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Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.

Questions/purposes

We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA.

Methods

All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes.

Results

High education attainment was associated with higher HRQoL (EQ-5D index ßhigh = 0.03 ± 0.01; EQ VAS ßhigh = 2.6 ± 0.5) after THA, whereas those with low and medium education were at risk for lower HRQoL. High education was associated with less pain after treatment (ßhigh = −3.3 ± 0.05). Individuals with low or medium education were at risk for less satisfaction with THA (p < 0.001).

Conclusions

Our results suggest clinicians should support patients with low and medium education to a greater extent. Identification of patients who will benefit most from THA and educating those at risk for poorer outcomes, like patients with low and medium education, ultimately may improve patient satisfaction, HRQoL, pain, and the cost utility of THA.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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References

  1. Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty. 2011;26:209–213.

    Article  PubMed  Google Scholar 

  2. Bischoff-Ferrari HA, Lingard EA, Losina E, Baron JA, Roos EM, Phillips CB, Mahomed NN, Barrett J, Katz JN. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum. 2004;51:829–835.

    Article  CAS  PubMed  Google Scholar 

  3. Callaghan JJ, Dysart SH, Savory CF, Hopkinson WJ. Assessing the results of hip replacement: a comparison of five different rating systems. J Bone Joint Surg Br. 1990;72:1008–1009.

    CAS  PubMed  Google Scholar 

  4. Cleveland RJ, Schwartz TA, Prizer LP, Randolph R, Schoster B, Renner JB, Jordan JM, Callahan LF. Associations of educational attainment, occupation and community poverty with hip osteoarthritis. Arthritis Care Res (Hoboken). 2013;65:954–961.

    Article  PubMed  Google Scholar 

  5. Dixon T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis. 2004;63:825–830.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Dixon T, Urquhart DM, Berry P, Bhatia K, Wang Y, Graves S, Cicuttini FM. Variation in rates of hip and knee joint replacement in Australia based on socio-economic status, geographical locality, birthplace and indigenous status. ANZ J Surg. 2011;81:26–31.

    Article  PubMed  Google Scholar 

  7. EuroQolGroup. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.

  8. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Belisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722–1728.

    Article  CAS  PubMed  Google Scholar 

  9. Genell A, Nemes S, Steineck G, Dickman PW. Model selection in medical research: a simulation study comparing Bayesian model averaging and stepwise regression. BMC Med Res Methodol. 2010;10:108.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Hannan MT, Anderson JJ, Pincus T, Felson DT. Educational attainment and osteoarthritis: differential associations with radiographic changes and symptom reporting. J Clin Epidemiol. 1992;45:139–147.

    Article  CAS  PubMed  Google Scholar 

  11. Hawker GA, Wright JG, Glazier RH, Coyte PC, Harvey B, Williams JI, Badley EM. The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis Rheum. 2002;46:3331–3339.

    Article  PubMed  Google Scholar 

  12. Hoeting JA, Madigan D, Raftery AE, Volinsky CT. Bayesian model averaging: a utorial. Statistical Science. 1999;14:382–417.

    Article  Google Scholar 

  13. Juhakoski R, Malmivaara A, Lakka TA, Tenhonen S, Hannila ML, Arokoski JP. Determinants of pain and functioning in hip osteoarthritis: a two-year prospective study. Clin Rehabil. 2013;27:281–287.

    Article  PubMed  Google Scholar 

  14. Karrholm J, Garellick G, Rogmark C, Herberts P. Swedish Hip Arthroplasty Register: Annual Report 2007. Gothenburg, Sweden: Swedish Hip Arthroplasty Register; 2008.

    Google Scholar 

  15. Kass RE, Raftery AE. Bayes factors. J Am Statist Assoc. 1995;90:773–795.

    Article  Google Scholar 

  16. Keurentjes JC, Blane D, Bartley M, Keurentjes JJ, Fiocco M, Nelissen RG. Socio-economic position has no effect on improvement in health-related quality of life and patient satisfaction in total hip and knee replacement: a cohort study. PLoS One. 2013;8:e56785.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. King MT. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11:171–184.

    Article  PubMed  Google Scholar 

  18. Leigh JP, Fries JF. Occupation, income, and education as independent covariates of arthritis in four national probability samples. Arthritis Rheum. 1991;34:984–995.

    Article  CAS  PubMed  Google Scholar 

  19. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013. Available at: http://www.eea.europa.eu/data-and-maps/indicators/oxygen-consuming-substances-in-rivers/r-development-core-team-2006. Accessed January 16, 2014.

  20. Raftery AE. Bayesian model selection in social research. Sociol Methodol. 1995;25:111–163.

    Article  Google Scholar 

  21. Rolfson O, Dahlberg LE, Nilsson JA, Malchau H, Garellick G. Variables determining outcome in total hip replacement surgery. J Bone Joint Surg Br. 2009;91:157–161.

    Article  CAS  PubMed  Google Scholar 

  22. Rolfson O, Karrholm J, Dahlberg LE, Garellick G. Patient-reported outcomes in the Swedish Hip Arthroplasty Register: results of a nationwide prospective observational study. J Bone Joint Surg Br. 2011;93:867–875.

    Article  CAS  PubMed  Google Scholar 

  23. Ross CE, Wu C-L. The links between education and health. Am Sociol Rev. 1995;60:719–745.

    Article  Google Scholar 

  24. Schafer T, Krummenauer F, Mettelsiefen J, Kirschner S, Gunther KP. Social, educational, and occupational predictors of total hip replacement outcome. Osteoarthritis Cartilage. 2010;18:1036–1042.

    Article  CAS  PubMed  Google Scholar 

  25. Singh JA, Lewallen D. Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol. 2009;28:1419–1430.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Stevens M, Wagenmakers R, Groothoff JW, Bulstra SK, van den Akker-Scheek I, Zijlstra W. Physical activity behavior after total hip arthroplasty (THA): a prediction based on patient characteristics. Patient Educ Couns. 2007;69:196–199.

    Article  PubMed  Google Scholar 

  27. Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14:1523–1532.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Thomas Eisler MD, for help in initiating this important work investigating the influence of socioeconomic status on patient-reported outcomes and for his role in obtaining local ethical approval.

Author information

Authors and Affiliations

  1. Swedish Hip Arthroplasty Register, Gothenburg, Sweden

    Meridith E. Greene BA, Ola Rolfson MD, PhD, Szilard Nemes PhD, Max Gordon MD, Henrik Malchau MD, PhD & Göran Garellick MD, PhD

  2. Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA, 02114, USA

    Meridith E. Greene BA & Henrik Malchau MD, PhD

  3. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Meridith E. Greene BA

  4. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Ola Rolfson MD, PhD, Henrik Malchau MD, PhD & Göran Garellick MD, PhD

  5. Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden

    Max Gordon MD

Authors
  1. Meridith E. Greene BA
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  2. Ola Rolfson MD, PhD
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  3. Szilard Nemes PhD
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  4. Max Gordon MD
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  5. Henrik Malchau MD, PhD
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  6. Göran Garellick MD, PhD
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Corresponding author

Correspondence to Meridith E. Greene BA.

Additional information

This study was funded by the Swedish Hip Arthroplasty Register, Gothenburg, Sweden (GG), the Harris Orthopaedic Laboratory, Boston, MA, USA (HM), and research grants from Dr Felix Neuberghs Foundation, Gothenburg, Sweden (OR).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Data from this project were provided from the Swedish Hip Arthroplasty Register in Gothenburg, Sweden, and the data analyses took place in Gothenburg, Sweden, and Boston, MA, USA.

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Greene, M.E., Rolfson, O., Nemes, S. et al. Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register. Clin Orthop Relat Res 472, 1868–1876 (2014). https://doi.org/10.1007/s11999-014-3504-2

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  • DOI: https://doi.org/10.1007/s11999-014-3504-2

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