Comparing Community-Level Social Determinants of Health with Patient Race in Total Hip Arthroplasty Outcomes.
Academic Article
Overview
abstract
OBJECTIVE: Social determinants of health (SDOH) including race have a key role in total hip arthroplasty (THA) disparities. We compared the collective influence of community-level SDOH to individual factors such as race on THA outcomes. METHODS: This retrospective cohort study of the Pennsylvania Health Care Cost Containment Council Database - 2012 to 2018 included 105,336 patients undergoing unilateral primary elective THA. We extracted "community" factors from the US census by geocoding patient zip codes including walkability index, household income, foreign-born, English proficiency, computer/internet access, unpaid family workers, those lacking health insurances, and education. We trained an explainable boosting machine, a modern form of generalized additive models to predict 90-day readmission, 90-day mortality, 1-year revision, and length of stay (LOS). Mean absolute scores were aggregated to measure variable importance (i.e. variables that contributed most to the prediction). RESULTS: The rates of readmission, revision, and mortality were 8%, 1.5%, and 0.3% respectively, with a median LOS of 2 days. Predictive performance measured by area under receiver operating characteristic was 0.76 for mortality, 0.66 for readmission, and 0.57 for 1-year revision. For LOS, root mean squared error was 0.41 (R2=0.2). The top three predictors of mortality were "community", discharge location, and age; for readmission they were discharge location, age, and comorbidities; for revision they were community, discharge location, and comorbidities and for LOS they were discharge location, community, and comorbidities. CONCLUSION: Community-level SDOH were significantly more important than individual race in contributing to the prediction of THA outcomes, especially for 90-day mortality.
