Abstract

BACKGROUND: The Index of Concentration at the Extremes (ICE), a measure of geographic socioeconomic polarization, predicts several health outcomes, but has not been evaluated in the context of total knee arthroplasty (TKA). This study evaluates ICE as a predictor of post-TKA resource utilization.METHODS: Using the Healthcare Cost and Utilization Project's New York State database from 2016 to 17, we retrospectively evaluated 57,426 patients = 50 years undergoing primary TKA. The ICE values for extreme concentrations of income and race were calculated using United States Census Bureau data with the formula ICEi = (Pi - Di)/Ti where Pi, Di, and Ti are the number of households in the most privileged extreme, disadvantaged extreme, and total population in zip code i, respectively. Extremes of privilege and disadvantage were defined as = $150,000 vs. < $25,000 for income and non-Hispanic White vs. non-Hispanic Black for race. Association of ICE values, demographics, and comorbidities with 90-day readmission and 90-day emergency department (ED) visits were examined using multivariable analysis.RESULTS: Overall 90-day readmission and ED visit rates were 12.8 and 9.4%, respectively. On multivariable analysis, the lowest ICEIncome quintile (concentrated poverty) predicted 90-day readmission (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.05-1.30, P = 0.005) and 90-day ED visit (OR 1.22, 95% CI 1.08-1.38, P = 0.001). The ICERace was not predictive of either outcome.CONCLUSION: Patients in communities with the lowest ICEIncome values utilize more inpatient and ED resources after primary TKA. Incorporating ICEIncome into risk-adjusted bundled payment models may help align incentives for equitable care.

View details for DOI 10.1016/j.arth.2023.08.024

View details for PubMedID 37595766