Comparing Community-Level Social Determinants of Health With Patient Race in Total Hip Arthroplasty Outcomes.

Authors

• Bella Mehta
• Yi Yiyuan
• Diyu Pearce-Fisher
• Kaylee Ho
• Susan M Goodman
• Michael L Parks
• Fei Wang
• Mark A Fontana
• Said Ibrahim
• Peter Cram
• Rich Caruana

Publication/Presentation Date

7-1-2025

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 the influence of individual factors such as race, on THA outcomes.

METHODS: This retrospective cohort study of the Pennsylvania Health Care Cost Containment Council Database (2012-2018) 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 individuals, English proficiency, computer and 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, one-year revision, and length of stay (LOS). Mean absolute scores were aggregated to measure variable importance (ie, 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 two days. Predictive performance measured by area under the receiver operating characteristic curve was 0.76 for mortality, 0.66 for readmission, and 0.57 for one-year revision. For LOS, the root mean squared error was 0.41 (R

CONCLUSION: Community-level SDOH were significantly more important than individual race in contributing to the prediction of THA outcomes, especially for 90-day mortality.

Volume

77

Issue

7

First Page

892

Last Page

899

ISSN

2151-4658

Published In/Presented At

Mehta, B., Yiyuan, Y., Pearce-Fisher, D., Ho, K., Goodman, S. M., Parks, M. L., Wang, F., Fontana, M. A., Ibrahim, S., Cram, P., & Caruana, R. (2025). Comparing Community-Level Social Determinants of Health With Patient Race in Total Hip Arthroplasty Outcomes. Arthritis care & research, 77(7), 892–899. https://doi.org/10.1002/acr.25511

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

39989237

Department(s)

Administration and Leadership

Document Type

Article