异，各研究之间的共识有限，但对于大多数纳入的文章而言，社交剥夺较多的患者相对于基线的改善较低。

 结论

这些发现鼓励继续努力关注适当的患者教育，了解与功能改善和术后恢复过程相关的期望，以及可用于进一步信息和社会支持的资源。我们建议将患者数据与区域剥夺指数等剥夺措施联系起来，以帮助鼓励共同决策策略，重点关注健康素养和与获取相关的常见障碍。鉴于社会剥夺可能对 TJA 的结果和利用产生潜在影响，医院应确定方法来确定社会剥夺程度较高的患者，并提供有针对性的干预措施，帮助患者克服他们所面临的任何社会剥夺。我们鼓励医生与社会剥夺程度较严重的患者保持密切沟通，以确保他们能够获得适当的资源。此外，由于研究中正在使用多种社会剥夺指标，未来的研究应确定一致的指标，以确保可靠地识别所有社会剥夺患者以接受适当的治疗。

 证据水平

III级，治疗研究。