Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study
In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England h...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/11/1629 |
| _version_ | 1827640770237038592 |
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| author | Jodian A. Pinkney Joshua B. Davis Jamie E. Collins Fatma M. Shebl Matthew P. Jamison Jose I. Acosta Julbe Laura M. Bogart Bisola O. Ojikutu Antonia F. Chen Sandra B. Nelson |
| author_facet | Jodian A. Pinkney Joshua B. Davis Jamie E. Collins Fatma M. Shebl Matthew P. Jamison Jose I. Acosta Julbe Laura M. Bogart Bisola O. Ojikutu Antonia F. Chen Sandra B. Nelson |
| author_sort | Jodian A. Pinkney |
| collection | DOAJ |
| description | In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16–3.89; <i>p</i> = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI. |
| first_indexed | 2024-03-09T17:04:14Z |
| format | Article |
| id | doaj.art-286c333ba4ae45babad4bc57e56317a2 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T17:04:14Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-286c333ba4ae45babad4bc57e56317a22023-11-24T14:25:25ZengMDPI AGAntibiotics2079-63822023-11-011211162910.3390/antibiotics12111629Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective StudyJodian A. Pinkney0Joshua B. Davis1Jamie E. Collins2Fatma M. Shebl3Matthew P. Jamison4Jose I. Acosta Julbe5Laura M. Bogart6Bisola O. Ojikutu7Antonia F. Chen8Sandra B. Nelson9Massachusetts General Hospital, Boston, MA 02114, USABrigham and Women’s Hospital, Boston, MA 02115, USAHarvard Medical School, Boston, MA 02115, USAMassachusetts General Hospital, Boston, MA 02114, USABrigham and Women’s Hospital, Boston, MA 02115, USABrigham and Women’s Hospital, Boston, MA 02115, USARAND Corporation, Santa Monica, CA 90401, USAMassachusetts General Hospital, Boston, MA 02114, USAHarvard Medical School, Boston, MA 02115, USAMassachusetts General Hospital, Boston, MA 02114, USAIn the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16–3.89; <i>p</i> = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI.https://www.mdpi.com/2079-6382/12/11/1629periprosthetic joint infectionracial disparitiesarthroplastyhealth equity |
| spellingShingle | Jodian A. Pinkney Joshua B. Davis Jamie E. Collins Fatma M. Shebl Matthew P. Jamison Jose I. Acosta Julbe Laura M. Bogart Bisola O. Ojikutu Antonia F. Chen Sandra B. Nelson Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study Antibiotics periprosthetic joint infection racial disparities arthroplasty health equity |
| title | Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study |
| title_full | Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study |
| title_fullStr | Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study |
| title_full_unstemmed | Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study |
| title_short | Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study |
| title_sort | racial disparities in periprosthetic joint infections after primary total joint arthroplasty a retrospective study |
| topic | periprosthetic joint infection racial disparities arthroplasty health equity |
| url | https://www.mdpi.com/2079-6382/12/11/1629 |
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