Lack of Demographic Information in THA/TKA

Hi, my name is Caitlin Donnelly. I'm a 3rd year medical student at LSU New Orleans. Our study was on the lack of demographic information in total Hip and Total knee arthroplasty randomized controlled trialal publications. I'd like to start by thanking my co-authors for their contributions.

These are disclosures.

Social determinants of health are at the forefront of many discussions today. Their impact is documented in orthopedic literature, however, there is a lack of data on the inclusion of these variables within Research. Therefore, our aim is to investigate how many total Hip and Total knee arthroplasty randomized controlled trials report social determinative health variables such as race, ethnicity, insurance, income, and education within the manuscript.

To do so, a PubMed search was performed for total Knee and Total hip arthroplasty randomized controlled trials from 2017 to 2019 in four major orthopedic journals. These included Core, Osteoarthritis and Cartilage, JBJS and Journal of Arthroplasty. Our inclusion criteria required that the publications be pertaining to total Hip and or total Knee arthroplasties, as well as including a patient demographic table. This resulted in 72 publications included in our study.

Data was collected on the publication year, the type of Surgery, and the inclusion of race, ethnicity, insurance, income, and education in the demographic table or discussion.

Analysis was performed with counts and percentages of the social determinant of health variables by journal year, journal name, and Surgery type, and Fisher exact tests were used for comparisons.

This is the summaries of social determinant variable inclusion and the discussion, demographic table and multivariable regressions.

Race was discussed within 4 of the manuscripts and only included in 3 of the demographic tables. Ethnicity was discussed in 3 manuscripts and included in 1 demographic table. Insurance, income, and education were not included in any of the discussions or demographic tables, and none of the social determinative health variables were included in any of the multivariable regressions.

Overall, only 5 of the manuscripts discussed any one of the social determinative health variables, and only 3 included any of the social determinant health variables within the demographic table. Therefore, there is a less than 10% reporting rate of any of the social determinative health variables.

This shows the publications broken down by year, journal, and Surgery type. In 2017, there were only two publications that discussed any one of the social determinative health variables, only one in 2018 and two in 2019. We found that there was an insignificant difference within the three years analyzed, showing that there was no significant improvement and there was not an incidence of just one bad year.

When broken down by journal type, there were no publications that met the inclusion criteria in Osteoarthritis and cartilage. Only 4 publications from Journal of Arthroplasty discussed any of the social determined health variables, one in core and none in JBJS. We found that there's an insignificant difference when broken down by journal type. They were also divided by the type of Surgery, and we found that there was an insignificant difference.

We found that social determinative health variables are vastly underreported, and there's growing evidence that social determinative health variables impact outcomes and should be considered as consequential as gender and BMI. Inclusion of these social determinative health variables allows to determine the applicability of randomized controlled trial findings to various patient populations outside of the studies.

We found that there was an insignificant difference over the 3 years analyzed, and it is also important to note that we only looked at randomized controlled trials. Therefore, investigators had an active choice to consider the social determinant health variables as variables of interest.

In conclusion, there's a significant shortcoming in the inclusion of social determinative health variables in total Hip and total Knee arthroplasy publications. Exclusion of these variables when making national standards and health policies may be indirectly perpetuating disparities. Research that does not use representative patient samples should be used with caution. We advocate for the standardization of the inclusion of the social determinative health variables and call to action, journals and readers must demand greater diversity, inclusivity in their Research.

Thank you.