The Impact of the Area Deprivation Index on Knee and Hip Health

Background: Racial and ethnic disparities have been widely reported in orthopaedic surgery, but recommendations for meaningful change remain limited. This study aimed to quantify the extent to which the relative socioeconomic differences of neighborhoods contribute to health inequity. Methods: A survey assessing a wide range of social determinants of health and patient-reported outcome measures was administered to 503 patients presenting to a multi-disciplinary orthopaedic clinic. Area Deprivation Index (ADI) was used as a neighborhood disparity indicator along with patient reported demographics, social, medical, and economic characteristics. Multivariable logistic regression analyses were performed to assess factors associated with lower Knee and Hip Disability and Osteoarthritis Outcome Scores (KOOS Jr. & HOOS Jr.). Results: Significant factors associated with lower hip and knee functional outcomes included advanced age, BMI ≥ 40.0 kg/m² (P ≤.002), decreased functional status (P ≤.014), increased distance traveled (P ≤.049), and Black race (P ≤.025). English non-fluency (P =.001) and opioid use (P =.001) were also associated with decreased HOOS Jr scores. No significant association was observed between the ADI and hip and knee osteoarthritis outcome scores in multivariable analysis (P > 0.05). Conclusions: The association between socioeconomic deprivation and the burden of knee and hip pain was better explained by direct patient factors such as race, advanced age, higher BMI, opioid use, non-English literacy, and longer distances traveled rather than indirect factors such as the ADI.