Social determinants of health variables greatly underreported in TJA studies
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The inclusion of social determinants of health variables in randomized controlled trials is lacking in studies published in key orthopedic journals, a speaker said at the American Association of Hip and Knee Surgeons Annual Meeting.
Katelynn M. Donnelly, MS, a third-year medical school student at Louisiana State University New Orleans, presented the findings.
Donnelly and colleagues performed a PubMed literature review from 2017 to 2019 and found the social determinants of health (SDOH) variables of insurance, income and education were not included in the 72 publications across four journal that discussed randomized controlled trials that concerned total joint arthroplasty, although other SDOH variables of race and ethnicity were mentioned.
The four journals researchers looked at were ones that pertained most to TJA: Clinical Orthopaedics and Related Research, Osteoarthritis & Cartilage, The Journal of Bone and Joint Surgery and Journal of Arthroplasty.
“We found that SDOH variables are vastly underreported. These variables impact outcomes and should be considered as consequential as gender and BMI. Their inclusion allows us to determine the applicability to be able to apply these findings to patient demographics outside of a study. We also found that there’s an insignificant difference over the 3 years analyzed,” Donnelly said.
To be included in the study, publications had to include a total hip arthroplasty or total knee arthroplasty randomized controlled trial with a table 1, as well as patient demographics.
Researchers used Fisher's exact tests to compare the inclusion of SDOH variables by publication year, journal name and the type of surgery – THA or TKA.
The analysis showed 5.6% of these manuscripts mentioned race, 4.2% of these included race within table 1 and 1.4% of the manuscripts included ethnicity in table 1.
“Overall, only five publications discussed these SDOH variables and only three included them in their table 1. Therefore, there was less than 10% of papers that reported the social determinants of health variables,” Donnelly said.
Results showed no statistically significant differences regarding inclusion of SDOH variable by journal year, journal name or THA vs. TKA.
“We found there are significant shortcomings in the inclusion of SDOH variables in total knee and total hip arthroplasty publications. Using publications excluding these variables to determine national standards and health policies may be indirectly perpetuating disparities. Research that does not use representative patient samples should be used with caution and we advocate to standardize the inclusion of SDOH variables,” Donnelly said.
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Donnelly KM, et al. Paper 9. Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 11-14, 2021; Dallas (hybrid meeting).
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