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Are Body Mass Index Cutoffs Creating Racial, Ethnic, and Gender Disparities in Eligibility for Primary Total Hip and Knee Arthroplasty?
Unabated increases in the prevalence of obesity among American adults have disproportionately affected women, Black persons, and Hispanic persons. The purpose of this study was to evaluate for disparity in rates of patient eligibility for primary total hip arthroplasty (THA) and total knee arthropla...
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| Published in: | The Journal of arthroplasty 2022-06, Vol.37 (6), p.1009-1016 |
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| Main Authors: | , , , , |
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| cites | cdi_FETCH-LOGICAL-c356t-6fd8a8efcb7f226145178ecb7dcd727da62610208158db1fef53d0e44de961313 |
| container_end_page | 1016 |
| container_issue | 6 |
| container_start_page | 1009 |
| container_title | The Journal of arthroplasty |
| container_volume | 37 |
| creator | Carender, Christopher N. DeMik, David E. Elkins, Jacob M. Brown, Timothy S. Bedard, Nicholas A. |
| description | Unabated increases in the prevalence of obesity among American adults have disproportionately affected women, Black persons, and Hispanic persons. The purpose of this study was to evaluate for disparity in rates of patient eligibility for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on race and ethnicity and gender by applying commonly used body mass index (BMI) eligibility criteria to two large national databases.
We retrospectively reviewed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2015-2019 for primary THA and TKA and the National Health and Nutrition Examination Survey (NHANES) from 2011-2018. Designations of race and ethnicity were standardized between cohorts. BMI cutoffs of |
| doi_str_mv | 10.1016/j.arth.2022.02.013 |
| format | article |
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We retrospectively reviewed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2015-2019 for primary THA and TKA and the National Health and Nutrition Examination Survey (NHANES) from 2011-2018. Designations of race and ethnicity were standardized between cohorts. BMI cutoffs of <50 kg/m2, <45 kg/m2, <40 kg/m2, and <35 kg/m2 were then applied. Rates of eligibility for surgery were examined for each respective BMI cutoff and stratified by age, race and ethnicity, and gender.
143,973 NSQIP THA patients, 242,518 NSQIP TKA patients, and 13,255 NHANES participants were analyzed. Female patients were more likely to be ineligible for surgery across all cohorts for all modeled BMI cutoffs (P < .001 for all). Black patients had relatively lower rates of eligibility across all cohorts for all modeled BMI cutoffs (P < .0001 for all). Hispanic patients had disproportionately lower rates of eligibility only at a BMI cutoff of <35 kg/m2.
Using BMI cutoffs alone to determine the eligibility for primary THA and TKA may disproportionally exclude women, Black persons, and Hispanic persons. These data raise concerns regarding further disparity and restriction of arthroplasty care to vulnerable populations that are already marginalized.
Retrospective Cohort Study, Level III.]]></description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2022.02.013</identifier><identifier>PMID: 35182664</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; BMI ; Body Mass Index ; cutoff ; disparity ; eligibility ; Ethnicity ; Female ; Humans ; Nutrition Surveys ; obesity ; Postoperative Complications - epidemiology ; race ; Retrospective Studies ; United States - epidemiology</subject><ispartof>The Journal of arthroplasty, 2022-06, Vol.37 (6), p.1009-1016</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-6fd8a8efcb7f226145178ecb7dcd727da62610208158db1fef53d0e44de961313</citedby><cites>FETCH-LOGICAL-c356t-6fd8a8efcb7f226145178ecb7dcd727da62610208158db1fef53d0e44de961313</cites><orcidid>0000-0002-5404-0433 ; 0000-0003-3535-5584</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35182664$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carender, Christopher N.</creatorcontrib><creatorcontrib>DeMik, David E.</creatorcontrib><creatorcontrib>Elkins, Jacob M.</creatorcontrib><creatorcontrib>Brown, Timothy S.</creatorcontrib><creatorcontrib>Bedard, Nicholas A.</creatorcontrib><title>Are Body Mass Index Cutoffs Creating Racial, Ethnic, and Gender Disparities in Eligibility for Primary Total Hip and Knee Arthroplasty?</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description><![CDATA[Unabated increases in the prevalence of obesity among American adults have disproportionately affected women, Black persons, and Hispanic persons. The purpose of this study was to evaluate for disparity in rates of patient eligibility for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on race and ethnicity and gender by applying commonly used body mass index (BMI) eligibility criteria to two large national databases.
We retrospectively reviewed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2015-2019 for primary THA and TKA and the National Health and Nutrition Examination Survey (NHANES) from 2011-2018. Designations of race and ethnicity were standardized between cohorts. BMI cutoffs of <50 kg/m2, <45 kg/m2, <40 kg/m2, and <35 kg/m2 were then applied. Rates of eligibility for surgery were examined for each respective BMI cutoff and stratified by age, race and ethnicity, and gender.
143,973 NSQIP THA patients, 242,518 NSQIP TKA patients, and 13,255 NHANES participants were analyzed. Female patients were more likely to be ineligible for surgery across all cohorts for all modeled BMI cutoffs (P < .001 for all). Black patients had relatively lower rates of eligibility across all cohorts for all modeled BMI cutoffs (P < .0001 for all). Hispanic patients had disproportionately lower rates of eligibility only at a BMI cutoff of <35 kg/m2.
Using BMI cutoffs alone to determine the eligibility for primary THA and TKA may disproportionally exclude women, Black persons, and Hispanic persons. These data raise concerns regarding further disparity and restriction of arthroplasty care to vulnerable populations that are already marginalized.
Retrospective Cohort Study, Level III.]]></description><subject>Arthroplasty, Replacement, Hip</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>BMI</subject><subject>Body Mass Index</subject><subject>cutoff</subject><subject>disparity</subject><subject>eligibility</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Humans</subject><subject>Nutrition Surveys</subject><subject>obesity</subject><subject>Postoperative Complications - epidemiology</subject><subject>race</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kd1uEzEQhS0EoqHwAlwgX3LRDf5Ze7cSEgohtBVFIFSuLccetxNt1lvbQeQJeG0cUrhEGmk01neOZnwIecnZnDOu32zmNpW7uWBCzFktLh-RGVdSNH3L9GMyY30vG9UyeUKe5bxhjHOl2qfkRCreC63bGfm1SEDfR7-nn23O9Gr08JMudyWGkOkygS043tJv1qEdzuiq3I3ozqgdPb2Ayib6AfNkExaETHGkqwFvcY0Dlj0NMdGvCbc27elNLHaglzj90X4aAeiiLp_iNNhc9u-ekyfBDhlePPRT8v3j6mZ52Vx_ubhaLq4bJ5UujQ6-tz0Et-6CEJq3inc91Mk734nOW10fmWA9V71f8wBBSc-gbT2cay65PCWvj75Tivc7yMVsMTsYBjtC3GUjtGTnguvugIoj6lLMOUEw0_EYw5k5BGA25hCAOQRgWC0uq-jVg_9uvQX_T_L3xyvw9ghAvfIHQjLZIYwOPCZwxfiI__P_DT9Tl1A</recordid><startdate>202206</startdate><enddate>202206</enddate><creator>Carender, Christopher N.</creator><creator>DeMik, David E.</creator><creator>Elkins, Jacob M.</creator><creator>Brown, Timothy S.</creator><creator>Bedard, Nicholas A.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5404-0433</orcidid><orcidid>https://orcid.org/0000-0003-3535-5584</orcidid></search><sort><creationdate>202206</creationdate><title>Are Body Mass Index Cutoffs Creating Racial, Ethnic, and Gender Disparities in Eligibility for Primary Total Hip and Knee Arthroplasty?</title><author>Carender, Christopher N. ; DeMik, David E. ; Elkins, Jacob M. ; Brown, Timothy S. ; Bedard, Nicholas A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-6fd8a8efcb7f226145178ecb7dcd727da62610208158db1fef53d0e44de961313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Arthroplasty, Replacement, Hip</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>BMI</topic><topic>Body Mass Index</topic><topic>cutoff</topic><topic>disparity</topic><topic>eligibility</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Humans</topic><topic>Nutrition Surveys</topic><topic>obesity</topic><topic>Postoperative Complications - epidemiology</topic><topic>race</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carender, Christopher N.</creatorcontrib><creatorcontrib>DeMik, David E.</creatorcontrib><creatorcontrib>Elkins, Jacob M.</creatorcontrib><creatorcontrib>Brown, Timothy S.</creatorcontrib><creatorcontrib>Bedard, Nicholas A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carender, Christopher N.</au><au>DeMik, David E.</au><au>Elkins, Jacob M.</au><au>Brown, Timothy S.</au><au>Bedard, Nicholas A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are Body Mass Index Cutoffs Creating Racial, Ethnic, and Gender Disparities in Eligibility for Primary Total Hip and Knee Arthroplasty?</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2022-06</date><risdate>2022</risdate><volume>37</volume><issue>6</issue><spage>1009</spage><epage>1016</epage><pages>1009-1016</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract><![CDATA[Unabated increases in the prevalence of obesity among American adults have disproportionately affected women, Black persons, and Hispanic persons. The purpose of this study was to evaluate for disparity in rates of patient eligibility for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on race and ethnicity and gender by applying commonly used body mass index (BMI) eligibility criteria to two large national databases.
We retrospectively reviewed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2015-2019 for primary THA and TKA and the National Health and Nutrition Examination Survey (NHANES) from 2011-2018. Designations of race and ethnicity were standardized between cohorts. BMI cutoffs of <50 kg/m2, <45 kg/m2, <40 kg/m2, and <35 kg/m2 were then applied. Rates of eligibility for surgery were examined for each respective BMI cutoff and stratified by age, race and ethnicity, and gender.
143,973 NSQIP THA patients, 242,518 NSQIP TKA patients, and 13,255 NHANES participants were analyzed. Female patients were more likely to be ineligible for surgery across all cohorts for all modeled BMI cutoffs (P < .001 for all). Black patients had relatively lower rates of eligibility across all cohorts for all modeled BMI cutoffs (P < .0001 for all). Hispanic patients had disproportionately lower rates of eligibility only at a BMI cutoff of <35 kg/m2.
Using BMI cutoffs alone to determine the eligibility for primary THA and TKA may disproportionally exclude women, Black persons, and Hispanic persons. These data raise concerns regarding further disparity and restriction of arthroplasty care to vulnerable populations that are already marginalized.
Retrospective Cohort Study, Level III.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35182664</pmid><doi>10.1016/j.arth.2022.02.013</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5404-0433</orcidid><orcidid>https://orcid.org/0000-0003-3535-5584</orcidid></addata></record> |
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| language | eng |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Arthroplasty, Replacement, Hip Arthroplasty, Replacement, Knee BMI Body Mass Index cutoff disparity eligibility Ethnicity Female Humans Nutrition Surveys obesity Postoperative Complications - epidemiology race Retrospective Studies United States - epidemiology |
| title | Are Body Mass Index Cutoffs Creating Racial, Ethnic, and Gender Disparities in Eligibility for Primary Total Hip and Knee Arthroplasty? |
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