Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains
Abstract Background As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-024-02131-5 |
| _version_ | 1827328177872044032 |
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| author | Viktoria Steinbeck Anja Yvonne Bischof Lukas Schöner Benedikt Langenberger David Kuklinski Alexander Geissler Christoph Pross Reinhard Busse |
| author_facet | Viktoria Steinbeck Anja Yvonne Bischof Lukas Schöner Benedikt Langenberger David Kuklinski Alexander Geissler Christoph Pross Reinhard Busse |
| author_sort | Viktoria Steinbeck |
| collection | DOAJ |
| description | Abstract Background As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. Methods The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). Results Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. Conclusions Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. Trial registration German Register for Clinical Trials, DRKS00019916, 26 November 2019. |
| first_indexed | 2024-03-07T15:14:12Z |
| format | Article |
| id | doaj.art-8fb2377ee2ba48ef9ef1117baeefca89 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-03-07T15:14:12Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
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| series | International Journal for Equity in Health |
| spelling | doaj.art-8fb2377ee2ba48ef9ef1117baeefca892024-03-05T18:01:33ZengBMCInternational Journal for Equity in Health1475-92762024-02-0123111110.1186/s12939-024-02131-5Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domainsViktoria Steinbeck0Anja Yvonne Bischof1Lukas Schöner2Benedikt Langenberger3David Kuklinski4Alexander Geissler5Christoph Pross6Reinhard Busse7Department of Healthcare Management, School of Economics and Management, Technical University BerlinSchool of Medicine, Chair of Health Economics, Policy and Management, University of St. GallenDepartment of Healthcare Management, School of Economics and Management, Technical University BerlinDepartment of Healthcare Management, School of Economics and Management, Technical University BerlinSchool of Medicine, Chair of Health Economics, Policy and Management, University of St. GallenSchool of Medicine, Chair of Health Economics, Policy and Management, University of St. GallenDepartment of Healthcare Management, School of Economics and Management, Technical University BerlinDepartment of Healthcare Management, School of Economics and Management, Technical University BerlinAbstract Background As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. Methods The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). Results Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. Conclusions Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. Trial registration German Register for Clinical Trials, DRKS00019916, 26 November 2019.https://doi.org/10.1186/s12939-024-02131-5Gender health gapPatient-reported outcomesHealth disparities |
| spellingShingle | Viktoria Steinbeck Anja Yvonne Bischof Lukas Schöner Benedikt Langenberger David Kuklinski Alexander Geissler Christoph Pross Reinhard Busse Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains International Journal for Equity in Health Gender health gap Patient-reported outcomes Health disparities |
| title | Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains |
| title_full | Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains |
| title_fullStr | Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains |
| title_full_unstemmed | Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains |
| title_short | Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains |
| title_sort | gender health gap pre and post joint arthroplasty identifying affected patient reported health domains |
| topic | Gender health gap Patient-reported outcomes Health disparities |
| url | https://doi.org/10.1186/s12939-024-02131-5 |
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